Neoadjuvant chemoradiotherapy for esophageal cancer

Phase II Study of Neoadjuvant Chemoradiotherapy with Hypofractionated Radiotherapy in Patients with Esophageal and Gastroesophageal Junction Adenocarcinoma

This study tests a new combination of chemotherapy and radiation treatment for people with esophageal cancer to see if it works better and is safer than standard methods before surgery.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 42 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: AHS Cancer Control Alberta (Academic / other)
• Drugs / interventions: chemotherapy, radiation
• Locations: 1 site (Calgary, Alberta)
• Trial ID: NCT05370144 on ClinicalTrials.gov

What this trial studies

This trial investigates the effectiveness of hypofractionated neoadjuvant concurrent chemoradiotherapy compared to conventional methods in patients with esophageal adenocarcinoma. Participants will receive a combination of carboplatin and paclitaxel chemotherapy for five weeks, followed by hypofractionated radiotherapy delivered in five sessions over one week. The study aims to assess the safety and efficacy of this treatment approach, with patients undergoing surgery for tumor removal after completing the therapy. Regular assessments for toxicity and follow-up imaging will be conducted to monitor patient progress.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 to 80 with biopsy-proven invasive adenocarcinoma of the esophagus or gastroesophageal junction who are eligible for surgical resection.

Not a fit: Patients with metastatic disease or those who do not meet the specified health criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could provide a more effective and less time-consuming treatment option for patients with esophageal cancer.

How similar studies have performed: While this approach is being tested in this trial, similar studies have shown promise in the use of hypofractionated radiotherapy in other cancer types, indicating potential for success.

Eligibility criteria

Inclusion Criteria:

1. Biopsy-proven invasive adenocarcinoma of the esophagus or GEJ (Siewart type I-II)
2. Surgically resectable clinical stage T1N1-3 or T2-3N0-3 and no clinical evidence of metastatic spread are eligible (M0).
3. Maximum length (based on best information available, with EGD preferred) and width of the tumor as seen on CT not exceeding 8 cm and 5 cm respectively.
4. ECOG performance status ≤ 2
5. Patient able to begin radiation treatment within 30 calendar days of signing the informed consent form.
6. Age ≥ 18 and ≤ 80.
7. Adequate hematological, renal, hepatic and pulmonary function as defined by:

   1. Hemoglobin \> 100 g/L
   2. Platelet count \> 100x109/L
   3. Absolute neutrophil count \> 1.5x109/L
   4. Total bilirubin ≤ 1.5x the upper limit of institutional normal
   5. Creatinine ≤ 120 µmol/L
   6. FEV1 ≥ 1.5 L
8. Patients capable of childbearing are using adequate contraception.
9. Written and informed consent of patient.

Exclusion Criteria:

1. Past or current history of malignancy other than entry diagnosis except for non-melanomatous skin cancer, or curatively treated carcinoma in situ of the cervix or a cured malignancy more than 5 years prior to enrollment
2. Previous chemotherapy and radiotherapy
3. New York heart Association Class III/IV and no history of active angina. Documented myocardial infarction within the 6 months preceding registration (pretreatment echocardiogram evidence of infarct only will not exclude patients). Patients with a history of significant ventricular arrhythmia requiring medication or congestive heart failure. History of 2nd or 3rd degree heart blocks
4. Pre-existing motor or sensory neurotoxicity greater than WHO grade 1
5. Active infection or other serious underlying medical condition which would impair the ability of the patient to receive the planned treatment
6. Dementia or altered mental status that would prohibit the understanding and giving of informed consent
7. Weight loss \> 20% within 3 months of the date of screening
8. Esophageal stent
9. Pregnant or lactating patients; women of childbearing potential must have a negative serum pregnancy test within 7 days of Treatment Visit 1. Women or men of childbearing potential must use effective contraception (defined by the use of two birth control methods, which can be either two barrier methods or a barrier method plus a hormonal method to prevent pregnancy). Subjects must start using birth control from the time they have signed the Informed Consent Form prior to start of therapy until 120 days post completion of study therapy or study discontinuation, which must be documented in the eCRF.
10. Patients unfit for any treatment component, including absolute contraindications for radiotherapy or Connective Tissue Disease.
11. Unable to complete surveys in English without aid of interpreter.

Where this trial is running

Calgary, Alberta

• Tom Baker Cancer Centre/Arthur J.E. Child Comprehensive Cancer Centre — Calgary, Alberta, Canada (Recruiting)

Study contacts

• Study coordinator: Sanjune Laurence Lee, MD

Conditions Esophageal Cancer