Utility Of Mutational Load As A Predictor For Endoscopic Treatment Response In Barrett's Esophagus

University of North Carolina (UNC)

Status: Completed

Conditions: Barretts Esophagus With Dysplasia; Intramucosal Adenocarcinoma

Treatments: Other: Study Driven Procurement of Biopsies

Study type: Interventional

Funder types: Other

Identifiers

NCT04316975

19-0679

Details and patient eligibility

About

To evaluate association between mutational load (ML) from esophageal biopsy specimens in pre-endoscopic eradication therapy (EET) in Barrett's Esophagus (BE) or Intramucosal adenocarcinoma (IMC) patients and treatment resistance (treatment resistance will be defined as disease recurrence and/or need for additional intervention such as increased acid suppression, need for anti-reflux surgery, or use of alternate ablative modality).

Full description

Potential subjects will be identified via protocol and Institutional Review Board (IRB) methods prior to obtaining written informed consent. Once written informed consent is obtained, subjects will continue with planned routine care upper endoscopy. During the first study visit an upper endoscopy will be performed. At this visit, research specimens will be obtained for mutational load (ML) analysis and gastroenterologist (GI) pathologist diagnosis for the presence of adenocarcinoma or degrees of dysplasia. ML will be correlated to the pathology diagnosis on this research biopsy. Subjects will then undergo EET per routine standard of care at the treating institution until CEIM achieved. Subjects will be followed (data collection only) during treatment period until CEIM is achieved. After subjects reach CEIM, four additional research biopsies will be collected, from the midpoint of previous BE site.

Enrollment: 75 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• No prior history of endoscopic treatment therapy for BE

• Previously untreated "treatment naïve" disease history with confirmed histopathology analysis of at least one of the following:

  • Low- or high-grade dysplastic BE (history of endoscopic mucosal resection (EMR)) is allowable or
  • Intramucosal adenocarcinoma (IMC)

• BE lesion length of at least: C0, M1

• At least 18 years of age at time of consent

• Able and willing to provide written informed consent

• Able and willing to comply with required study procedures and follow-up schedule

Exclusion criteria

• History of endoscopic intervention for the treatment of gastroesophageal reflux disease (GERD), BE, or IMC (prior EMR is allowable)
• Current esophageal stenosis/stricture preventing advancement of a therapeutic scope or significant esophageal anatomic abnormalities (masses, obstructive lesions, etc.)
• Dysplasia of intestinal metaplasia (IM) confined only to the gastric cardia (BE Prague Criteria: C0M0)
• Uncontrolled coagulopathy
• Severe medical comorbidities precluding endoscopy, or limiting life expectancy to less than 2 years in the judgment of the endoscopist
• Known portal hypertension, visible esophageal varices, or history of esophageal varices
• Previous esophagectomy surgery involving the gastroesophageal junction (history of a fundoplication is OK)
• General poor health, multiple co-morbidities placing the patient at risk, or otherwise unsuitable for trial participation
• Subject has any condition that, in the opinion of the investigator or sponsor, would interfere with accurate interpretation of the study endpoints or preclude participation in the trial

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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75 participants in 1 patient group

Biopsy: Barrett's Esophagus, Intramucosal adenocarcinoma

Other group

Description:

Subjects will undergo standard of care (SOC) standard esophagogastroduodenoscopy (EGD) for the treatment of their condition (BE or IMC). Four (4) research biopsies will be taken from the midpoint of current disease. In cases where EMR (Endoscopic Mucosal Resection) is performed clinically, no research biopsies will be taken. Following CEIM, four (4) additional research biopsies will be collected, from the midpoint of previous BE site. Laboratory Biomarker Analysis: Correlative studies Esophagogastroduodenoscopy: Standard of care, research biopsies will be collected if clinical biopsies are taken

Treatment:

Other: Study Driven Procurement of Biopsies