Lapatinib With Carboplatin and Paclitaxel in Esophagus and Gastroesophageal Junction (GEJ)

• Sponsor: Case Comprehensive Cancer Center (Other)
• Overall Status: Terminated
• CT.gov ID: NCT01395537
• Collaborator: (none)
• Enrollment: 13
• Locations: 2
• Arm: 1
• Actual Duration (Months): 40
• Patients Per Site: 6.5
• Patients Per Site Per Month: 0.2

Study Details

Study Description

Brief Summary

RATIONALE: Since lapatinib inhibits both EGFR and HER2 receptors, it is an attractive agent for the treatment of esophageal and GEJ tumors.

PURPOSE: Lapatinib is currently approved for HER2 positive metastatic breast cancer in combination with capecitabine or letrozole. It is hoped that by giving lapatinib and carboplatin and paclitaxel together, their combined effects will further slow or stop the cancer cells from growing.

Condition or Disease	Intervention/Treatment	Phase
Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction	Drug: Carboplatin AUC; Drug: Paclitaxel; Drug: lapatinib	Phase 1/Phase 2

Detailed Description

OBJECTIVES:

1. Phase I: To assess the toxicity and feasibility of the addition of lapatinib to carboplatin and paclitaxel in patients with recurrent/metastatic adenocarcinoma of the esophagus and gastroesophageal junction.

2. Phase II: To assess the response rate to this regimen.

OUTLINE:

1. There will be an initial phase I safety cohort studies requiring up to 12 patients, followed by a phase II cohort using the lapatinib dose defined in phase I. Carboplatin and paclitaxel doses will not be escalated.

The initial dose of lapatinib of 750 mg daily by mouth will be given to 6 patients. There will be no dose escalation of the lapatinib above 1000 mg daily. The lapatinib dose for the phase II cohort of this trial will be based only on toxicities experienced during the first cycle (3 weeks) of treatment.

1. Phase II: Once the optimal lapatinib dose has been chosen, all remaining patients will initiate treatment at this dose level. Patients with stable or responding disease after 6 cycles will continue treatment with lapatinib alone until progression of disease or intolerable side effects. Feasibility, toxicity and response rate of this combination will be assessed.

PROJECTED ACCRUAL: A total of 43 patients will be accrued for this study.

Study Design

• Study Type: Interventional
• Actual Enrollment: 13 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase I/II Pilot Study of Lapatinib in Combination With Carboplatin and Paclitaxel in the Treatment of Recurrent/Metastatic Adenocarcinoma of the Esophagus and Gastroesophageal Junction (GEJ)
• Actual Study Start Date: Aug 1, 2011
• Actual Primary Completion Date: Dec 1, 2014
• Actual Study Completion Date: Dec 1, 2014

Arms and Interventions

Arm

Intervention/Treatment

Experimental: Lapatinib With Carboplatin and Paclitaxel

Drug: Carboplatin AUC; Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects.; Drug: Paclitaxel; Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects.; Drug: lapatinib; Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.

Outcome Measures

Primary Outcome Measures

1. PHASE I: Number of Patients That Experience a Grade 3-4 Dose Limiting Toxicity [after 9 weeks (3 cycles) of treatment]

   A dose limiting toxicity (DLT) will be defined as any grade 3-4 non-hematologic toxicity or increase in bilirubin >/= 2 mg/dL (>2X baseline in patients with Gilbert's syndrome), or elevation in AST/ALT > 3.0 X ULN during the first 3 week course of therapy.

2. PHASE II: To Assess the Response Rate to This Regimen. [after 37 months]

   Number of patients with stable or responding disease after 6 cycles of carboplatin and paclitaxel will continue treatment with lapatinib alone until progression of disease or intolerable side effects.

Secondary Outcome Measures

1. To Determine the Overall Survival [after 37 months]

   Overall survival is defined as the length of time between the date of starting treatment and death due to any cause. For a patient who is alive at the time of the statistical analysis, the patient will be considered censored at the last date of known contact.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Patients must have a histologic diagnosis of adenocarcinoma of the esophagus, or gastroesophageal junction based on biopsy material or adequate cytologic exam.

• Patients must have incurable metastatic or recurrent adenocarcinoma of esophagus or gastroesophageal junction.

• Patients must have an ECOG performance status of 0-1.

• Patients must have adequate bone marrow function as evidence by: absolute neutrophil count > 1500/uL, and platelet count > 100,000/uL

• Patients must have adequate renal function as evidenced by a Cockcroft-Gault calculated creatinine clearance > 30 mL/min.

