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CompletedNCT01212822Updated Sep 7, 2022Results posted

Bevacizumab and Combination Chemotherapy Before Surgery in Treating Patients With Locally Advanced Esophageal or Stomach Cancer

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

Phase
Phase 2
Study type
Interventional
Enrollment
20
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

  • Adenocarcinoma of the Esophagus
  • Adenocarcinoma of the Gastroesophageal Junction
  • Diffuse Adenocarcinoma of the Stomach
  • Intestinal Adenocarcinoma of the Stomach
  • Mixed Adenocarcinoma of the Stomach
  • Squamous Cell Carcinoma of the Esophagus
  • Stage IA Esophageal Cancer
  • Stage IA Gastric Cancer
  • Stage IB Esophageal Cancer
  • Stage IB Gastric Cancer
  • Stage IIA Esophageal Cancer
  • Stage IIA Gastric Cancer
  • Stage IIB Esophageal Cancer
  • Stage IIB Gastric Cancer
  • Stage IIIA Esophageal Cancer
  • Stage IIIA Gastric Cancer
  • Stage IIIB Esophageal Cancer
  • Stage IIIB Gastric Cancer
  • Stage IIIC Esophageal Cancer
  • Stage IIIC Gastric Cancer
03

In context

Adenocarcinoma

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 →

Lead sponsor

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.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patients must have biopsy proven adenocarcinoma, squamous cell carcinoma or undifferentiated carcinoma of the esophagus, GE junction and/or gastric cardia
  • Patients must have potentially resectable disease by the thoracic, minimally invasive or transhiatal approach

    • No portion of the lesion may be within 5 cm of the cricopharyngeus
    • Patient must be considered medically fit for surgery with average or below average risk
    • T1-3 or T4 with local invasion confined to diaphragm, pleura or pericardium
    • No myocardial infarction within 12 months of enrollment
  • Patients must have Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
  • White blood cells (WBC) >= 3,500/mm\^3
  • Platelet count >= 100,000/mm\^3
  • Serum creatinine (Cr) =\< 1.5 mg and/or creatinine clearance >= 60 cc/min
  • Bilirubin must be \< upper limit of normal (ULN) unless the patient has a chronic grade 1 bilirubin elevation due to Gilbert's disease or similar syndrome due to slow conjugation of bilirubin
  • Alkaline phosphatase must be \< ULN
  • Aspartate aminotransferase (AST) \& alanine aminotransferase (ALT) must be \< ULN
  • Urine protein/creatinine (UPC) ratio of \< 1.0 or dipstick for protein of \< 2+, Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v 4) grade \< 2; patients with a UPC ratio >= 1.0 or dipstick of 2+ must undergo a 24-hour urine collection and must demonstrate \< 1 gm of protein in order to participate
  • Patients must give written informed consent and Health Insurance Portability and Accountability Act (HIPAA) consent

Exclusion criteria

Exclusion Criteria:

  • Patients with prior chemotherapy for any malignant disorder, thoracic radiotherapy or prior surgical resection of an esophageal tumor are ineligible
  • Patients with biopsy-proven invasion of the tracheobronchial tree or tracheo-esophageal fistula are ineligible
  • Patients with a history of a curatively treated malignancy must be disease-free for at least two years and have a survival prognosis that is greater than five years
  • Eligible patients of reproductive potential (both sexes) must agree to use an accepted and effective method of contraceptive during study therapy and for at least 6 months after the completion of bevacizumab; women must not be pregnant or breast-feeding because the study drugs administered may cause harm to an unborn fetus or breastfeeding child; all females of childbearing potential must have a serum pregnancy test to rule out pregnancy within 7 days prior to registration
  • Patients with a history of hypertension must measure \< 150/90 mmHg and be on a stable regimen of anti-hypertensive therapy; patients with a history of hypertension who have a blood pressure of 150/90 mmHg, or greater are not eligible; patients with a history of hypertension who have a blood pressure of \< 150/90 mmHg but are not on a stable regimen of anti-hypertensive therapy, are not eligible
  • Any prior history of hypertensive crisis or hypertensive encephalopathy
  • New York Association (NYHA) grade II or greater congestive heart failure
  • Patients must not have a serious or non-healing wound, skin ulcers or unhealed bone fracture, or known human immunodeficiency virus (HIV) infection
  • Patients with >= grade 2 neuropathy are not eligible
  • Patients must not have had significant traumatic injury within 28 days prior to randomization
  • Patients with PT (INR) > 1.5 are not eligible; the patient may not be receiving full-dose anticoagulation; prophylactic or full dose anticoagulation are permitted post-resection or for treatment of an intercurrent thrombotic event
  • Patients with non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that would preclude any of the study therapy drugs are not eligible; specifically excluded are the following conditions: current symptomatic arrhythmia, symptomatic peripheral vascular disease
  • Patients with a history of the following within 12 months of study entry are not eligible: arterial thromboembolic events, unstable angina
  • Any history of stroke or transient ischemic attack
  • Significant vascular disease (i.e. aortic dissection, aortic aneurysm)
  • Patients with psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude them from meeting the study requirements are not eligible
  • Distant metastases
  • History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to study enrollment
  • Known hypersensitivity to any component of bevacizumab
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
20 participants (actual)

