Radiation Therapy and Chemotherapy, With or Without Cetuximab, Followed by Surgery in Treating Patients With Locally Advanced Esophageal Cancer That Can Be Removed by Surgery

Last updated: October 19, 2020
Sponsor: Swiss Group for Clinical Cancer Research
Overall Status: Completed

Phase

3

Condition

Esophageal Cancer

Esophageal Disorders

Digestive System Neoplasms

Treatment

N/A

Clinical Study ID

NCT01107639
SAKK 75/08
CDR0000669249
2009-016584-10
EU-21024
  • Ages 18-75
  • All Genders

Study Summary

RATIONALE: Radiation therapy uses high-energy x-rays and to kill tumor cells. Drugs used in chemotherapy, such as docetaxel and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether giving radiation therapy together with chemotherapy is more effective with or without cetuximab in treating patients with esophageal cancer.

PURPOSE: This randomized phase III trial is studying giving radiation therapy together with chemotherapy, with or without cetuximab, followed by surgery in treating patients with locally advanced esophageal cancer that can be removed by surgery.

Eligibility Criteria

Inclusion

DISEASE CHARACTERISTICS:

  • Histologically confirmed esophageal carcinoma

  • Meets the following criteria:

  • Resectable, locally advanced disease as determined by the combination of CT scan, endoluminal ultrasound (EUS), PET scan, and a multidisciplinary team discussion

  • T2, N1-3; T3, any N; or T4a, any N (if technically resectable with curative intent [R0] as decided by a multidisciplinary team discussion)

  • EUS-guided fine-needle aspiration (FNA) allowed, but determines nodal status only if positive FNA

  • No T1, any N, M0; or T2, N0, M0; T4a (due to infiltration of the trachea-bronchial tree or organ involvement that cannot be operated on with curative intent [R0] as decided by a multidisciplinary team discussion); T4b; or distant metastasis (M1)

  • Type I or II disease according to the Siewert classification

  • Squamous cell carcinoma (including basaloid-squamous cell and adenosquamous carcinoma) or adenocarcinoma of the thoracic esophagus or the esophagogastric junction (from 5 cm below the entrance of the esophagus into the thorax to the gastric cardia)

  • Patients with obstructive tumors are eligible (obstructive tumors will be considered as locally advanced tumors)

  • No cervical esophageal carcinoma and tumors involving the first 5 cm of the thoracic esophagus

  • No airway infiltration in case of tumors at or above the tracheal bifurcation

  • No peritoneal carcinomatosis in case of adenocarcinomas infiltrating the gastric cardia (i.e., esophagogastric junction carcinoma Siewert type I or II)

PATIENT CHARACTERISTICS:

  • WHO performance status 0-1

  • Neutrophil count ≥ 1.5 x 10^9/L

  • Platelet count ≥ 100 x 10^9/L

  • Creatinine clearance > 60 mL/min

  • Bilirubin ≤ 1.0 times upper limit of normal (ULN)

  • Alkaline phosphatase ≤ 2.5 times ULN

  • AST ≤ 1.5 times ULN

  • INR normal

  • PTT ≤ 1.0 times ULN

  • Not pregnant or nursing

  • Negative pregnancy test

  • Fertile patients must use effective contraception during and for 12 months after completion of study therapy

  • FEV_1 ≥ 1.5 L OR ≥ 75% of the reference value

  • Must be compliant and geographically proximal for staging and follow-up

  • Considered operable (i.e., appropriate organ functions and ability to undergo general anesthesia)

  • No other malignancies within the past 5 years except nonmelanomatous skin cancer or adequately treated carcinoma in situ of the cervix

  • No severe or uncontrolled cardiovascular disease, including any of the following:

  • NYHA class III-IV congestive heart failure

  • Unstable angina pectoris

  • Myocardial infarction within the past 12 months

  • Significant arrhythmias

  • No psychiatric disorder precluding understanding of information on trial related topics, giving informed consent, and answering questionnaires

  • No active uncontrolled infection

  • No serious underlying medical condition that, in the opinion of the investigator, could impair the ability of the patient to participate in the trial (e.g., uncontrolled diabetes mellitus or active autoimmune disease)

  • No preexisting peripheral neuropathy > grade 1

  • No definite contraindications for the use of corticosteroids and antihistamines as premedication

  • No known hypersensitivity to trial drugs or hypersensitivity to any other component of the trial drugs

