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Erlotinib and Radiation Therapy in Treating Older Patients With Stage I, Stage II, Stage III, or Stage IV Esophageal Cancer

Phase II Study of Erlotinib (Tarceva®) and Radiotherapy for Elderly Patients With Esophageal Carcinoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00524121
Enrollment
22
Registered
2007-09-03
Start date
2006-03-31
Completion date
2011-10-31
Last updated
2016-04-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Esophageal Cancer

Keywords

adenocarcinoma of the esophagus, squamous cell carcinoma of the esophagus, stage I esophageal cancer, stage II esophageal cancer, stage III esophageal cancer, stage IV esophageal cancer

Brief summary

RATIONALE: Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving erlotinib together with radiation therapy may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving erlotinib together with radiation therapy works in treating older patients with stage I, stage II, stage III, or stage IV esophageal cancer.

Detailed description

OBJECTIVES: Primary * Assess the overall survival of older patients with stage I-IV squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction treated with erlotinib hydrochloride in combination with radiotherapy. Secondary * Assess the proportion of patients achieving mucosal complete response after treatment with this regimen. * Determine the progression-free survival of patients treated with this regimen. * Assess the effect of this regimen on dysphagia control, performance status, and overall quality of life of these patients. * Investigate the correlation between smoking status and overall survival of these patients. * To correlate the Epidermal growth factor receptor (EGFR) and phosphor Epidermal growth factor receptor (pEGFR) expression by IHC and EGFR mutation status with clinical outcomes. OUTLINE: This is a multicenter study. Patients receive oral erlotinib hydrochloride once daily for 1 year in the absence of disease progression or unacceptable toxicity. Patients undergo external beam radiotherapy 5 days a week in weeks 1-4 or 5 days a week for the first 5.5 weeks. Tumor tissue samples are analyzed by IHC for the expression of E-cadherin, P-cadherin, vimentin, cytokeratin, phospho-S6, and Ki67. After completion of study treatment, patients are followed at 30 days and annually thereafter.

Interventions

DRUGerlotinib hydrochloride

Oral

OTHERimmunohistochemistry staining method

Correlative Study

RADIATIONradiation therapy

Radiation Treatment

Sponsors

Roswell Park Cancer Institute
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
65 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Biopsy-proven primary squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal (GE) junction * GE junction tumors with 50% or more tumor located in the esophagus determined by radiologic or endoscopic evaluation * Stage I-IVA disease determined by CT scan or MRI of the chest and abdomen * Stage IVB disease allowed if metastases to distant regional lymph nodes (celiac or cervical) only and no other sites * Not a surgical candidate and ineligible for chemotherapy due to any of the following: * Neuropathy * Cardiac disease * Performance status 2 * General overall condition felt by the investigator to be a contraindication to platinum-based therapy * Bronchoscopy with biopsy and cytology required if primary esophageal cancer is \< 26 cm from incisors * No evidence of clinically active interstitial lung disease (patients who are asymptomatic with chronic, stable, radiographic lung changes allowed) PATIENT CHARACTERISTICS: * ECOG performance status 0-2 * Life expectancy \> 4 months * WBC ≥ 3,000/mm³ * ANC ≥ 1,500/mm³ * Platelet count \> 100,000/mm³ * Bilirubin ≤ 1.3 mg/dL * ALT and AST ≤ 2.5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 2.5 times ULN * No prior malignancies except basal cell or squamous cell skin cancer, in situ cervical cancer, or superficial transitional cell bladder cancer, unless diagnosed and/or treated \> 2 years prior to current study and are without evidence of recurrence * No history of allergy to erlotinib or any of its excipients * No serious, uncontrolled, concurrent infection * No clinically serious, uncontrolled medical conditions that the investigator feels might compromise study participation * No lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome * No unwillingness to participate or inability to comply with the protocol for the duration of the study PRIOR CONCURRENT THERAPY: * No prior chemotherapy or radiotherapy for this tumor * No prior resection or attempted resection of esophageal cancer * No prior anti-epidermal growth factor receptor therapy (unless given in an adjuvant setting and completed at least 12 months earlier) * No participation in any investigational drug study within the past 4 weeks * No HIV-positive patients receiving antiretroviral therapy * No concurrent CYP3A4/5 inducers or inhibitors

Design outcomes

Primary

MeasureTime frame
Overall Survival5 years

Secondary

MeasureTime frameDescription
Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) ExpressionRadiologic evaluation every 3 months, up to 5 years
Response by EGFR Mutation StatusRadiologic evaluation every 3 months, up to 5 years
Complete Response4-8 weeks after completion of radiation.Response assessment by CT scans and upper endoscopy performed between 4-8 weeks after completion of radiation. Complete Response (CR) is defined as absence of viable tumor in endoscopic evaluation post chemoradiation, with four-quadrant biopsies taken at 1 cm intervals throughout length of original tumor.
Progresssion-Free SurvivalEvery 3 months, up to 5 yearsProgression is defined as at least a 20% increase in the sum of long distance of target lesions taking as reference the smallest sum long distance recorded since the treatment started or the appearance of one or more new lesions, or appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E ScaleBaseline and Week 3Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life instrument validated in esophageal cancer patients. All of the scales and single-item measures range in score from 0 to 4. The ranges of average quality of life scores was from 0 to 4 and was adjusted as lower scores indicate better outcomes
Correlation of Smoking Status With Overall Survival5 years
Response by Epidermal Growth Factor Receptor (EGFR) ExpressionRadiologic evaluation every 3 months, up to 5 years

