A Phase 2 interventional study of bevacizumab and oxaliplatin in Adenocarcinoma of the Esophagus, Adenocarcinoma of the Gastroesophageal Junction and Diffuse Adenocarcinoma of the Stomach, sponsored by Fox Chase Cancer Center. Completed at 3 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-09-07.
Sponsored by Fox Chase Cancer Center · Phase 2, Interventional, and Treatment
This pilot phase II trial studies how well giving bevacizumab and combination chemotherapy together before surgery works in treating patients with locally advanced esophageal or stomach cancer. Monoclonal antibodies, such as bevacizumab, 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. Drugs used in chemotherapy, such as leucovorin calcium, fluorouracil, and oxaliplatin work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving bevacizumab and combination chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving these treatments after surgery may kill any tumor cells that remain after surgery.
PRIMARY OBJECTIVES:
I. To investigate two-year disease-free survival in patients with resectable esophageal and gastroesophageal (GE) junction cancer treated with perioperative bevacizumab and leucovorin calcium, fluorouracil, and oxaliplatin (FOLFOX).
SECONDARY OBJECTIVES:
I. To assess, by pathological examination after surgical resection, complete and partial response to neoadjuvant therapy.
II. To characterize overall and progression free survival. III. To compare baseline and post-chemotherapy/bevacizumab tissues for biomarkers predicting response or resistance to this approach.
IV. To investigate safety in this setting.
OUTLINE:
NEOADJUVANT THERAPY: Patients receive bevacizumab intravenously (IV) over 30-90 minutes on day 1. Patients also receive FOLFOX chemotherapy comprising oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1, and fluorouracil IV continuously over 46 hours on days 1-2. Treatment with bevacizumab repeats every 2 weeks for 4 courses and treatment with FOLFOX repeats every 2 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
SURGERY: Patients then undergo planned surgical resection 4-6 weeks after 6 courses of chemotherapy and at least 8 weeks since the last dose of bevacizumab.
ADJUVANT THERAPY: Beginning 8-10 weeks after surgery, patients receive bevacizumab IV, oxaliplatin IV, leucovorin calcium IV, and fluorouracil IV as in neoadjuvant therapy. Treatment repeats every 2 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.
2,004 studies on the registry are indexed under Adenocarcinoma; 375 are open to participants now.
This study's enrollment of 20 is below the median of 45 across 1,553 interventional studies indexed under Adenocarcinoma.
Browse Adenocarcinoma studies →Fox Chase Cancer Center is the lead sponsor of 211 studies on the registry; 30 are open to participants now.
Of its 15 completed or terminated interventional studies of FDA-regulated products, 8 (53%) have results posted.
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Patients must have potentially resectable disease by the thoracic, minimally invasive or transhiatal approach
Exclusion Criteria:
NEOADJUVANT THERAPY: Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive FOLFOX chemotherapy comprising oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1, and fluorouracil IV continuously over 46 hours on days 1-2. Treatment with bevacizumab repeats every 2 weeks for 4 courses and treatment with FOLFOX repeats every 2 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. SURGERY: Patients then undergo planned surgical resection 4-6 weeks after 6 courses of chemotherapy and at least 8 weeks since the last dose of bevacizumab. ADJUVANT THERAPY: Beginning 8-10 weeks after surgery, patients receive bevacizumab IV, oxaliplatin IV, leucovorin calcium IV, and fluorouracil IV as in neoadjuvant therapy. Treatment repeats every 2 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Biological: bevacizumab · Drug: oxaliplatin · Drug: leucovorin calcium · Drug: fluorouracil · Procedure: therapeutic conventional surgery · Other: laboratory biomarker analysis
Given IV
Also known as: anti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, Avastin, rhuMAb VEGF
Given IV
Also known as: 1-OHP, Dacotin, Dacplat, Eloxatin, L-OHP
Given IV
Also known as: CF, CFR, LV
Given IV
Also known as: 5-fluorouracil, 5-Fluracil, 5-FU
Undergo surgical resection
Correlative studies
Disease-free Survival
To investigate 2 year disease free survival in pts with resectable esophageal and GE junction cancer treated with perioperative bevaciumab and FOLFOX
Time frame: 2 years
Complete and Partial Response to Neoadjuvant Therapy Based on the Response Evaluation Criteria in Solid Tumors (RECIST)
To assess, by path examination after surgical resection, complete and partial response to neoadjuvant therapy. Characterized using proportions and 95% confidence intervals.
