The purpose of this study is to evaluate the efficacy and safety of the combination of Cisplatin,5-Fluorouracil(5FU) and Afatinib as first-line therapy in patients with advanced gastric or gastroesophageal junction cancer. The study will include 55 patients in all. The patients will receive open-label Cisplatin intravenous 75mg/m2 on Day 1, 5FU 750mg/m2 at 24-hour intravenous infusion on Days 1-4, and Afatinib 40mg per os on Days 3-5, 8-12, 15-19. The administration of Afatinib will start on Day 3 of each therapy cycle with an administration interval on each weekend ("Weekday on, Weekend off") for 21 days. Instructions are given on the dose reduction scheme in the presence of toxicity. The administration of the combination Cisplatin-5FU-Afatinib will be continued until disease progression, appearance of significant toxicity, completion of 6 treatment cycles, or withdrawal of consent. At completion of 6 cycles of the combination, in the absence of disease progression, the administration of Afatinib as maintenance monotherapy will be continued until disease progression, appearance of significant toxicity, or withdrawal of consent at the weekday on-weekend off schedule. Imaging will be applied once every 8 weeks, and once every 12 weeks in the Afatinib maintenance therapy phase.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
55
2nd Dept of Internal Medicine, Agios Savvas Cancer Hospital
Athens, Greece
Dept of Medical Oncology, 251 Air Force Hospital
Athens, Greece
2nd Dept of Internal Medicine, General Hospital of Athens "Hippokratio"
Athens, Greece
Oncology Section, Dept of Clinical Therapeutics, General Hospital of Athens "Alexandra"
Athens, Greece
Division of Oncology, 2nd Dept of Internal Medicine, University Hospital "Attikon"
Athens, Greece
2nd Dept of Medical Oncology, Agii Anargiri Cancer Hospital
Athens, Greece
3rd Dept of Medical Oncology, Agii Anargiri Cancer Hospital
Athens, Greece
3rd Dept of Medical Oncology, Hygeia Hospital
Athens, Greece
1st Dept of Medical Oncology, Metropolitan Hospital
Athens, Greece
2nd Dept of Medical Oncology, Metropolitan Hospital
Athens, Greece
...and 5 more locations
Objective Response Rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
Imaging will be performed once every 8 weeks during treatment with cisplatin-5FU-afatinib (6 cycles), and once every 12 weeks in the Afatinib maintenance therapy phase.
Time frame: At an average of 6 months for each patient
Evaluation of Overall Survival (OS)
Time frame: OS will be calculated from the date of treatment initiation to the date of death from any cause assessed up to 36 months.
Evaluation of Progression-Free Survival (PFS)
Time frame: PFS will be calculated from the date of treatment initiation to the date of disease progression or date of death, assessed up to 36 months.
Assessment of safety and tolerability
Distribution of Adverse Events (AEs) according to severity grade. Evaluation of AEs will be performed: On Day 1 and day 10 in cycle 1,on Day 1 in cycles 2-6 (every 21 days) and on Day 1 during maintenance treatment with afatinib (every 4 weeks).
Time frame: Assessed up to 36 months
Value of prognostic and/or predictive biomarkers measured in tissue and blood samples
Immunochemical expression of proteins/messenger ribonucleic acid (mRNA) of the tumor that can be linked to the efficacy / safety of the treatment, the tumor angiogenesis and the mechanism of action of the combination cisplatin/5FU/Afatinib. In bioptic material for gastric or gastroesophageal adenocarcinoma: * Epidermal Growth Factor Receptor (EGFR) immunohistochemical expression; * EGFR gene amplification (chromosome 7 gene number by FISH); * mRNA levels of the EGFR ligands epiregulin and amphiregulin; * Kirsten Rat Sarcoma (KRAS) mutations; * Human Epidermal Growth Factor Receptor 2 (HER2) immunohistochemical expression and gene amplification * HER2 p95, Human Epidermal Growth Factor Receptor 3 (HER3), Human Epidermal Growth Factor Receptor 4 (HER4) immunohistochemical and mRNA expression In peripheral blood and plasma:HER2 shed extracellular domain (ECD) There may be additions to the biomarkers to be analysed, dependent on the clinical and bibliographical data.
Time frame: Tumor blocks and blood samples will be collected at baseline
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