A clinical trial for people who have cancer of the food pipe and junction of the food pipe and stomach, to compare chemotherapy before and after surgery, with chemotherapy with radiotherapy before surgery.
- Conditions
- Adenocarcinoma of the oesophagus and oesophago-gastric junctionMedDRA version: 21.1Level: LLTClassification code 10007445Term: Carcinoma of oesophagus NOSSystem Organ Class: 100000004864Therapeutic area: Diseases [C] - Cancer [C04]
- Registration Number
- EUCTR2011-001858-28-GB
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised-recruitment may be ongoing or finished
- Sex
- All
- Target Recruitment
- 540
Countries with Group Specific Appendices with sections relating to the inclusion and exclusion criteria, should refer to this documents when reviewing patient eligibility.
1. Histologically verified adenocarcinoma of the oesophagus or oesophago-gastric junction based on endoscopy(OGD).
2. CT-18FDG-PET performed in all patients for disease staging
3. EUS in all patients unless luminal obstruction precludes sensitivity of the test.
4. Staging laparoscopy will be performed at the investigators discretion for locally advanced AEG II and AEG III tumours
5. Pre-treatment stage cT2-3, N0-3, M0
6. Maximum tumour length should be no more than 8cm (equal to 8 cm is acceptable).
7. Male/female patients aged =18 years.
8. ECOG Performance Status 0, 1 or 2 (Appendix F)
9. ASA Grading I-II (Appendix F).
10. Adequate cardiac function. For all patients an ejection fraction of > 50% is required. If patients have a known cardiac history (e.g. known ischemic disease, cardiomyopathy) an ejection fraction > 50% and cardiac clearance by a consultant cardiologist for major surgery and cancer therapies is required
11. Adequate respiratory function. Patients should have pulmonary function tests completed with a minimum FEV1 =1.5L. CPEX acceptable.
12. Adequate bone marrow function: absolute neutrophil count (ANC) >1.5x109/l; white blood cell count >3x109/l; platelets >100x109/l; haemoglobin (Hb) >9g/dl (can be post-transfusion).
13. Adequate renal function: glomerular filtration rate >60ml/minute calculated using the Cockcroft-Gault Formula(Appendix O).
14. Adequate liver function: serum bilirubin = ULN; AST <2.5x ULN and ALP <3x ULN (ULN as per institutional standard)
15. Written informed consent must be obtained from the patient before any study-specific procedures are performed.
16. Women of child-bearing potential and male subjects must agree to use an effective barrier method of contraception for up to 6 months following discontinuation of therapy. Effective contraception is defined as any medically recommended (or combination of methods) as per standard of care.
17. Women of childbearing potential must have pregnancy excluded by urine or serum beta-HCG testing within 7 days prior to registration.
Are the trial subjects under 18? no
Number of subjects for this age range: 0
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 540
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 540
Countries with Group Specific Appendices with sections relating to the inclusion and exclusion criteria, should refer to this documents when reviewing patient eligibility.
1. Tumours of squamous histology.
2. Patients with advanced inoperable or metastatic oesophageal, junctional or gastric adenocarcinoma.
3. Disease length (total length of tumour plus node) greater than 10 cm (up to 10 cm will be allowed) -measured by any modality or, if appropriate, combination of modalities-, unless in the opinion of the investigator in discussion with
national RT lead, it is felt that OAR constraints are likely to be achievable.
4. Any prior chemotherapy for gastrointestinal cancer.
5. Prior abdominal, thoracic, chest wall or breast radiotherapy.
6. Patients who are unfit for surgery or cancer treatments based on cardiac disease.
7. Patients with acute systemic infections.
8. Patients who are receiving treatment with sorivudine or its chemical related analogues, such as brivudine which is contraindicated with capecitabine and 5-fluorouracil administration.
9. Clinical COPD with significant obstructive airways disease classified by FEV1 < 1.5 L or PaO2 less than 9kPa on room air.
10. Known peripheral neuropathy >Grade 1 (absence of deep tendon reflexes as the sole neurological abnormality does not render the patient ineligible).
11. Known positive tests for human immunodeficiency virus (HIV) infection, acute or chronic active hepatitis B infection.
12. Any other malignancies within the last 5 years (other than curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix).
13. Participation in other clinical trials of investigational or marketed agents for the treatment of oesophageal cancer or other diseases within 30 days prior to registration. UK sites please refer to Group Specific Appendix.
14. Women who are pregnant or breastfeeding.
15. Psychiatric illness/social situations that would limit compliance with study requirements.
16. Known Dihydropyrimidine dehydrogenase (DPD) deficiency
UK and French sites for inclusion and exclusion please refer to your country specific appendices.
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Main Objective: To evaluate one, two and three year survival of patients treated with chemotherapy before and after surgery versus chemotherapy and radiotherapy before surgery.;Secondary Objective: To evaluate the effect of both neoadjuvant regimens on clinical and endoscopic response rate (in particular relief of dysphagia, improvement in health-related quality of life (HRQL), endoscopic regression, and CT-PET evidence of tumour response), tumour regression grade, node-positivity, post-operative pathology, disease-free survival, time to treatment failure, toxicity, post-operative complications and HRQL;Primary end point(s): The primary endpoint is overall survival. ;Timepoint(s) of evaluation of this end point: The overall survival will be calculated from the date of randomisation to the registered date of death (from any cause). <br>Patients lost to follow-up, or those with no date of death recorded at the time of database lock, will be censored on the date of their last follow-up.
- Secondary Outcome Measures
Name Time Method Secondary end point(s): Response rate, tumour regression grade, node positivity, pathological assessment, disease-free survival, time to treatment failure, toxicity and post-operative complications, quality of life.;Timepoint(s) of evaluation of this end point: 3 years post-surgery.<br><br>Over 80% of patients who relapse after oesophagogastric surgery do so within 2 years and therefore we propose that statistical considerations are based on 3-year overall or disease-free survival.