Time frame: Up to 3 years
Overall Survival
Characterized using Kaplan-Meier curves.
Time frame: 4.5 years
Progression Free Survival
Characterized using Kaplan-Meier curves. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions and a 5 mm absolute increase, or a measurable increase in a non-target lesion, or the appearance of new lesions
Time frame: 3 years
Change in Biomarker Levels
Means, medians, and standard deviations of the biomarker levels and change in biomarker levels within groups defined by response/resistance outcomes will be reported.
Time frame: Baseline up to day of surgery
| Milestone | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Started | 20 |
| Completed | 20 |
| Not completed | 0 |
To investigate 2 year disease free survival in pts with resectable esophageal and GE junction cancer treated with perioperative bevaciumab and FOLFOX
| Participants | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Disease-free Survival | 4 |
To assess, by path examination after surgical resection, complete and partial response to neoadjuvant therapy. Characterized using proportions and 95% confidence intervals.
| percent of patients | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Complete and Partial Response to Neoadjuvant Therapy Based on the Response Evaluation Criteria in Solid Tumors (RECIST) | 44.4 (21.5 to 69.2) |
Characterized using Kaplan-Meier curves.
| months | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Overall Survival | 26.0 (23.7 to 51.4) |
Characterized using Kaplan-Meier curves. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions and a 5 mm absolute increase, or a measurable increase in a non-target lesion, or the appearance of new lesions
| months | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Progression Free Survival | 19.0 (13.1 to NA) |
Means, medians, and standard deviations of the biomarker levels and change in biomarker levels within groups defined by response/resistance outcomes will be reported.
No measurements were reported for this outcome.
Collected over All-cause mortality was assessed up to 4.5 years. Serious Adverse Events and Other (Not Including Serious) Adverse Events were assessed up to 6 weeks after treatment. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment (Bevacizumab, FOLFOX) | 10/20 (50%) | 11/20 (55%) | 20/20 (100%) |
| Event | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| DiarrheaGastrointestinal disorders | 4/20 |
| NauseaGastrointestinal disorders | 3/20 |
| FeverGeneral disorders | 3/20 |
| VomittingGastrointestinal disorders | 2/20 |
| Abdominal painGastrointestinal disorders | 2/20 |
| Urinary tract infectionInfections and infestations | 2/20 |
| DehydrationGeneral disorders | 1/20 |
| Esophageal pain and obstructionGastrointestinal disorders | 1/20 |
| Low potassiumInvestigations | 1/20 |
| PancolitisGastrointestinal disorders | 1/20 |
| Event | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| FatigueGeneral disorders | 17/20 |
| HypoalbuminemiaMetabolism and nutrition disorders | 17/20 |
| AnemiaBlood and lymphatic system disorders | 16/20 |
| Neuropathy/paresthesiaNervous system disorders | 13/20 |
| PainGeneral disorders | 13/20 |
| DiarrheaGastrointestinal disorders | 12/20 |
| Weight lossMetabolism and nutrition disorders | 11/20 |
| Neutrophil count decreasedInvestigations | 10/20 |
| Platelet count decreasedInvestigations | 10/20 |
| White blood cell decreasedInvestigations | 10/20 |
| Age, Customized(Participants) | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| 30-39 | 1 |
| 40-49 | 1 |
| 50-59 | 6 |
| 60-69 | 5 |
| 70-79 | 7 |
| Sex: Female, Male(Participants) | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| Female | 1 |
| Male | 19 |
| Race/Ethnicity, Customized(Participants) | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| White | 20 |
| Region of Enrollment(Participants) | Treatment (Bevacizumab, FOLFOX) |
|---|---|
| United States | 20 |
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