Trial of Preoperative Therapy for Gastric and Esophagogastric Junction Adenocarcinoma
- Conditions
- Gastric Cancer
- Interventions
- Radiation: Preoperative chemoradiotherapyProcedure: Gastric resection
- Registration Number
- NCT01924819
- Lead Sponsor
- Australasian Gastro-Intestinal Trials Group
- Brief Summary
Gastric cancer remains a significant global public health problem. Although in developed countries its incidence has dramatically decreased, on a worldwide scale it is still a leading cause of cancer-related deaths. Surgery is the only potentially curative treatment for gastric cancer. Although the survival rates for patients with early stage disease (stage 1A and 1B) are good, this subgroup of patients constitutes only 20% of those undergoing resection. The majority of patients will have locally advanced or metastatic disease at presentation, which has an extremely poor prognosis. The current five-year survival rate for gastric cancer in Western countries is approximately 20-30%, a figure that has improved little over the past 30 years. The intervention arm in TOPGEAR consists of pre-operative chemotherapy, pre-operative chemoradiotherapy, surgery and post-operative chemotherapy. The control arm consists of pre-operative chemotherapy, surgery and post-operative chemotherapy. The primary objective of TOPGEAR is to investigate whether the addition of chemoradiotherapy to chemotherapy is superior to chemotherapy alone in the neoadjuvant setting by improving pathological complete response rates in the first instance, and subsequently overall survival, in patients undergoing adequate surgery (D1+ dissection) for resectable gastric cancer.
- Detailed Description
Purpose:
The purpose of this phase II/III clinical trial is to determine if pre-operative chemoradiotherapy improves overall survival in participants with resectable gastric cancer.
Trial details:
Participants will be randomised to receive either pre-operative chemotherapy or pre-operative chemoradiotherapy. The will undergo surgery and then receive further post-operative chemotherapy. Participants will be followed up for 5 years after treatment.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 574
-
Histologically proven adenocarcinoma of the stomach or gastroesophageal junction (GEJ) that is:
- Stage IB (T1N1 only, T2N0 not eligible) - IIIC, i.e. T3 - T4 and/or node positive, according to American Joint Committee on Cancer (AJCC) 7th edition.
- Considered operable following initial staging investigations (surgeon believes that an R0 resection can be achieved) (GEJ tumours are defined as tumours that arise in the cardia or at the GEJ that do not involve more than 2cm of the lower esophagus, i.e. Siewert Type II and Siewert Type III)
-
Age >=18 years
-
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
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Adequate organ function defined as follows:
- Bone marrow: Haemoglobin >=90 g/L, Absolute neutrophil count (ANC) >=1.5 x 10⁹ /L, White blood cell count >=3 x 10⁹ /L, Platelet count >=100 x 10⁹ /L
- Hepatic: Serum bilirubin <=1.5 x upper limit of normal (ULN), aspartate aminotransferase (AST) and/or alanine transaminase (ALT) <=3.0 x ULN
- Renal: Serum creatinine <=0.150 mmol/L, Calculated creatinine clearance >=50 mL/min
-
Disease which can be radically treated with radiotherapy to 45 Gy with standard fractionation
-
Any patient with a history of ischaemic heart disease and abnormal ECG, or who is over 60 years of age should have a pre-treatment evaluation of cardiac function with a multigated acquisition (MUGA) scan or echocardiogram. Patients will only be included if the left ventricular ejection fraction is >=50%.
-
Written informed consent obtained before randomization
-
Negative pregnancy test for women of childbearing potential within 7 days of commencing study treatment. Males and females of reproductive potential must agree to practice adequate contraceptive measures.
-
Evidence of metastatic disease
-
Prior chemotherapy or radiotherapy
-
Patients with a past history of cancer in the 5 years before randomization except for the following. Patients with squamous or basal cell carcinoma of the skin that has been effectively treated, and patients with carcinoma in situ of the cervix that has been treated by operation only are eligible, even if they were diagnosed and treated within the 5 years before randomization.
