Using trastuzumab with capecitabine and cisplatin for advanced gastric cancer

A Phase II Clinical Study of Trastuzumab in Combination With Capecitabine and Cisplatin (XP) in Patients With Tissue HER2-negative But Serum HER2-positive Advanced Gastric Cancer: XP+Samfenet

This study is testing if a combination of trastuzumab, capecitabine, and cisplatin can help people with advanced gastric cancer who have a specific type of HER2 status.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 28 (estimated)
• Ages: 19 Years and up
• Sex: All
• Sponsor: Asan Medical Center (other)
• Drugs / interventions: chemotherapy, radiation, trastuzumab
• Locations: 1 site (Seoul)
• Trial ID: NCT04309578 on ClinicalTrials.gov

What this trial studies

This phase II clinical study investigates the effectiveness of trastuzumab combined with capecitabine and cisplatin in patients diagnosed with advanced gastric or gastroesophageal junction adenocarcinoma who have tissue HER2-negative but serum HER2-positive status. The treatment regimen involves administering trastuzumab intravenously, capecitabine orally, and cisplatin intravenously over a 3-week cycle. The study aims to evaluate the response of these patients to the combination therapy, focusing on measurable disease outcomes.

Who should consider this trial

Good fit: Ideal candidates are patients with inoperable, locally-advanced or recurrent metastatic gastric adenocarcinoma or gastroesophageal junction adenocarcinoma who are HER2-negative in tissue but HER2-positive in serum.

Not a fit: Patients who have previously received chemotherapy for advanced or metastatic gastric cancer may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with advanced gastric cancer who currently have limited treatment choices.

How similar studies have performed: While this approach is novel in targeting HER2-negative tissue with HER2-positive serum, similar studies have shown promise in utilizing trastuzumab in various cancer treatments.

Eligibility criteria

Inclusion Criteria:

1. Patients with inoperable, locally-advanced or recurrent and/or metastatic gastric adenocarcinoma or gastroesophageal junction adenocarcinoma who are not eligible for curative therapy and are histologically diagnosed.
2. Diseases measurable according to Response Evaluation Criteria in Solid Tumors (RECIST1.1) using imaging technique (CT or MRI).
3. Tissue HER2-negative tumors (primary or metastatic tumors) defined as IHC2+ and FISH- or IHC 0 or 1+ according to gastric cancer assessment system for HER2 (see Annex 12.5).
4. ECOG Performance status 0, 1 or 2 (see Annex 12.1).
5. Survival for at least 3 months should be possible.
6. Appropriate bone marrow, renal, and hepatic functions. General inclusion criteria
7. Males or females aged 19 years.
8. Patients should sign the informed consent form (ICF).

Exclusion Criteria:

1. Patients who previously received chemotherapy for advanced/metastatic diseases (adjuvant/neoadjuvant chemotherapy, completed at least 6 months prior to enrollment in this clinical study, is permitted, but platinum-based adjuvant/neoadjuvant chemotherapy is not permitted).
2. Patients with a lack of physical integration of the upper gastrointestinal tract or with a malabsorption syndrome (e.g., patients who underwent partial or total gastric resection can participate in this clinical study, but patients equipped with a jejunostomy tube cannot participate).
3. Patients with active (serious or uncontrolled) gastrointestinal bleeding.
4. Patients with relevant toxicities remaining following previous curative therapy (except for alopecia). For example, neurotoxicity ≥ grade 2 based on NCI-CTCAE version 5.0.
5. Patients with a history of other malignant diseases based on the date of complete recovery within 5 years prior to the initiation of treatment in this clinical study (except for in-situ cervical cancer and basal cell carcinoma).

   Hematologic, blood chemistry, and organ functions
6. Neutrophil count \< 1.5 × 109/L, or platelet count \< 100 × 109/L.
7. Serum bilirubin\> 1.5 × upper limit of normal (ULN); or AST or ALT \> 2.5 × ULN (or \> 5 × ULN hepatic metastasis patients); or alkaline phosphatase \> 2.5 × ULN (or \> 5 × ULN hepatic metastasis patients, or \> 10 × ULN hepatic metastasis-free bone metastasis patients); or, albumin \< 2.5 g/dL.
8. Creatinine clearance \< 60 mL/min. However, creatinine clearance is first calculated using the Cockroft-Gault formula, and if the value is \< 60ml/min, a 24hr urine collection test is carried out. Subject enrollment is possible only when creatinine clearance is ≥ 60mL/min.

   Other investigational product-associated exclusion criteria
9. History of proven congestive heart failure; angina pectoris in need of medication; evidence of transmural myocardial infarction through electrocardiogram (ECG); uncontrolled hypertension (systolic blood pressure \> 180 mmHg or diastolic blood pressure \> 100 mmHg); clinically significant heart valve disorders; and high-risk uncontrolled arrhythmia.
10. Baseline left ventricular ejection fraction (LVEF) \< 50% (measured with echocardiogram or MUGA).
11. Patients with dyspnoea at rest due to advanced tumors or other diseases, or who need an adjuvant oxygen therapy.
12. Patients who are treated with long-term or high-dose corticosteroids (steroid inhalation or short-term use of oral steroids for vomiting inhibition and appetite stimulation is permitted).
13. Patients with Clinically significant hypoacusis
14. Patients known to show dihydropyrimidine dehydrogenase (DPD) deficiency. General exclusion criteria
15. Patients with a history of brain metastasis or clinical evidence.
16. Uncontrolled serious systemic intercurrent diseases (e.g., infection or uncontrolled diabetes).
17. Females who are pregnant or are breast-feeding.
18. Fertile males and females who are unwilling to use effective contraceptive methods.
19. Patients who are treated with another investigational product within 4 weeks prior to the initiation of treatment in this clinical study.
20. Patients receiving radiation therapy within 4 weeks prior to the initiation of treatment with the study drug (palliative radiation curative therapy that is partially carried out for bone metastasis. Washout period of 2 weeks is also permitted in patients recovered from all acute toxicities.).
21. Patients who underwent major surgery within 4 weeks prior to the initiation of treatment with the study drug and have not yet been completely recovered.
22. Patients known to have HIV infectivity or active infection with HBV or HCV.
23. Patients with hypersensitivity to the study drug.

Where this trial is running

Seoul

• Asan Medical Center — Seoul, Korea, Republic of (RECRUITING)

Study contacts

• Principal investigator: Min-Hee Ryu, MD, PhD — Asan Medical Center
• Study coordinator: Min-Hee Ryu, MD, Ph.D

Conditions: Gastric or Gastroesophageal Junction Adenocarcinoma