PRIOR CONCURRENT THERAPY:

  • No prior chemotherapy or radiotherapy to the chest

  • At least 30 days since prior treatment in another clinical trial

  • No concurrent drugs contraindicated for use with the trial drugs

  • No other concurrent anticancer treatments

  • No other concurrent experimental drugs or investigational treatments

Study Design

Total Participants: 297
Study Start date:
May 27, 2010
Estimated Completion Date:
December 09, 2018

Study Description

OBJECTIVES:

Primary

  • To determine the efficacy of neoadjuvant radiochemotherapy comprising docetaxel, cisplatin, and radiotherapy in combination with cetuximab followed by surgery and adjuvant cetuximab versus neoadjuvant radiochemotherapy comprising docetaxel, cisplatin, and radiotherapy followed by surgery in patients with locally advanced esophageal carcinoma.

Secondary

  • To compare the toxicity of the two therapy arms.

  • To determine patterns of failure overall and with regard to histology.

  • To evaluate economic aspects in a subproject and to perform a radiotherapy quality assurance program.

OUTLINE: This is a multicenter study. Patients are stratified according to center, histology (adenocarcinoma vs squamous cell carcinoma), primary tumor (T2 vs T3-4), and gender (male vs female). Patients are randomized to 1 of 2 treatment arms.

  • Arm A:

    • Induction chemotherapy (docetaxel and cisplatin) and concurrent cetuximab Patients receive docetaxel IV over 1 hour and cisplatin IV over 1 hour on day 1 and cetuximab IV over 1-2 hours on day 1, 8, and 15. Treatment repeats every 21 days for 2 courses.

    • Chemotherapy (docetaxel and cisplatin), cetuximab, and concurrent radiotherapy Beginning in week 7, patients receive cetuximab IV over 1 hour, docetaxel IV over 30 minutes, cisplatin IV over 1 hour on days 43, 50, 57, 64, and 71 and undergo radiotherapy 5 days a week for 5 weeks. Patients then undergo surgery 4-7 weeks after completion of radiotherapy.

    • Adjuvant cetuximab Beginning 3-6 weeks after completion of surgery, patients receive cetuximab IV over 1-2 hours once every 2 weeks for a total of 6 doses.

  • Arm B: Patients receive induction chemotherapy comprising docetaxel IV and cisplatin IV for 2 courses as in arm A. Beginning in week 7, patients receive docetaxel IV, cisplatin IV, and concurrent radiotherapy for 5 weeks as in arm A. Patients then undergo surgery 4-7 weeks after completion of radiotherapy.

After completion of study therapy, patients are followed up at 1 (arm B) or 6 (arm A) months, every 3 months for 3 years, and then every 6 months for 2 years.