Study arms

  • Experimental
    Treatment (bevacizumab, FOLFOX)

    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

Interventions

  • Biologicalbevacizumab

    Given IV

    Also known as: anti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, Avastin, rhuMAb VEGF

  • Drugoxaliplatin

    Given IV

    Also known as: 1-OHP, Dacotin, Dacplat, Eloxatin, L-OHP

  • Drugleucovorin calcium

    Given IV

    Also known as: CF, CFR, LV

  • Drugfluorouracil

    Given IV

    Also known as: 5-fluorouracil, 5-Fluracil, 5-FU

  • Proceduretherapeutic conventional surgery

    Undergo surgical resection

  • Otherlaboratory biomarker analysis

    Correlative studies

06

What researchers measure

Primary outcomes

  1. 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

Secondary outcomes

  1. 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

  2. Overall Survival

    Characterized using Kaplan-Meier curves.

    Time frame: 4.5 years

  3. 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

Other outcomes

  1. 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

07

Results

Posted Sep 7, 2022

Participant flow

Participant flow — Overall Study
MilestoneTreatment (Bevacizumab, FOLFOX)
Started20
Completed20
Not completed0

Outcome measures

PrimaryDisease-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
Reported as:
Count of participants · Participants
Disease-free Survival
ParticipantsTreatment (Bevacizumab, FOLFOX)
Disease-free Survival4
SecondaryComplete 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
Reported as:
Number · percent of patients
Complete and Partial Response to Neoadjuvant Therapy Based on the Response Evaluation Criteria in Solid Tumors (RECIST)
percent of patientsTreatment (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)
SecondaryOverall Survival

Characterized using Kaplan-Meier curves.

Time frame:
4.5 years
Reported as:
Median · months
Overall Survival
monthsTreatment (Bevacizumab, FOLFOX)
Overall Survival26.0 (23.7 to 51.4)
SecondaryProgression 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
Reported as:
Median · months
Progression Free Survival
monthsTreatment (Bevacizumab, FOLFOX)
Progression Free Survival19.0 (13.1 to NA)
Other pre-specifiedChange 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

No measurements were reported for this outcome.

Adverse events

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.

Adverse event summary by group
GroupDeathsSeriousOther
Treatment (Bevacizumab, FOLFOX)10/20 (50%)11/20 (55%)20/20 (100%)
Most frequent serious events
Showing 10 of 19
Most frequent serious events
EventTreatment (Bevacizumab, FOLFOX)
DiarrheaGastrointestinal disorders4/20
NauseaGastrointestinal disorders3/20
FeverGeneral disorders3/20
VomittingGastrointestinal disorders2/20
Abdominal painGastrointestinal disorders2/20
Urinary tract infectionInfections and infestations2/20
DehydrationGeneral disorders1/20
Esophageal pain and obstructionGastrointestinal disorders1/20
Low potassiumInvestigations1/20
PancolitisGastrointestinal disorders1/20
Most frequent other events
Showing 10 of 55
Most frequent other events
EventTreatment (Bevacizumab, FOLFOX)
FatigueGeneral disorders17/20
HypoalbuminemiaMetabolism and nutrition disorders17/20
AnemiaBlood and lymphatic system disorders16/20
Neuropathy/paresthesiaNervous system disorders13/20
PainGeneral disorders13/20
DiarrheaGastrointestinal disorders12/20
Weight lossMetabolism and nutrition disorders11/20
Neutrophil count decreasedInvestigations10/20
Platelet count decreasedInvestigations10/20
White blood cell decreasedInvestigations10/20

Baseline characteristics

Age, Customized
Age, Customized(Participants)Treatment (Bevacizumab, FOLFOX)
30-391
40-491
50-596
60-695
70-797
Sex: Female, Male
Sex: Female, Male(Participants)Treatment (Bevacizumab, FOLFOX)
Female1
Male19
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Treatment (Bevacizumab, FOLFOX)
White20
Region of Enrollment
Region of Enrollment(Participants)Treatment (Bevacizumab, FOLFOX)
United States20
08

Study locations

3 sites
  • Case Western Reserve University
    Cleveland, Ohio 44106, United States
  • Fox Chase Cancer Center
    Philadelphia, Pennsylvania 19111-2497, United States
  • University of Pittsburgh Cancer Institute
    Pittsburgh, Pennsylvania 15232, United States
09

References and documents

Study documents

  • Protocol and statistical analysis plan · Feb 19, 2014

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 7, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01212822
Lead sponsor
Fox Chase Cancer Center
Collaborators
National Cancer Institute (NCI)
Responsible party
Sponsor
First posted
Oct 1, 2010
Start date
Apr 27, 2011
Primary completion
Oct 24, 2014
Completion
Jan 3, 2018
Results posted
Sep 7, 2022
Last update
Sep 7, 2022

Study contacts

Crystal Denlinger
principal investigator · Fox Chase Cancer Center

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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