Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy
| Status: | Terminated |
|---|---|
| Conditions: | Cancer, Cancer, Cancer, Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - 99 |
| Updated: | 11/1/2018 |
| Start Date: | October 31, 2017 |
| End Date: | July 27, 2018 |
Background:
The number of patients with esophageal cancer keeps rising. For many patients, a combination
of surgery, chemotherapy, and radiation is necessary to completely treat the disease.
Usually, patients receive chemotherapy and radiation at the same time followed by surgery to
remove the part of the esophagus with the tumor (Neoadjuvant chemoradiotherapy (nCRT)).
Researchers want to learn how to make this treatment more effective.
Objective:
To see if biopsies before treatment can show which patients will do the best with a
combination of chemotherapy, radiation, and surgery.
Eligibility:
Adults at least 18 years old with esophageal adenocarcinoma or squamous cell carcinoma who
should be treated with chemotherapy, radiation, and surgery.
Design:
Patients will undergo standard testing that is routine for all patients with this disease.
These tests include:
Medical history
Physical exam with activity and nutritional assessment
Standard lab tests
Imaging studies including a computerized axial tomography (CAT) scan and positron-emission
tomography (PET) scan
Breathing test into a machine to measure size and function of lungs.
Biopsy for a small sample of tumor is removed by esophagogastroduodenoscopy (EGD): A tube
inserted into the mouth under anesthesia
Endoscopic ultrasound is performed in some but not all patients.
Patients will have nCRT at the clinic or with their local doctor.
In 6 -12 weeks after nCRT, patients will undergo surgery with:
1. A robotically-assisted, minimally-invasive esophagectomy
2. Or, a traditional, open approach.
After surgery, patients are usually in the hospital for 2 weeks and have a feeding tube for
at least 2 weeks and potentially longer until they are eating enough to not lose weight.
Patients will return for follow-up visits with labs and CAT scans every 6 months for the
first two years then every year afterwards.
The number of patients with esophageal cancer keeps rising. For many patients, a combination
of surgery, chemotherapy, and radiation is necessary to completely treat the disease.
Usually, patients receive chemotherapy and radiation at the same time followed by surgery to
remove the part of the esophagus with the tumor (Neoadjuvant chemoradiotherapy (nCRT)).
Researchers want to learn how to make this treatment more effective.
Objective:
To see if biopsies before treatment can show which patients will do the best with a
combination of chemotherapy, radiation, and surgery.
Eligibility:
Adults at least 18 years old with esophageal adenocarcinoma or squamous cell carcinoma who
should be treated with chemotherapy, radiation, and surgery.
Design:
Patients will undergo standard testing that is routine for all patients with this disease.
These tests include:
Medical history
Physical exam with activity and nutritional assessment
Standard lab tests
Imaging studies including a computerized axial tomography (CAT) scan and positron-emission
tomography (PET) scan
Breathing test into a machine to measure size and function of lungs.
Biopsy for a small sample of tumor is removed by esophagogastroduodenoscopy (EGD): A tube
inserted into the mouth under anesthesia
Endoscopic ultrasound is performed in some but not all patients.
Patients will have nCRT at the clinic or with their local doctor.
In 6 -12 weeks after nCRT, patients will undergo surgery with:
1. A robotically-assisted, minimally-invasive esophagectomy
2. Or, a traditional, open approach.
After surgery, patients are usually in the hospital for 2 weeks and have a feeding tube for
at least 2 weeks and potentially longer until they are eating enough to not lose weight.
Patients will return for follow-up visits with labs and CAT scans every 6 months for the
first two years then every year afterwards.
Background:
- The incidence of esophageal cancer continues to increase with an estimated 16,900 new
cases and 15,700 deaths in 2016. Esophageal adenocarcinoma (EAC) is the dominant
histology in the United States and accounts for the rising incidence; the incidence of
esophageal squamous cell cancer (ESCC) remains stable.
- Neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy is now a standard
approach for locally advanced, operable esophageal cancer.
- A survival advantage compared to surgery alone was demonstrated in the phase III Chemo
Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial.
- Patients who experience a pathological complete response (pCR) following neoadjuvant
therapy are most likely to have long-term survival.
- Presently, accurate assessment of pathologic response requires esophagectomy.
Positron-emissions tomography (fludeoxyglucose (FDG-PET)) and endoscopic evaluation with
biopsies fail to detect cancer in a significant percentage of patients with residual
disease following neoadjuvant therapy.
- Currently there are no validated tissue or serologic biomarkers which can be used to
guide surgical management of esophageal cancer patients based on response to nCRT.
Primary Objective:
-To determine whether a metabolomic signature in tumor, blood, or urine or whether BH3
profiling of pre-neoadjuvant tumor biopsies correlates with the outcome of pathological
complete response after neoadjuvant chemoradiotherapy for patients with esophageal
adenocarcinoma or squamous cell carcinoma.
Eligibility:
-Patients with locally-advanced, histologically confirmed EAC or ESCC who are candidates for
nCRT and esophagectomy.
Design:
- Patients will receive standard of care nCRT either at the National Cancer Institute
(NCI) or at referring institutions.
- Specimens of plasma, urine, and esophageal tumor with matched normal esophagus will be
obtained before neoadjuvant therapy for metabolomic profiling and BH3 profiling.
Blood, urine, normal esophagus, and tumor (if present) will be obtained after neoadjuvant
therapy.
