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About
RATIONALE: Drugs used in chemotherapy, such as epirubicin, cisplatin, and capecitabine, 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 bevacizumab, and small molecule tyrosine kinase inhibitors, such as lapatinib, 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. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Lapatinib targets a specific growth receptor, HER-2. Chemotherapy together with bevacizumab or lapatinib, in HER-2 positive tumours, may kill more tumor cells.
PURPOSE: This randomized phase II/III trial is studying the side effects and how well giving combination chemotherapy together with bevacizumab works compared with combination chemotherapy alone in treating patients with previously untreated stomach cancer, gastroesophageal junction cancer or lower oesophageal cancer that can be removed by surgery. The feasibility study is studying the safety of adding lapatinib to chemotherapy in patients with HER-2 positive previously untreated stomach cancer, gastroesophageal junction cancer or lower oesophageal cancer that can be removed by surgery. The feasibility study will also assess the feasibility of timely HER-2 testing and estimate the HER-2 positivity rate in this patient population.
Full description
OBJECTIVES:
Primary
OUTLINE: This is a multicenter, randomized, open-label, controlled study. Patients are randomized to 1 of 4 treatment arms.
Patients undergo surgery 5-6 weeks after completion of chemotherapy. Patients then receive 3 additional courses of chemotherapy beginning 6-10 weeks after surgery.
Patients undergo surgery 5-8 weeks after completion of chemotherapy. Patients then receive 3 additional courses of chemotherapy and bevacizumab beginning 6-10 weeks after surgery. Patients then receive maintenance therapy comprising bevacizumab IV over 30-90 minutes on day 1. Maintenance therapy repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Patients undergo surgery 5-8 weeks after completion of chemotherapy. Patients then receive 3 additional courses of chemotherapy and lapatinib beginning 6-10 weeks after surgery. Patients then receive maintenance therapy comprising lapatinib orally once daily on days 1-21. Maintenance therapy repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed at baseline, during treatment, and during the follow-up period.
After completion of study treatment, patients are followed at 9, 18, and 27 weeks after the start of course 4, 1 year post surgery, every 6 months for 2 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 1063 patients were recruited to the bevacizumab comparison of the study (now closed to recruitment) and 40 patients with HER-2 positive tumours will be recruited into the ST03 feasibility study.
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Inclusion and exclusion criteria
This is a combined eligibility criteria for both bevacizumab comparison and the lapatinib feasibility study. Please note the bevacizumab comparison closed to recruitment on 28th March 2014.
DISEASE CHARACTERISTICS:
Gastric and Type III junctional tumours should be Stage Ib (T1 N1, T2a/b N0), II, III or stage IV (T4 N1 or N2) with no evidence of distant metastases (M0)
Lower oesophageal and Type I and II junctional tumours should be Stage II to Stage IVa (T1 N1, T2 N1, T3 N0-1, but not T2N0). T4 (N0 or N1) tumours are also eligible providing that they involve only the crura OR invade only the mediastinal pleura. Patients with nodal disease affecting the origin of the left gastric and splenic artery or coeliac axis (staged as M1a) are also eligible.
PATIENT CHARACTERISTICS:
WHO performance status 0 or 1
Absolute neutrophil count ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3
Hemoglobin ≥ 9 g/dL (can be post transfusion)
WBC ≥ 3,000/mm^3
Glomerular filtration rate ≥ 60 mL/min
Proteinuria ≤ 1 g by 24-hour urine collection
Bilirubin ≤ 1.5 times upper limit of normal (ULN)
ALT and AST ≤ 2.5 times ULN
Alkaline phosphatase ≤ 3 times ULN (in the absence of liver metastases)
INR ≤ 1.5
PTT ≤ 1.5 times ULN
FEV_1 ≥ 1.5 L
Cardiac ejection fraction ≥ 50% by MUGA scan or echocardiogram
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
Must be fit enough to receive protocol treatment
No other malignancies within the past 5 years except for curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix
No prior or concurrent significant medical conditions, including any of the following:
Cerebrovascular disease (including transient ischemic attack and stroke) within the past year
Cardiovascular disease, including the following:
Major trauma within the past 28 days
Serious nonhealing wound, ulcer, or bone fracture
Evidence of bleeding diathesis or coagulopathy
Recent history of any active gastrointestinal inflammatory condition (e.g., peptic ulcer disease, diverticulitis, or inflammatory bowel disease)
No severe tinnitus
No lack of physical integrity of the upper gastrointestinal tract, malabsorption syndrome, or inability to take oral medication
No known peripheral neuropathy ≥ 1 (absence of deep tendon reflexes as the sole neurological abnormality does not render the patient ineligible)
No known dihydropyrimidine dehydrogenase deficiency
No history of interstitial lung disease or radiological evidence of lung fibrosis
No known allergy to any of the following:
Due to an increase in perforations associated with self-expandable metal stents in patients with colorectal cancer receiving bevacizumab, patients with an oesophageal or gastric stent (metal or biodegradable) in situ are ineligible for the study.
PRIOR CONCURRENT THERAPY:
No prior anthracycline
More than 28 days since prior major surgery or open biopsy
More than 10 days since prior thrombolytic therapy
No concurrent thrombolytic therapy
No concurrent dipyridamole
No concurrent capecitabine or sorivudine (or sorivudine analogues [e.g., brivudine])
No chronic, daily high-dose acetylsalicylic acid (> 325 mg/day) or nonsteroidal anti-inflammatory drugs
No chronic corticosteroids (≥ 10 mg/day methylprednisolone equivalent)
No other concurrent cytotoxic agents
No other concurrent investigational drugs
No concurrent radiotherapy
Low molecular weight heparin allowed
More than 7 days since prior CYP3A4 inhibitor therapy
More than 14 days since prior CYP3A4 inducer therapy
More than 6 months since prior amiodarone therapy
More than 14 days since prior St John's Wort, modafinil, ginkgo biloba, kava, grape seed, valerian, ginseng, echinacea and evening primrose oil
Primary purpose
Allocation
Interventional model
Masking
1,103 participants in 3 patient groups
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Central trial contact
Nicholas Kleovoulou
Data sourced from clinicaltrials.gov
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