Gastric Cancer, Locally Advanced Malignant Neoplasm
Conditions
Keywords
Locally, Advanced, Resectable, Gastric Cancer
Brief summary
Study design: Multicenter, randomized, open label phase II study Arm A: DOX 4 cycles - Surgery - Follow-up Arm B: DOX 2 cycles - Surgery - DOX 2 cycles - Follow-up Population: Male or female, 18-75 years of age, with a diagnosis of histologically confirmed, potentially resectable adenocarcinoma of the stomach. Sample Size: Planned sample size is 90 patients, 45 patients for each arm (p0=50%, p1=80%, alpha=0.05 (two sides), beta=0.2) Treatment Plan: Treatment will be administered for 4 and 2 cycles before surgery in arm A and B, respectively, and in arm B for a further 2 cycles after surgery unless progression or unacceptable toxicity occurs, or a patient refuses treatment. In such cases patients will go off treatment. 3-6 weeks after the end of the fourth (arm A) or second (arm B) preoperative cycle, patients will undergo surgery. After surgery 3-6 weeks from surgery patients in arm B will receive 2 more cycles. DOX: Docetaxel 35 mg/m2 day 1 and 8 Oxaliplatin 80 mg/m2 day 1 Capecitabine 750 mg/m2 x 2 daily for 2 weeks Cycles repeated every 3 weeks Evaluation criteria: Tumor assessment will be performed according to the RECIST criteria (version 1.1). Duration of Study: Overall study duration: 07/2010- 03/2017 Planned study duration per patient: 5 years
Detailed description
Title: A randomised phase II study of pre-operative or peri-operative docetaxel, oxaliplatin, capecitabine (DOX) regimen in patients with locally advanced resectable gastric cancer. Clinical Phase: II Study Objectives: Primary: The percentage of patients receiving all the planned chemotherapeutic cycles. Secondary: * Downstaging according to Recist criteria * pT1-3 vs pT0. * Safety: number of patients with grade 3-4 toxicity * The role of PET Scan as predictor of response * Curative vs palliative surgery * TTP * OS * Diagnostic correlation between the various staging methods * Possible correlations between CT scan, CT/PET, laparoscopy; * Molecular markers related to toxicity: DPYD, MTHFR, TS, XPD, ERCC1, XRCC1; * Molecular markers related to prognosis: TYMS, GSTP1, COX-2, RUNX3, methylation profile (Cox2, hMLH1, MGMT); * Molecular markers related to therapy response: TYMS, DPYD, MTHFR, OPRT, ERCC1, XRCC1/2/3, GSTP1, GSTM1, GSTT1, ABCB1, methylation profile (Cox2, hMLH1, MGMT), whole genome arrayCGH. Study design: Multicenter, randomized, open label phase II study Arm A: DOX 4 cycles - Surgery - Follow-up Arm B: DOX 2 cycles - Surgery - DOX 2 cycles - Follow-up Population: Male or female, 18-75 years of age, with a diagnosis of histologically confirmed, potentially resectable adenocarcinoma of the stomach. Sample Size: Planned sample size is 90 patients, 45 patients for each arm (p0=50%, p1=80%, alpha=0.05 (two sides), beta=0.2) Treatment Plan: Treatment will be administered for 4 and 2 cycles before surgery in arm A and B, respectively, and in arm B for a further 2 cycles after surgery unless progression or unacceptable toxicity occurs, or a patient refuses treatment. In such cases patients will go off treatment. 3-6 weeks after the end of the fourth (arm A) or second (arm B) preoperative cycle, patients will undergo surgery. After surgery 3-6 weeks from surgery patients in arm B will receive 2 more cycles. DOX: Docetaxel 35 mg/m2 day 1 and 8 Oxaliplatin 80 mg/m2 day 1 Capecitabine 750 mg/m2 x 2 daily for 2 weeks Cycles repeated every 3 weeks Evaluation criteria: Tumor assessment will be performed according to the RECIST criteria (version 1.1). Duration of Study: Overall study duration: 07/2010- 03/2017 Planned study duration per patient: 5 years
Interventions
OTHERDOX 4 cycles - Surgery
DOX 4 cycles - Surgery
OTHERDOX 2 cycles - Surgery - DOX 2 cycles
DOX 2 cycles - Surgery - DOX 2 cycles
Sponsors
Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Signed written informed consents 2. Male or female 18-75 years of age 3. Diagnosis of histologically confirmed, potentially resectable adenocarcinoma of the stomach 4. cT3 subserosal - cT4a - cT4b (7th edition UICC TNM) or bulky lymph node metastases independently of T 5. ECOG performance status of 0-1 at study entry 6. Laboratory requirements (≤ 7 days prior chemotherapy start): 1. Hematology: I) Neutrophils \> 1.5 x 109 /L II) Platelets \> 100 x 109 /L III) Hemoglobin \> 10g/dL 2. Hepatic function I) Total bilirubin \< 1.25 UNL II) AST (SGOT) and ALT (SGPT) \< 2.5xUNL III) Alkaline phosphatase \< 2.5xUNL 3. Renal function I) Creatinine \<1.5 UNL In the event of border-line values, the calculated creatinine clearance should be \> 60 mL/min; * Written informed consent signed and dated before randomization procedures, including expected cooperation of patients for treatment and follow-up, must be obtained and documented according to local regulatory requirements. * Effective contraception for both male and female patients if the risk of conception exists
Exclusion criteria
1. Early gastric cancer (if N0) 2. T2 (according to 7th edition of UICC TNM) if N0 3. Linitis plastica 4. Positive peritoneal cytology 5. Distant metastases 6. Neoplasm involving the gastro-esophageal junction 7. Pertoneal involvement 8. Concurrent chronic systemic immune therapy 9. Any investigational agent(s) administered 4 weeks prior to entry 10. Clinically relevant coronary artery disease, a history of myocardial infarction or of hypertension not controlled by therapy within the last 12 months 11. Known grade 3 or 4 allergic reaction to any of the components of the treatment 12. Known drug abuse/alcohol abuse 13. Legal incapacity or limited legal capacity 14. Medical or psychological condition which, in the opinion of the investigator, would not permit the patient to complete the study or sign meaningful informed consent 15. Women who are pregnant or breastfeeding 16. Acute or subacute intestinal occlusion 17. Any concurrent malignancy other than non-melanoma skin cancer, or carcinoma in situ of the cervix. (Patients with a previous malignancy but without evidence of disease for ≥ 5 years will be allowed to enter the trial)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| the difference in percentage of patients receiving all the planned chemotherapeutic cycles between the two arms. | 7 years |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Treatment tolerability and safety and tumor response in patients with pathological stage pT1-3 vs pT0 | 7 years | Comparation of treatment tolerability and safety and tumor response between patients with pathological stage pT1-3 vs pT0 (detected at the time of surgery) |
| Number of patients with adverse events of grade 3-4 as a measure of safety and tolerability | 7 years | — |
| Diagnostic capability of PET | 7 years | Evaluation of the role of PET as a tool to detect tumor response |
| Efficacy comparation between curative vs palliative surgery | 7 years | — |
| Time to progression | 7 years | — |
| The percentage of tumors downstaged at the diagnosis | 7 years | To determine the percentage of tumors downstaged at the diagnosis, compared with the pathological stage detected at the time of surgery (according to Recist criteria) |
| Diagnostic capability of CT scan, CT/PET and laparoscopy | 7 years | Evaluation of possible correlations between the diagnostic techniques CT scan, CT/PET and laparoscopy |
| Biological profile of treatment toxicity | 7 years | Biological detection of molecular markers related to treatment toxicity (DPYD, MTHFR, TS, XPD, ERCC1, XRCC1) |
| Biological profile of treatment prognosis | 7 years | Biological detection of molecular markers related to treatment prognosis (TYMS, GSTP1, COX-2, RUNX3, methylation profile (Cox2, hMLH1, MGMT)) |
| Biologcal profile of treatment response | 7 years | Biological detection of molecular markers related to therapy response (TYMS, DPYD, MTHFR, OPRT, ERCC1, XRCC1/2/3, GSTP1, GSTM1, GSTT1, ABCB1, methylation profile (Cox2, hMLH1, MGMT), whole genome arrayCGH) |
| Overall survival | 7 years | — |
Countries
Italy
Outcome results
None listed