This phase I trial investigates the side effects and best dose of adavosertib and how well it works when given in combination with radiation therapy in treating patients with esophageal or gastroesophageal junction cancer for which no treatment is currently available (incurable). Adavosertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving adavosertib together with radiation therapy kill more tumor cells than radiation therapy alone in treating patients with esophageal and gastroesophageal junction cancer.
PRIMARY OBJECTIVE: I. To identify the maximally tolerated dose of adavosertib (AZD1775) to be used in combination with radiation therapy for patients with esophageal/gastroesophageal junction (GEJ) cancer that is metastatic or inoperable and not eligible for definitive chemoradiation. SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. II. To evaluate the efficacy of AZD1775 when administered in combination with radiation therapy by assessing changes in Ogilvie dysphagia score following treatment, time to second intervention for dysphagia, and overall survival. III. To identify biomarkers that are predictive for response to experimental therapy. OUTLINE: This is a dose escalation study of adavosertib. Patients undergo radiation therapy once daily (QD) 5 days per week for 3 weeks in the absence of disease progression or unacceptable toxicity. Patients also receive adavosertib orally (PO) QD for 2-5 days (depending on dose level) during weeks 1 and 3 of radiation therapy in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 3 weeks, every 3 months for 2 years, then every 6 months for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
4
Given PO
Undergo radiation therapy
City of Hope Comprehensive Cancer Center
Duarte, California, United States
Northwestern University
Chicago, Illinois, United States
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, United States
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, United States
University of Utah Sugarhouse Health Center
Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, United States
Maximum Tolerated Dose (MTD)
Planned analysis for the MTD was to employ a BOIN design where the target toxicity rate for the MTD is 25% with 75% dose-elimination cut-off. Due to the study ending early and low enrollment numbers, analysis of MTD was unable to be performed. The data presented is the maximum dose that was reached in the dose-escalation.
Time frame: After completion of treatment, an average of 3 weeks
Number of Adverse Events
Frequency and severity of adverse events and tolerability of the regimen will be collected and summarized with descriptive statistics. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns.
Time frame: From baseline until completion, an average of 6 months
Symptom Relief Rate
Will be calculated with 95% binomial confidence intervals.
Time frame: After completion of treatment, assessed up to 5 years
Time to Second Intervention for Dysphagia
Patient dysphagia will be evaluated using the Ogilvie dysphagia score, comparing pre-treatment to post-treatment scores
Time frame: The time from initiation of therapy to the time of second intervention for dysphagia, assessed up to 5 years
Overall Survival
Overall survival was planned to be analyzed using Kaplan-Meier methods, resulting in median survival times with 95% confidence interval (CI). Due to early termination of the study and low enrollment numbers, planned analysis did not occur. The data presented in this table is the actual months of survival for each participant, measured from enrollment to death.
Time frame: From date of patient enrollment to death due to any cause, an average of 11.5 months
Ogilvie Dysphagia Scores
The scores will be summarized and compared using paired t-test or Wilcoxon signed-rank test. Patient dysphagia will be evaluated using the Ogilvie dysphagia score, comparing pre-treatment to post-treatment scores.
Time frame: At baseline and after completion of treatment
Biomarkers
Will be described graphically or summary measures (e.g. mean and standard errors, or median and range) and compared between responders and non-responders using a two sample t-test or Wilcoxon test if the data is not normally distributed.
Time frame: Up to 5 years
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