-
Patients with other significant underlying medical conditions that may be aggravated by the study treatment or are not controlled
-
Pregnant or lactating females or female patients of childbearing potential who have not been surgically sterilized or are without adequate contraceptive measures
-
Cardiac failure and other contraindications to epirubicin
-
Patients with impaired gastrointestinal absorption for whatever reason
-
Patients medically unfit for cisplatin chemotherapy due to one or more of the following reasons:
- Clinically significant sensorineural hearing impairment (audiometric abnormalities without corresponding clinical deafness will not be regarded as a contraindication to cisplatin)
- Severe tinnitus
- Renal impairment (GFR <=50ml/min)
- Peripheral neuropathy >=grade 2
- Inability to tolerate intravenous hydration e.g due to cardiac disease
- Co-morbidities (based on clinical judgement by the investigator) that in the view of the investigator would preclude the safe administration of cisplatin.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Preoperative chemoradiotherapy Epirubicin + cisplatin + 5-fluorouracil OR epirubicin + cisplatin + capecitabine OR epirubicin + oxaliplatin + capecitabine OR 5-Fluorouracil + leucovorin + oxaliplatin + docetaxel 2 cycles preoperative chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 3 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel 5 weeks preoperative chemoradiotherapy. Gastric resection. 3 cycles adjuvant chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Preoperative chemotherapy Epirubicin + cisplatin + 5-fluorouracil OR epirubicin + cisplatin + capecitabine OR epirubicin + oxaliplatin + capecitabine OR 5-Fluorouracil + leucovorin + oxaliplatin + docetaxel 3 cycles preoperative chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Gastric resection. 3 cycles adjuvant chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine) OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Preoperative chemoradiotherapy Gastric resection 2 cycles preoperative chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 3 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel 5 weeks preoperative chemoradiotherapy. Gastric resection. 3 cycles adjuvant chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Preoperative chemoradiotherapy Preoperative chemoradiotherapy 2 cycles preoperative chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 3 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel 5 weeks preoperative chemoradiotherapy. Gastric resection. 3 cycles adjuvant chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Preoperative chemotherapy Gastric resection 3 cycles preoperative chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine). OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel Gastric resection. 3 cycles adjuvant chemotherapy with: epirubicin + cisplatin + 5-fluorouracil. (5-fluorouracil may be replaced with capecitabine) OR epirubicin + oxaliplatin + capecitabine OR 4 cycles of 5-fluorouracil +Leucovorin + oxaliplatin + docetaxel
- Primary Outcome Measures
Name Time Method Overall survival Up to 5 years The interval from the date of randomisation to the date of death from any cause, or the date last known alive.
- Secondary Outcome Measures
Name Time Method Surgical complete resection rate (R0) At the time of surgery The complete macroscopic resection of gross tumour with negative surgical margins.
Disease free survival Up to 5 years The time from the date of randomisation to the first observation of disease progression or death due to any cause.
Pathological response rate At time of surgery The extent of reduction in tumour size following pre-operative treatment, as determined by macroscopic and microscopic assessment of the tumour.
Proportion of participants with given grades of toxicities Up to 5 years The proportion of participants starting at least one cycle of treatment and the grades of the toxicities reported.