Countries

United States

Participant flow

Participants by arm

ArmCount
Erlotinib in Combination With Radiotherapy
Erlotinib (150 mg) administered orally once daily starting day 1 and continued with radiotherapy (RT) and through day 365 (one year therapy duration). RT will be administered day 1-28 (Mon-Fri) in dose of 1.8 Gy per fraction.
17
Total17

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event4
Overall StudyDeath1
Overall StudyDisease progression6
Overall StudyNot treated (became ineligible)4
Overall StudyNot treated (changed mind)1
Overall StudyOther1
Overall StudyPatient refused2

Baseline characteristics

CharacteristicErlotinib in Combination With Radiotherapy
Age, Continuous79.94 years
STANDARD_DEVIATION 6.44
Sex: Female, Male
Female
6 Participants
Sex: Female, Male
Male
11 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
17 / 17
serious
Total, serious adverse events
9 / 17

Outcome results

Primary

Overall Survival

Time frame: 5 years

ArmMeasureValue (MEDIAN)
Erlotinib in Combination With RadiotherapyOverall Survival7.3 months
Secondary

Complete Response

Response assessment by CT scans and upper endoscopy performed between 4-8 weeks after completion of radiation. Complete Response (CR) is defined as absence of viable tumor in endoscopic evaluation post chemoradiation, with four-quadrant biopsies taken at 1 cm intervals throughout length of original tumor.

Time frame: 4-8 weeks after completion of radiation.

Population: Patients Treated with Study Therapy

ArmMeasureValue (NUMBER)
Erlotinib in Combination With RadiotherapyComplete Response11.76 percentage of participants
Secondary

Correlation of Smoking Status With Overall Survival

Time frame: 5 years

Population: Patients Treated with Study Therapy

ArmMeasureValue (MEDIAN)
Erlotinib in Combination With RadiotherapyCorrelation of Smoking Status With Overall Survival2.4 months
Erlotinib in Combination With Radiotherapy at Week 3Correlation of Smoking Status With Overall Survival7.2 months
Never SmokersCorrelation of Smoking Status With Overall Survival16.6 months
p-value: 0.115Log Rank
Secondary

Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale

Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life instrument validated in esophageal cancer patients. All of the scales and single-item measures range in score from 0 to 4. The ranges of average quality of life scores was from 0 to 4 and was adjusted as lower scores indicate better outcomes

Time frame: Baseline and Week 3

Population: Patients Treated with Study Therapy and with FACT-E scores available

ArmMeasureValue (MEDIAN)
Erlotinib in Combination With RadiotherapyEffect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale1.05 FACT-E Score
Erlotinib in Combination With Radiotherapy at Week 3Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale1.36 FACT-E Score
p-value: 0.011Wilcoxon signed rank test
Secondary

Progresssion-Free Survival

Progression is defined as at least a 20% increase in the sum of long distance of target lesions taking as reference the smallest sum long distance recorded since the treatment started or the appearance of one or more new lesions, or appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.

Time frame: Every 3 months, up to 5 years

ArmMeasureValue (MEDIAN)
Erlotinib in Combination With RadiotherapyProgresssion-Free Survival4.5 months
Secondary

Response by EGFR Mutation Status

Time frame: Radiologic evaluation every 3 months, up to 5 years

ArmMeasureGroupValue (NUMBER)
Erlotinib in Combination With RadiotherapyResponse by EGFR Mutation StatusNonresponder9 participants
Erlotinib in Combination With RadiotherapyResponse by EGFR Mutation StatusResponder3 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by EGFR Mutation StatusNonresponder2 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by EGFR Mutation StatusResponder2 participants
p-value: 0.5467Fisher Exact
Secondary

Response by Epidermal Growth Factor Receptor (EGFR) Expression

Time frame: Radiologic evaluation every 3 months, up to 5 years

ArmMeasureGroupValue (NUMBER)
Erlotinib in Combination With RadiotherapyResponse by Epidermal Growth Factor Receptor (EGFR) ExpressionNon-responder6 participants
Erlotinib in Combination With RadiotherapyResponse by Epidermal Growth Factor Receptor (EGFR) ExpressionResponder2 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by Epidermal Growth Factor Receptor (EGFR) ExpressionNon-responder5 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by Epidermal Growth Factor Receptor (EGFR) ExpressionResponder3 participants
p-value: 1Fisher Exact
Secondary

Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression

Time frame: Radiologic evaluation every 3 months, up to 5 years

ArmMeasureGroupValue (NUMBER)
Erlotinib in Combination With RadiotherapyResponse by Phosphor Epidermal Growth Factor Receptor (pEGFR) ExpressionNon-responder5 participants
Erlotinib in Combination With RadiotherapyResponse by Phosphor Epidermal Growth Factor Receptor (pEGFR) ExpressionResponder3 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) ExpressionNon-responder6 participants
Erlotinib in Combination With Radiotherapy at Week 3Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) ExpressionResponder2 participants
p-value: 1Fisher Exact

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026