Esophageal Adenocarcinoma
Conditions
Keywords
chemoradiation, consolidation chemotherapy, esophageal cancer, non-metastatic esophageal adenocarcinoma
Brief summary
The goal of this trial is to learn if adding consolidative chemotherapy to routine chemoradiation can better control both local recurrence and metastasis and reduce the need for surgical intervention.
Interventions
modified-FOLFOX-6 or FLOT
Sponsors
Duke University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subject must be able to provide study specific informed consent prior to study entry * Must be newly diagnosed, histologically proven diagnosis of adenocarcinoma of the thoracic esophagus or gastroesophageal junction (Siewert I-II); * Stage II-IVA, excluding T4b, according to the American Joint Committee on Cancer (AJCC) 8th edition; * Complete history and physical examination within 21 days of signing consent; * Staging whole-body FDG-PET/CT with or without contrast (preferred) or chest/abdominal (CT with contrast) confirming there is no evidence of metastatic disease must be obtained within 45 days of study enrollment * ECOG performance status of 0-2 * Subjects must be appropriate candidates for planned chemoradiation (concurrent carboplatin/paclitaxel) and chemotherapy (FLOT, m-FOLFOX-6) as determined by the treating radiation oncologist, medical oncologist, and surgical oncologist. * Adequate hematologic, renal, and hepatic function within 14 days of initiation of therapy
Exclusion criteria
* Cervical esophageal cancers arising 15-18 cm from the incisors. * Esophageal squamous cell carcinoma. * Patients with T4b disease according to the AJCC 8th Edition. * Definitive clinical or radiologic evidence of metastatic disease. * Has had prior systemic therapy or radiation therapy for the current diagnosis. * Prior thoracic radiotherapy for any reason that would result in overlap of radiation therapy fields; all patients with prior radiotherapy must be reviewed by the PI to determine if patient is eligible. * Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer * Severe, active co-morbidity defined as follows: * Active uncontrolled infection requiring IV antibiotics; * Pregnant and/or nursing subjects; * HIV positive with CD4 count \< 200 cells/microliter. Note that subjects who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count ≥ 200 cells/microliter within 30 days prior to registration. Note also that HIV testing is not required for eligibility for this protocol. This exclusion criterion is necessary because the treatments involved in this protocol may be significantly immunosuppressive. * Has a history or current evidence of physical or physiological contraindication to participation in this study, at the discretion of the treating investigator. * Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with Clinical complete response (cCR) | approximately 36 weeks | cCR defined as absence of malignancy on endoscopic biopsies obtained at the time of reassessment following neoadjuvant therapy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with pathologic complete response (pCR) | approximately 36 weeks | Pathologic complete response (pCR) is defined as absence of detectable tumor of esophagectomy tissues. |
| Number of participants who complete both chemoradiation and chemotherapy | approximately 36 weeks | — |
| Number of participants with local control | up to 5 years | Local control in participants achieving clinical complete remission (cCR) estimated using the Kaplan-Meier method. cCR is defined as the disappearance of all detectable signs and symptoms of a disease, such as cancer, have completely disappeared. |
| Number of participants with Disease free survival | up to 5 years | Disease free survival in participants achieving cCR estimated using the Kaplan-Meier method. cCR is defined as the disappearance of all detectable signs and symptoms of a disease, such as cancer, have completely disappeared. |
| Time to distant metastasis | up to 5 years | Time to distant metastasis in participants achieving cCR estimated using the Kaplan-Meier method. cCR is defined as the disappearance of all detectable signs and symptoms of a disease, such as cancer, have completely disappeared. |
| Overall survival | up to 5 years | Measured in participants achieving cCR and estimated using the Kaplan-Meier method. cCR is defined as the disappearance of all detectable signs and symptoms of a disease, such as cancer, have completely disappeared. |
| Number of participants with Local control | up to 5 years | Measured in participants achieving pCR and estimated using the Kaplan-Meier method. pCR is defined as absence of detectable tumor of esophagectomy tissues. |
| Disease free survival | up to 5 years | Disease free survival in participants achieving pCR. pCR is defined as absence of detectable tumor of esophagectomy tissues. |
Countries
United States
Contacts
CONTACTClinical Trials Office
PRINCIPAL_INVESTIGATORManisha Palta, MD
Duke Health
Outcome results
None listed