Connect with a study center

  • Landeskrankenhaus

    Feldkirch, A-6807
    Austria

    Site Not Available

  • Universitätsklinik für Innere Medizin I

    Innsbruck, A-6020
    Austria

    Site Not Available

  • Krankenhaus Barmherzige Schwestern Linz

    Linz, A-4010
    Austria

    Site Not Available

  • Krankenhaus der Elisabethinen Linz GmbH

    Linz, A-4010
    Austria

    Site Not Available

  • Universitätsklinikum der PMU Salzburg

    Salzburg, A-5020
    Austria

    Site Not Available

  • Klinikum Wels-Grieskirchen GmbH

    Wels, A-4600
    Austria

    Site Not Available

  • Universitätsklinik für Innere Medizin

    Wien, 1090
    Austria

    Site Not Available

  • Hôpital Avicenne

    Bobigny, 93000
    France

    Site Not Available

  • Centre Hospitalier Général

    Béziers, 34525
    France

    Site Not Available

  • Hôtel Dieu Estaing

    Clermont Ferrand, 63003
    France

    Site Not Available

  • Centre Georges-François Leclerc

    Dijon, 21079
    France

    Site Not Available

  • CHU Le Bocage

    Dijon Cedex, 21079
    France

    Site Not Available

  • CHRU de Lille

    Lille, 59037
    France

    Site Not Available

  • Centre Bourgogne

    Lille, 59000
    France

    Site Not Available

  • Clinique François Chénieux

    Limoges, 87000
    France

    Site Not Available

  • CHU la TIMONE

    Marseille, 13385
    France

    Site Not Available

  • CH Régional de la Source

    Orleans, 45067
    France

    Site Not Available

  • CH Saint Jean

    Perpignan Cedex, 66046
    France

    Site Not Available

  • Hôpital Haut Leveque

    Pessac Cedex, 33604
    France

    Site Not Available

  • CHU

    Rennes Cedex 9, 35033
    France

    Site Not Available

  • CHU de Saint Etienne - Hôpital Nord

    St Priest En Jarez, 42277
    France

    Site Not Available

  • Clinique Ste Anne

    Strasbourg, 67000
    France

    Site Not Available

  • Hôpital Purpan

    Toulouse, 31509
    France

    Site Not Available

  • Charite University Hospital - Campus Virchow Klinikum

    Berlin, D-13353
    Germany

    Site Not Available

  • Universitaetsklinikum Duesseldorf

    Duesseldorf, D-40225
    Germany

    Site Not Available

  • Kliniken Essen - Mitte

    Essen, D-45136
    Germany

    Site Not Available

  • Universitaetsklinikum Freiburg

    Freiburg, D-79106
    Germany

    Site Not Available

  • SLK-Kliniken Heilbronn GmbH

    Heilbronn, 74078
    Germany

    Site Not Available

  • Klinikum Herford

    Herford, D-32049
    Germany

    Site Not Available

  • Klinikum Ludwigsburg

    Ludwigsburg, D-71640
    Germany

    Site Not Available

  • Universitaetsklinikum Giessen und Marburg GmbH

    Marburg, D-35043
    Germany

    Site Not Available

  • Klinikum der Universitaet Muenchen - Grosshadern Campus

    Munich, D-81377
    Germany

    Site Not Available

  • Staedtisches Klinikum Solingen

    Solingen, D-42653
    Germany

    Site Not Available

  • Klinikum Stuttgart - Katharinenhospital

    Stuttgart, 70174
    Germany

    Site Not Available

  • Universitaetsklinikum Tuebingen

    Tuebingen, D-72076
    Germany

    Site Not Available

  • Szent Laszlo Korhaz

    Budapest, 1097
    Hungary

    Site Not Available

  • Hirslanden Klinik Aarau

    Aarau, CH-5001
    Switzerland

    Site Not Available

  • Kantonsspital Aarau

    Aarau, CH-5001
    Switzerland

    Site Not Available

  • Kantonsspital Baden

    Baden, CH-5404
    Switzerland

    Site Not Available

  • St. Claraspital AG

    Basel, CH-4016
    Switzerland

    Site Not Available

  • Universitaetsspital-Basel

    Basel, CH-4031
    Switzerland

    Site Not Available

  • Inselspital Bern

    Bern, CH-3010
    Switzerland

    Site Not Available

  • Kantonsspital Bruderholz

    Bruderholz, CH-4101
    Switzerland

    Site Not Available

  • Kantonsspital Graubuenden

    Chur, CH-7000
    Switzerland

    Site Not Available

  • Hopital Cantonal Universitaire de Geneve

    Geneva, CH-1211
    Switzerland

    Site Not Available

  • Centre Hospitalier Universitaire Vaudois

    Lausanne, CH-1011
    Switzerland

    Site Not Available

  • Kantonsspital Liestal

    Liestal, CH-4410
    Switzerland

    Site Not Available

  • Ospedale Civico

    Lugano, CH-6903
    Switzerland

    Site Not Available

  • Kantonsspital Olten

    Olten, CH-4600
    Switzerland

    Site Not Available

  • Hôpital du Valais (RSV)-CHCVs

    Sion, 1951
    Switzerland

    Site Not Available

  • Kantonsspital - St. Gallen

    St. Gallen, CH-9007
    Switzerland

    Site Not Available

  • Regionalspital

    Thun, 3600
    Switzerland

    Site Not Available

  • Ospedale Italiano

    Viganello, CH-6962
    Switzerland

    Site Not Available

  • Kantonsspital Winterthur

    Winterthur, CH-8400
    Switzerland

    Site Not Available

  • City Hospital Triemli

    Zurich, CH-8063
    Switzerland

    Site Not Available

  • Klinik Hirslanden

    Zurich, CH-8032
    Switzerland

    Site Not Available

  • Onkozentrum Klinik im Park

    Zurich, 8038
    Switzerland

    Site Not Available

  • UniversitaetsSpital Zuerich

    Zurich, CH-8091
    Switzerland

    Site Not Available

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