• Patient must have adequate hepatic function as evidenced by: serum total bilirubin < 2.0 mg/dl, and AST/ALT < 3 X the institutional upper limit of normal. Patients with an elevated unconjugated bilirubin (Gilbert's syndrome) will be eligible if hepatic enzymes and function are otherwise completely normal (AST/ALT/Alk Phos within normal limits), and there is no evidence of hemolysis.

• Patients must have cardiac ejection fraction > 50% as measured by echocardiogram or MUGA scan.

• Patient must agree to stop medications or substances known to affect, or with the potential to affect the activity or pharmacokinetics of lapatinib. (See Appendix I).

• Patients must be able to adhere to the study visit schedule and other protocol requirements.

• Patients must have measurable/evaluable disease as per RECIST 1.1 criteria.

• Tumor must be tested for HER2 and EGFR before patient registration.

• Patients of childbearing potential must agree to use an effective form of contraception during the study and for 90 days following the last dose of study medication (an effective form of contraception is an oral contraceptive or a double barrier method).

• Patients must be >18 years old.

• Women of childbearing potential must have a negative pregnancy test prior to enrollment.

• Patients must have a life expectancy >12 weeks.

• Patients must be able to tolerate oral (or feeding-tube administered) medications.

Exclusion Criteria:

• Patients with any other diagnosis except for adenocarcinoma (squamous cell carcinoma, small cell carcinoma, lymphoma, etc) will be ineligible.

• Patients with another active malignancy within the last 5 years will not be eligible except for curatively treated basal cell carcinoma of the skin, cervical intra-epithelial neoplasia, or localized prostate cancer with PSA <1.0 mg/dL on 2 successive evaluations at least 3 months apart, with the most recent evaluation within 4 weeks of entry.

• Patients may not have had any previous chemotherapy for recurrent or metastatic disease and no chemotherapy or radiation therapy within the past 4 weeks.

• Patients may not have received any previous treatment with carboplatin, paclitaxel, or a HER2 or EGFR inhibitor prior to enrollment.

• Patients may not be receiving any other investigational agents or other concurrent anticancer therapy.

• Patients with brain metastases are excluded.

• Patients with > grade 2 peripheral neuropathy per NCI's Common Toxicity Criteria Version 4.0 will be ineligible.

• Males with QTc > 450 or females with QTc > 470msec will be ineligible.

• Patients with active cardiac disease are excluded including current uncontrolled or symptomatic angina, history of clinically significant arrhythmias requiring medications, (with the exception of asymptomatic atrial tachycardias requiring anticoagulation and/or beta-blockade), myocardial infarction < 6 months from study entry, uncontrolled or symptomatic congestive heart failure, or any other cardiac condition, which in the opinion of the treating physician, would make this protocol unreasonably hazardous for the patient

• Women who are currently pregnant or lactating will be ineligible.

• Any other uncontrolled inter-current medical or psychiatric illness.

• Known HIV-positive patients will be excluded.

• Patients with any gastrointestinal disease resulting in an inability to take oral )or feeding-tube administered medication, malabsorption syndrome, a requirement for IV alimentation, prior surgical procedures affecting absorption, or uncontrolled inflammatory GI disease (e.g., Crohn's, ulcerative colitis).

• Concomitant requirement for medication classified as CYP3A4 inducers or inhibitors.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center	Cleveland	Ohio	United States	44016
2	Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center	Cleveland	Ohio	United States	44106

Sponsors and Collaborators

• Case Comprehensive Cancer Center

Investigators

• Principal Investigator: David Adelstein, MD, Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
• Principal Investigator: Neelesh Sharma, MD, Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Case Comprehensive Cancer Center
• ClinicalTrials.gov Identifier: NCT01395537
• Other Study ID Numbers: CASE2310
• First Posted: Jul 15, 2011
• Last Update Posted: Mar 19, 2019
• Last Verified: Mar 1, 2019

• Additional relevant MeSH terms: Adenocarcinoma; Esophageal Neoplasms; Paclitaxel; Carboplatin; Lapatinib

Study Results

Participant Flow

Recruitment Details	Participants were recruited from medical clinic from 8/2011 to 4/2013.

Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
Period Title: Phase I
STARTED	13
COMPLETED	13
NOT COMPLETED	0
Period Title: Phase I
STARTED	1
COMPLETED	1
NOT COMPLETED	0

Baseline Characteristics

Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
Overall Participants	13
Age (years) [Median (Full Range) ]
Median (Full Range) [years]	58
Sex: Female, Male (Count of Participants)
Female	0 0%
Male	13 100%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	0 0%
Not Hispanic or Latino	12 92.3%
Unknown or Not Reported	1 7.7%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%
Asian	0 0%
Native Hawaiian or Other Pacific Islander	0 0%
Black or African American	0 0%
White	13 100%
More than one race	0 0%
Unknown or Not Reported	0 0%
Region of Enrollment (participants) [Number]
United States	13 100%