Trial Locations
- Locations (59)
UHN - Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Hopital Maisonneuve-Rosemont
🇨🇦Montreal, Quebec, Canada
Hospital Notre-Dame
🇨🇦Montreal, Quebec, Canada
Jewish General Hospital
🇨🇦Montreal, Quebec, Canada
Geelong Hospital
🇦🇺Geelong, Victoria, Australia
Austin Hospital
🇦🇺Melbourne, Victoria, Australia
Monash Medical Centre
🇦🇺Melbourne, Victoria, Australia
Peter MacCallum Cancer Centre
🇦🇺Melbourne, Victoria, Australia
St Vincent's Hospital
🇦🇺Melbourne, Victoria, Australia
Auckland Hospital
🇳🇿Auckland, New Zealand
Dunedin Hospital
🇳🇿Dunedin, New Zealand
Centre Hospitalier de Belfort Montbeliard site du Mittan
🇫🇷Montbeliard, France
Centre Paul Strauss
🇫🇷Strasbourg, France
The Institute of Oncology
🇸🇮Ljubljana, Slovenia
Chris O Brien Lifehouse
🇦🇺Sydney, New South Wales, Australia
Sunshine Hospital (Western Health)
🇦🇺Melbourne, Victoria, Australia
AZ Klina
🇧🇪Brasschaat, Belgium
Universitair Ziekenhuis Antwerpen
🇧🇪Edegem, Belgium
Hospital De Jolimont
🇧🇪La Louvière, Belgium
U.Z Leuven Campus Gasthuisberg
🇧🇪Leuven, Belgium
AZ Damiaan
🇧🇪Oostende, Belgium
AZ Turnhout- Campus Sint Elisabeth
🇧🇪Turnhout, Belgium
Centre Hospitalier Peltzer- La Tourelle
🇧🇪Verviers, Belgium
BCCA - Vancouver Centre
🇨🇦Vancouver, British Columbia, Canada
Cancer Care Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Royal Victoria Regional Health Centre
🇨🇦Barrie, Ontario, Canada
Cancer Centre of Southeastern Ontario at Kingston General Hospital
🇨🇦Kingston, Ontario, Canada
Grand River Regional Cancer Center, Kitchener
🇨🇦Kitchener, Ontario, Canada
London Regional Cancer Program
🇨🇦London, Ontario, Canada
Ottawa Health Research Institute
🇨🇦Ottawa, Ontario, Canada
Odette Cancer Centre, Sunnybrook Hospital
🇨🇦Toronto, Ontario, Canada
Centre hospitalier universitaire de Sherbrooke
🇨🇦Sherbrooke, Quebec, Canada
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Charles University Hospital
🇨🇿Hradec Kralove, Czechia
Institut Sainte Catherine
🇫🇷Avignon, France
CHRU de Besancon Hopital Jean Minjoz
🇫🇷Besancon, France
Klinikum der Universitaet Muenchen - Campus Grosshadern
🇩🇪München, Bavaria, Germany
Rambam Medical Center
🇮🇱Haifa, Israel
Tel Aviv Sourasky Medical Center
🇮🇱Tel Aviv, Israel
ICO L Hospitalet Hospital Duran i Reynals (Institut Catala D Oncologia)
🇪🇸L'Hospitalet De Llobregat, Barcelona, Spain
Institut Catala d Oncologia - ICO Badalona - Hospital Germans Trias i Pujol
🇪🇸Badalona, Spain
Vall D Hebron University Hospital
🇪🇸Barcelona, Spain
Hospital Clinico Universitario De Valencia
🇪🇸Valencia, Spain
Calvary Mater Newcastle
🇦🇺Newcastle, New South Wales, Australia
Liverpool Hospital
🇦🇺Sydney, New South Wales, Australia
Nepean Hospital
🇦🇺Sydney, New South Wales, Australia
Prince of Wales Hospital
🇦🇺Sydney, New South Wales, Australia
Royal North Shore Hospital
🇦🇺Sydney, New South Wales, Australia
St George Hospital
🇦🇺Sydney, New South Wales, Australia
Westmead Hospital
🇦🇺Sydney, New South Wales, Australia
The Tweed Hospital
🇦🇺Tweed Heads, New South Wales, Australia
Wollongong Hospital
🇦🇺Wollongong, New South Wales, Australia
Princess Alexandra Hospital
🇦🇺Brisbane, Queensland, Australia
Flinders Medical Centre
🇦🇺Adelaide, South Australia, Australia
Royal Hobart Hospital
🇦🇺Hobart, Tasmania, Australia
Launceston General Hospital
🇦🇺Launceston, Tasmania, Australia
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Western Australia, Australia
Waikato Hospital
🇳🇿Hamilton, New Zealand