Esophageal Cancer
Conditions
Keywords
squamous cell carcinoma of the esophagus, adenocarcinoma of the esophagus, stage II esophageal cancer, stage III esophageal cancer, stage IV esophageal cancer
Brief summary
RATIONALE: Drugs used in chemotherapy, such as docetaxel and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Irinotecan 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. Irinotecan and docetaxel may also make tumor cells more sensitive to radiation therapy. Giving combination chemotherapy together with radiation therapy may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of docetaxel when given together with irinotecan and radiation therapy with or without cisplatin in treating patients with locally advanced esophageal cancer.
Detailed description
OBJECTIVES: Primary * To determine the dose limiting toxicity and recommended phase II dose of docetaxel when given at escalating doses with weekly irinotecan hydrochloride and concurrent radiotherapy in patients with locally advanced esophageal cancer. * To determine the dose limiting toxicity of cisplatin, once the recommended phase II dose of docetaxel is established, when given weekly with docetaxel, irinotecan hydrochloride, and concurrent radiotherapy in patients with locally advanced esophageal cancer. Secondary * To evaluate the clinical and pathological complete response rate in patients with locally advanced esophageal cancer treated with induction chemotherapy comprising docetaxel and irinotecan hydrochloride with or without cisplatin followed by concurrent docetaxel and irinotecan hydrochloride with or without cisplatin plus radiotherapy. OUTLINE: Patients receive one of the following regimens. Regimen 2 is for patients recruited after the recommended phase II dose has been determined in patients recruited (who receive regimen 1). * Regimen 1: * Induction chemotherapy (weeks 1-6): Patients receive docetaxel IV over 15 minutes and irinotecan hydrochloride IV over 30 minutes on days 1 and 8. Treatment repeats every 3 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. * Chemoradiotherapy (weeks 8-13): Beginning in week 8, patients receive docetaxel IV over 15 minutes and irinotecan hydrochloride IV over 30 minutes on days 1 (week 8) and 8 (week 9). Patients also undergo radiotherapy once daily, 5 days a week, in weeks 8-10. Treatment with chemoradiotherapy repeats every 3 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. * Regimen 2: * Induction chemotherapy (weeks 1-6): Patients receive docetaxel IV and irinotecan hydrochloride as in regimen 1 induction chemotherapy. They also receive cisplatin IV over 20-30 minutes on days 1 and 8. Treatment with irinotecan hydrochloride, docetaxel, and cisplatin repeats every 3 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. * Chemoradiotherapy (weeks 8-13): Patients receive docetaxel IV, irinotecan hydrochloride IV, and undergo radiotherapy as in regimen 1 chemoradiotherapy. Patients also receive cisplatin IV over 20-30 minutes on days 1 (week 8) and 8 (week 9). Treatment with irinotecan hydrochloride, docetaxel, cisplatin, and radiotherapy repeats every 3 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
Interventions
DRUGcisplatin
Given IV
DRUGdocetaxel
Given IV
DRUGirinotecan hydrochloride
Given IV
RADIATIONradiation therapy
Given 5 days a week for 3 weeks
Sponsors
National Cancer Institute (NCI)
Memorial Sloan Kettering Cancer Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: Inclusion criteria: * Histologically confirmed squamous cell carcinoma, adenocarcinoma, poorly differentiated carcinoma, or carcinoma not otherwise specified, of the esophagus or gastroesophageal (GE) junction * Disease clinically limited to the esophagus or GE junction (T1, N1, M0, or T2-4, any N, M0) * M1a metastatic disease to lymph nodes allowed * Includes celiac lymph nodes in a patient with a distal third esophageal primary lesion or a gastroesophageal junction primary or supraclavicular lymph nodes in a patient with a proximal third esophageal lesion * Disease must be able to be contained in a radiotherapy field * Previously untreated patients with primary tumors of the cervical or thoracic esophagus, including the GE junction, are eligible for this study * At least 50% of the tumor must involve the distal esophagus for tumors of the GE junction
Exclusion criteria
* Positive malignant cytology of the pleura, pericardium, or peritoneum * Metastatic disease to distant organs (e.g. liver) or non-regional lymph nodes * Biopsy proven tumor invasion of the tracheobronchial tree or tracheo-esophageal fistula PATIENT CHARACTERISTICS: Inclusion criteria: * Karnofsky performance status (PS) 70-100% OR ECOG PS 0-2 * ANC ≥ 1,500 cells/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9.0 mg/dL * Creatinine ≤ 1.5 mg/dL * Total serum bilirubin ≤ 1.0 mg/dL * AST ≤ 1.5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 2.5 times ULN * Men and women of child bearing potential must use effective contraception while on treatment and for a reasonable period thereafter * Negative pregnancy test
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximum tolerated dose of docetaxel when administered together with irinotecan hydrochloride and radiotherapy | 2 years |
Secondary
| Measure | Time frame |
|---|---|
| Clinical and pathological complete response rate | 2 years |
Countries
United States
Outcome results
None listed