- Patients will undergo an esophagectomy as a robotically-assisted, minimally-invasive
esophagectomy (RAMIE) or a traditional open approach for contraindications to
minimally-invasive approaches or based on institutional expertise.
- Analysis will be performed to determine if pathological complete response (pCR) after
chemoradiotherapy (CRT) correlates with pretreatment metabolomic signatures or BH3
profiling in tumor, blood or urine.
- Patients with EAC and ESCC will be evaluated independently.
- The accrual ceiling will be set to 120 patients for the entire study - 80 patients for
EAC and 40 patients for ESCC to allow for unevaluable patients. The accrual is expected
to be completed in 4 years.
- The incidence of esophageal cancer continues to increase with an estimated 16,900 new
cases and 15,700 deaths in 2016. Esophageal adenocarcinoma (EAC) is the dominant
histology in the United States and accounts for the rising incidence; the incidence of
esophageal squamous cell cancer (ESCC) remains stable.
- Neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy is now a standard
approach for locally advanced, operable esophageal cancer.
- A survival advantage compared to surgery alone was demonstrated in the phase III Chemo
Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial.
- Patients who experience a pathological complete response (pCR) following neoadjuvant
therapy are most likely to have long-term survival.
- Presently, accurate assessment of pathologic response requires esophagectomy.
Positron-emissions tomography (fludeoxyglucose (FDG-PET)) and endoscopic evaluation with
biopsies fail to detect cancer in a significant percentage of patients with residual
disease following neoadjuvant therapy.
- Currently there are no validated tissue or serologic biomarkers which can be used to
guide surgical management of esophageal cancer patients based on response to nCRT.
Primary Objective:
-To determine whether a metabolomic signature in tumor, blood, or urine or whether BH3
profiling of pre-neoadjuvant tumor biopsies correlates with the outcome of pathological
complete response after neoadjuvant chemoradiotherapy for patients with esophageal
adenocarcinoma or squamous cell carcinoma.
Eligibility:
-Patients with locally-advanced, histologically confirmed EAC or ESCC who are candidates for
nCRT and esophagectomy.
Design:
- Patients will receive standard of care nCRT either at the National Cancer Institute
(NCI) or at referring institutions.
- Specimens of plasma, urine, and esophageal tumor with matched normal esophagus will be
obtained before neoadjuvant therapy for metabolomic profiling and BH3 profiling.
Blood, urine, normal esophagus, and tumor (if present) will be obtained after neoadjuvant
therapy.
- Patients will undergo an esophagectomy as a robotically-assisted, minimally-invasive
esophagectomy (RAMIE) or a traditional open approach for contraindications to
minimally-invasive approaches or based on institutional expertise.
- Analysis will be performed to determine if pathological complete response (pCR) after
chemoradiotherapy (CRT) correlates with pretreatment metabolomic signatures or BH3
profiling in tumor, blood or urine.
- Patients with EAC and ESCC will be evaluated independently.
- The accrual ceiling will be set to 120 patients for the entire study - 80 patients for
EAC and 40 patients for ESCC to allow for unevaluable patients. The accrual is expected
to be completed in 4 years.
- INCLUSION CRITERIA:
- Patients must have histologically confirmed esophageal adenocarcinoma (EAC) or
esophageal squamous cell carcinoma (ESCC).
- Disease should be deemed resectable by pre-operative computed tomography (CT) and/or
positron-emission tomography (PET) scans and the patient should be operable based on
surgeon assessment.
- Patients willing to complete neoadjuvant chemoradiotherapy (nCRT) per standard of care
followed by esophagectomy. Patients will be treated under protocol 04-C0165.
- 18 years of age or older.
- Able to understand and sign the Informed Consent Document.
- Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2.
- Patients must have organ and marrow function that is not prohibitive of surgical
resection as defined below:
leukocytes greater than or equal to 3,000/mcL
absolute neutrophil count greater than or equal to 1,500/mcL
platelets greater than or equal to 50,000/mcL
- nCRT used in this study is potentially dangerous for developing human fetus. For this
reason, women of child-bearing potential and men must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) prior to study
entry, for the duration and 6 months post chemoradiotherapy. Should a woman become
pregnant or suspect she is pregnant while she or her partner is participating in this
study, she should inform her treating physician immediately.
- Women must have a negative urine pregnancy test OR be post-menopausal for at least 2
years OR patient has had a hysterectomy
EXCLUSION CRITERIA:
- Patients in which nCRT followed by surgery is not the appropriate management:
- Early stage disease that requires local therapy without chemoradiotherapy (CRT).
- Patients with metastatic disease.
- Patients in which biopsy prior to starting nCRT is not obtainable.
- Patients who previously received neoadjuvant chemotherapy
- Concomitant medical problems in the opinion of physician that would place the patient
at unacceptable risk for a major surgical procedure.
- Active systemic infections, coagulation disorders or other major medical illnesses of
the cardiovascular, respiratory or immune system, myocardial infarction, heart
failure, hepatic disease that prohibits administration of neoadjuvant therapy or
surgery.
- Women who are pregnant or breastfeeding because of the potentially dangerous effects
of the chemotherapy on the fetus or infant.
- Patients with a diagnosis of another malignancy that is either active or in remission
less than five years. Basal cell and squamous cell carcinoma of the skin are not
contraindications to this protocol
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
301-496-2563
Phone: 888-624-1937
National Institutes of Health Clinical Center The National Institutes of Health (NIH) Clinical Center in...
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