This is a single institutional, single arm, open labeled phase II study to assess the overall radiographic response of adding Avelumab to chemotherapy and palliative radiotherapy in patients with metastatic advanced esophageal squamous cell carcinoma.
Avelumab belongs to the group of immune checkpoint blockade cancer therapies. Avelumab binds to the programmed death-ligand 1 (PD-L1) and therefore inhibits binding to its receptor programmed cell death 1 (PD-1). In the case of avelumab, the formation of PD-1/PDL1 ligand pairs is blocked and CD8+ T cell immune response should be increased. This study comprises 2 phases, the concurrent immune-chemoradiotherapy (Ave-PF-CRT) phase and the immune-chemotherapy (Ave-PF) phase. In the immune-chemoradiotherapy phase, patients are treated with PF-CRT and concomitant Avelumab. In the immune-chemotherapy phase, patients are treated with PF plus Avelumab. Overall radiological response, time to progression, overall survival and adverse events will be evaluated. Subjects' health-related quality of life will be assessed as well.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
26
The study treatment comprises two phases, the concurrent immune-chemoradiotherapy (Ave-PF-CRT) phase and the immune-chemotherapy (Ave-PF) phase. All the subjects will receive Avelumab at both phases.
National Taiwan University Hospital, Taiwan
Taipei, Taiwan
overall radiographic response
overall radiographic response at six-month will be determined by iRECIST
Time frame: 6 months
Best radiographic response
The best radiographic response of in-field irradiated and out-field non-irradiated (abscopal effect) target lesions will be determined by iRECIST.
Time frame: up to 2 years
Progression-free survival
Kaplan-Meier survival estimator will be used to determine the median time to progression for study population (along with 95% confidence interval). The log-rank test will be performed to evaluate the equality of survivor functions across stage, and other covariates of interest on progression-free survival.
Time frame: up to 2 years
Overall survival
Kaplan-Meier survival estimator will be used to determine the median time to death for study population (along with 95% confidence interval). The log-rank test will be performed to evaluate the equality of survivor functions across stage, age, and other covariates of interest on overall survival.
Time frame: up to 2 years
Frequency of adverse events
The tabulations will count the number of subjects reporting individual adverse events. Adverse events are collected/assessed during treatment period (every week in the Ave-PF-CRT phase \[one cycle, 4 weeks\], the first and third week of each cycle in the Ave-PF phase \[5 cycles, each cycle is 4 weeks\]), every 3 months during evaluation, and in 2 years.
Time frame: up to 2 years
Heath-related quality of life
The self-reported health-related quality of life specific to esophageal cancer is a 44-item functioning scale captured using the Functional Assessment Of Cancer Therapy-Esophageal (FACT-E) Traditional Chinese version. Each question uses a 5-point Likert scale ranging from 0 to 4, and higher scores indicate better quality of life (0-176 for FACT-E total score). The FACT-E is assessed before treating is given, in the third week of Ave-PF-CRT phase (one cycle, 4 weeks), in the first week of every cycle (4 weeks) during the Ave-PF phase (5 cycles), and in the 2 years. Changes in total score of FACT-E from baseline to each assessment point will be calculated.
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Time frame: up to 2 years
New metastasis-free survival
Kaplan-Meier survival estimator will be used to determine the median time to development of new metastasis for study population (along with 95% confidence interval). The log-rank test will be performed to evaluate the equality of survivor functions across stage, and other covariates of interest on new metastasis-free survival.
Time frame: up to 2 years