A Randomized Phase II/III Study of Paclitaxel/Cisplatin Versus Cisplatin/5-fluorouracil in Neoadjuvant Chemoradiation Followed by Surgery for Patients With Locally Advanced Esophageal Squamous Cell Carcinoma (ESCC)
Overview
- Phase
- Phase 2
- Intervention
- neoadjuvant chemoradiation
- Conditions
- Esophageal Squamous Cell Carcinoma
- Sponsor
- National Taiwan University Hospital
- Enrollment
- 248
- Locations
- 1
- Primary Endpoint
- pathological complete response
- Last Updated
- 3 years ago
Overview
Brief Summary
This clinical trial has two stages: phase II and phase III. Eligible patients will be randomized 1:1 to the two arms: paclitaxel plus cisplatin and cisplatin plus 5-fluorouracil. The phase II stage will enroll 128 patients, 64 patients for each arm. The endpoint of the phase II stage is complete pathological response (pCR). If the endpoint, i.e., the significant improvement of pCR rate, is met, the clinical trial will proceed to the phase III stage, in which 120 more patients will be enrolled. The estimated enrollment time is four years with 3 more years of follow-up after completing enrollment. The primary endpoint of the clinical trial is overall survival, and the secondary endpoints include clinical response, disease free survival, operation rate, complete resection rate, tumor regression rate, hospital stay days after surgery, safety and toxicity, and quality of life.
Detailed Description
Stage 1: Neoadjuvant chemoradiation (CRT): Stage 2: Evaluation of clinical responses 1. Evaluation will be done at 3±1 weeks after completing the last fraction of radiotherapy. 2. Evaluation will be performed with panendoscopy, endoscopic ultrasonography (EUS), computed tomography (CT), and positron emission tomography (PET). Stage 3: Surgery 1. Patients will receive esophagectomy with two field lymph node dissection unless: A. Patients become medically unfit for surgery. B. Tumor becomes metastatic or unresectable. C. Patients refuse surgery. 2. Patients who do not receive surgery will go on a second section of CRT: A. Radiation: 180cGy/fraction, once daily, 5 days a week, up to a total of 6,300cGy. B. Arm A: i. T: Paclitaxel 50 mg/m2, 1h IVF, weekly, week 1 to week 3 during CRT. ii. P: Cisplatin 30 mg/m2, 2 h IVF, weekly following paclitaxel, week 1 to week 3 during CRT. C. Arm B: i. P: Cisplatin 75 mg/m2, 2 h IVF, on day 1 of week 1 during CRT. ii. F: 5-FU 1,000 mg/m2, 24 h IVF, on day 1, 2, 3, 4 of week 1 during CRT. 3. Patients, who receive surgery with R2 resection or the pathology showing positive margins or extracapsular invasion of regional lymph nodes, will also receive the second section of CRT described in above-mentioned stage 3-2.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Pathologically proven squamous cell carcinoma of the intrathoracic esophagus.
- •Locally advanced disease, which is defined by the TNM system of the American Joint Committee on Cancer (AJCC) Cancer Staging System (7th edition), fulfilling one of the following criteria as determined by endoscopic ultrasound, computed tomography, bronchoscopy and positron emission tomography:
- •A. T3/4a, N0, M0; B. T1-3, N1-3, M0;
- •Tumor length longitudinal ≤ 8cm and radial ≤ 5cm.
- •The tumor must not extend more than 2cm into the stomach.
- •The tumor must not involve cervical esophagus.
- •No invasion of the tracheobronchial tree or presence of tracheoesophageal fistula.
- •Age ≥ 20 and ≤ 75 years old.
- •Performance status ECOG 0\~
- •Adequate bone marrow reserves, defined as:
Exclusion Criteria
- •Adenocarcinoma.
- •Previous thoracic irradiation.
- •Previous systemic chemotherapy
- •Synchronously diagnosed squamous cell carcinoma of aerodigestive way, other than esophageal cancer.
- •Prior malignancy, except for the following:
- •A. adequately treated basal cell or squamous cell skin cancer; B. in-situ cervical cancer; C. a "cured" malignancy more than 5 years prior to enrollment.
- •Significant co-morbid disease, which prohibits the conduction of chemotherapy, concurrent chemo- radiotherapy, or radical surgery, such as active systemic infection, symptomatic cardiac or pulmonary disease, or psychiatric disorders.
- •Documented myocardial infarction within the 6 months preceding registration (pretreatment ECG evidence of infarct only will not exclude patients). Patients with a history of significant ventricular arrhythmia requiring medication. Patients with a history of 2nd or 3rd degree heart block.
- •Pre-existing motor or sensory neurotoxicity greater than grade
- •Patients with prior allergic reactions to drug containing Cremophor, such as teniposide or cyclosporine.
Arms & Interventions
paclitaxel plus cisplatin
A. T: Paclitaxel 50 mg/m2, 1h IVF, weekly, week 1 to week 5 during CRT. B. P: Cisplatin 30 mg/m2, 2 h IVF, weekly following paclitaxel, week 1 to week 5 during CRT.
Intervention: neoadjuvant chemoradiation
cisplatin plus 5-fluorouracil
A. P: Cisplatin 75 mg/m2, 2 h IVF, on day 1 of week 1 and week 5 during CRT. B. F: 5-FU 1,000 mg/m2, 24 h IVF, on day 1, 2, 3, 4 of week 1 and week 5 during CRT.
Intervention: neoadjuvant chemoradiation
Outcomes
Primary Outcomes
pathological complete response
Time Frame: 2 years
No cancer cells in primary tumor and all lymph nodes resected are observed by pathologists
Secondary Outcomes
- Overall survival(4 years)
- disease free survival(4 years)
- clinical response(2 years)
- operation rate(2 years)
- R0 resection rate(2 years)
- Number of participants with treatment-related adverse events as assessed by the NCI Common Toxicity Criteria (CTC)(2 years)
- tumor regression grade(2 years)
- The total score of participants of both arms will be analyzed and compared.(2 years)