Neoadjuvant RCT Versus CT for Patients With Locally Advanced Potentially Resectable Adenocarcinoma of the GEJ

STATUS

Recruiting
End date

Aug 5, 2028
participants needed

340
sponsor

Universitätsmedizin Mannheim

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Updated on 19 February 2024

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estrogen

calcium

renal function

neutrophil count

docetaxel

oxaliplatin

adenocarcinoma

fluorouracil

leucovorin

hormonal contraception

aptt

progestogen

kidney function test

adenocarcinoma of the gastroesophageal junction

tubal occlusion

intrauterine device (iud)

flot

flot regimen

Summary

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This is a multicenter, prospective, randomized, stratified, controlled, open-label study comparing neoadjuvant radiochemotherapy with FLOT versus FLOT chemotherapy alone fr patients with locally advanced, potentially resectable adenocarcinoma of the gastroesophageal junction (GEJ)

Description

The RACE trial seeks to demonstrate superiority of preoperative FLOT induction chemotherapy followed by preoperative radiochemotherapy and postoperative FLOT chemotherapy over perioperative FLOT chemotherapy without radiotherapy in patients with adenocarcinoma of the gastroesophageal junction undergoing adequate oncological surgery.

Eligible patients will be randomly allocated to one of two treatment groups, i.e. preoperative chemotherapy (Arm A) or preoperative chemotherapy with subsequent preoperative radiochemotherapy (arm B), both followed by resection and postoperative completion of chemotherapy. Randomization will occur in a 1:1 ratio with stratification by primary tumor site (Siewert I vs. Siewert II/III).

Arm A:

Patients randomized to Arm A (control arm) will be treated with four preoperative cycles of FLOT. Cycles will be repeated every two weeks. The preoperative chemotherapy duration in Arm A is eight weeks. Surgical resection will follow 4-6 weeks after day 1 of the last cycle of neoadjuvant therapy. Postoperative chemotherapy will start 6-12 weeks after surgery and consists of another four cycles of FLOT every two weeks. The total treatment period is 25-32 weeks.

Arm B:

Patients randomized in Arm B (experimental arm) will be treated with two cycles of FLOT every two weeks. Radiochemotherapy will start three weeks after day 1 of the second cycle and consists of oxaliplatin and infusional 5-fluorouracil plus concurrent radiotherapy given to a dose of 45 Gy (25 daily fractions with 1.8 Gy) over five weeks. The preoperative treatment duration is 10 weeks. Surgical resection will follow 4-6 weeks after last treatment with chemotherapy / radiation. Postoperative chemotherapy will start 6-12 weeks after surgery and consists of four cycles of FLOT every two weeks. The total treatment period is 26-33 weeks.

Details

Condition	Gastroesophageal Junction Adenocarcinoma
Age	18years - 100years
Treatment	Radiation, Oxaliplatin, Calcium folinate, Docetaxel, 5-Fluorouracil, Oxaliplatin during radiotherapy, 5-Fluorouracil during radiotherapy
Clinical Study Identifier	NCT04375605
Sponsor	Universitätsmedizin Mannheim
Last Modified on	19 February 2024

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Histologically proven, locally advanced and potentially resectable adenocarcinoma of the gastroesophageal junction (GEJ) (Siewert I- III) that is: cT3-4, any N, M0 or cT2 N+, M0 according to AJCC 8th edition
	Patients must be candidates for potential curative resection as determined by the treating surgeon
	ECOG performance status 0-1
	Age 18 years or above
	Adequate hematologic function with absolute neutrophil count (ANC) 1.5 x 10^9/l, platelets 100 x 10^9/l and hemoglobin 9.0 mg/dl
	INR <1.5 and aPTT<1.5 x upper limit of normal (ULN) within 7 days prior to starting study treatment
	Adequate liver function as measured by serum transaminases (ASAT, ALAT) 2.5 x ULN and total bilirubin 1.5 x ULN
	Adequate renal function with serum creatinine 1.5 x ULN
	QTc interval (Bazett) 440 ms
	Written informed consent obtained before randomization
	Negative pregnancy test for women of childbearing potential within 7 days of commencing study treatment. Males and females of reproductive potential must agree to practice highly effective contraceptive measures during the study and for 6 months after the end of study treatment. Male patients must also agree to refrain from father a child during treatment and up to 6 months afterwards and additionally to use a condom during treatment period. Their female partner of childbearing potential must also agree to use an adequate contraceptive measure
	There are no data that indicate special gender distribution. Therefore, patients will be enrolled in the study gender-independently
	formula for QTc interval calculation (Bazett): QTc= ((QT) " (ms)" )/(RR (sec))= ((QT) " (ms)" )/(60/(Frequence (1/min)))
	highly effective (i.e. failure rate of <1% per year when used consistently and correctly) methods: intravaginal and transdermal combined (estrogen and progestogen containing) hormonal contraception; injectable and implantable progestogen-only hormonal contraception; intrauterine device (IUD); intrauterine hormone-releasing system (IUS); bilateral tubal occlusion; vasectomised partner; sexual abstinence (complete abstinence is defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments)
Exclusion Criteria
	Evidence of metastatic disease (exclusion of distant metastasis by CT of thorax and abdomen, bone scan or MRI [if osseous lesions are suspected due to clinical signs])
	Past or current history (within the last 5 years prior to treatment start) of other malignancies. Patients with curatively treated basal and squamous cell carcinoma of the skin or in situ carcinoma of the cervix are eligible
	Evidence of peripheral sensory neuropathy > grade 1 according to CTCAE version 4.03
	Patients with other significant underlying medical conditions that may be aggravated by the study treatment or are not controlled
	Pregnant or lactating females
	Patients medically unfit for chemotherapy and radiotherapy
	Patients receiving any immunotherapy, cytotoxic chemotherapy or radiotherapy other than defined by the protocol. The participation in another clinical trial with the use of investigational agents, chemotherapy or radiotherapy during the trial is not permitted
	Known hypersensitivity against 5-FU, leucovorin, oxaliplatin or docetaxel
	Other known contraindications against 5-FU, leucovorin, oxaliplatin, or docetaxel
	Clinically significant active coronary heart disease, cardiomyopathy or congestive heart failure, NYHA III-IV
	Clinically significant valvular defect
	Other severe internal disease or acute infection
	Peripheral polyneuropathy > NCI Grade II according to CTCAE version 4.03
	Chronic inflammatory bowel disease

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Neoadjuvant RCT Versus CT for Patients With Locally Advanced Potentially Resectable Adenocarcinoma of the GEJ