Outcome Measures

1. Primary Outcome

Title	PHASE I: Number of Patients That Experience a Grade 3-4 Dose Limiting Toxicity
Description	A dose limiting toxicity (DLT) will be defined as any grade 3-4 non-hematologic toxicity or increase in bilirubin >/= 2 mg/dL (>2X baseline in patients with Gilbert's syndrome), or elevation in AST/ALT > 3.0 X ULN during the first 3 week course of therapy.
Time Frame	after 9 weeks (3 cycles) of treatment

Outcome Measure Data

Analysis Population Description

All participants that received treatment

Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
Measure Participants	13
Count of Participants [Participants]	1 7.7%

2. Primary Outcome

Title	PHASE II: To Assess the Response Rate to This Regimen.
Description	Number of patients with stable or responding disease after 6 cycles of carboplatin and paclitaxel will continue treatment with lapatinib alone until progression of disease or intolerable side effects.
Time Frame	after 37 months

Outcome Measure Data

Analysis Population Description

Participants eligible to move to phase II of study. Study was cancelled prior to additional participants moving to study.

Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
Measure Participants	1
Count of Participants [Participants]	0 0%

3. Secondary Outcome

Title	To Determine the Overall Survival
Description	Overall survival is defined as the length of time between the date of starting treatment and death due to any cause. For a patient who is alive at the time of the statistical analysis, the patient will be considered censored at the last date of known contact.
Time Frame	after 37 months

Outcome Measure Data

Analysis Population Description

Participants that received treatment

Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
Measure Participants	13
Median (Full Range) [weeks]	32

Adverse Events

Time Frame	Adverse events were collected while participants were on study ranging from 4 to 19 months.
Arm/Group Title	Lapatinib With Carboplatin and Paclitaxel
Arm/Group Description	Carboplatin AUC: Carboplatin AUC 6 IV over 30 minutes on day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. Paclitaxel: Paclitaxel 175 mg/m2 IV over 3 hours day one of a three week cycle. This will be continued for 6 cycles or until progression of disease or intolerable side effects. lapatinib: Lapatinib should be taken once daily, at the same time daily, on an empty stomach, either 1 hour before, or 1 hour after meals.
All Cause Mortality
	Lapatinib With Carboplatin and Paclitaxel
	Affected / at Risk (%)	# Events
Total	13/13 (100%)
Serious Adverse Events
	Lapatinib With Carboplatin and Paclitaxel
	Affected / at Risk (%)	# Events
Total	4/13 (30.8%)
Blood and lymphatic system disorders
Febrile neutropenia	2/13 (15.4%)	2
Neutropenic Fever	1/13 (7.7%)	1
Gastrointestinal disorders
Diarrhea	1/13 (7.7%)	1
Infections and infestations
Infections and infestations - Other, specify	1/13 (7.7%)	1
Other (Not Including Serious) Adverse Events
	Lapatinib With Carboplatin and Paclitaxel
	Affected / at Risk (%)	# Events
Total	11/13 (84.6%)
Blood and lymphatic system disorders
anemia	1/13 (7.7%)	1
febrile neutropenia	1/13 (7.7%)	1
Gastrointestinal disorders
diarrhea	7/13 (53.8%)	10
dysphagia	6/13 (46.2%)	8
Gastritis	1/13 (7.7%)	1
mucositis	1/13 (7.7%)	2
Mucositis/stomatitis	1/13 (7.7%)	1
nausea	6/13 (46.2%)	6
Nausea/Vomiting	2/13 (15.4%)	2
right upper quadrant pain	1/13 (7.7%)	1
General disorders
fatigue	2/13 (15.4%)	4
infusion reaction	1/13 (7.7%)	1
Investigations
Neutropenia	1/13 (7.7%)	1
platelets, decreased	1/13 (7.7%)	3
weight loss	1/13 (7.7%)	1
Metabolism and nutrition disorders
anorexia	1/13 (7.7%)	1
Musculoskeletal and connective tissue disorders
Arthalgias	1/13 (7.7%)	1
myalgia	1/13 (7.7%)	1
Nervous system disorders
Neuropathy	1/13 (7.7%)	1
Numbness	1/13 (7.7%)	1
peripheral neuropathy	1/13 (7.7%)	3
Skin and subcutaneous tissue disorders
Acneiform Rash	1/13 (7.7%)	2
Rash	1/13 (7.7%)	1
rash on nose and chin	1/13 (7.7%)	1
Rosacea	1/13 (7.7%)	1

Limitations/Caveats

One patient was treated in phase II cohort. The study was then prematurely terminated because of the results of the TRIO-013/LOGiC trial. It failed to meet its primary survival endpoint, suggesting little justification for continuation of our study.

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.