FOLFOX +/- Ziv-Aflibercept for Esophageal and Gastric Cancer
Esophageal Cancer - Gastric Cancer
Conditions: official terms
Esophageal Neoplasms - Stomach Neoplasms
Conditions: Keywords
Study Type
Study Phase
Phase 2
Study Design
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver), Primary Purpose: Treatment
Name: Oxaliplatin Type: Drug
Name: Folinic Acid Type: Drug
Name: 5-Fluorouracil Type: Drug
Name: Ziv-aflibercept Type: Drug
Name: Ziv-aflibercept Placebo Type: Drug
Overall Status
This research study is a Phase II clinical trial to test the safety and effectiveness of the investigational drug Ziv-aflibercept in combination with mFOLFOX6 compared to mFOLFOX6 alone. The drugs used in mFOLFOX6 include Fluorouracil (5-FU), Leucovorin and Oxaliplatin.

In patients with esophagogastric cancer, mFOLFOX6 has been used in both clinical trials and standard of care. "Investigational" means that the FDA has not yet approved this combination for the treatment of esophagogastric cancer.

Every person has molecules in their bloodstream called vascular endothelial growth factors (VEGFs). These molecules help grow and sustain new blood vessels needed by the human body. Cancer tumors hijack this mechanism because they need new blood vessels and oxygen to grow. Ziv-aflibercept is an antibody, a "targeted therapy" called a "VEGF Trap", that "traps" (binds) these VEGFs and prevents the cancer from using them to grow. Ziv-aflibercept has recently been approved by the FDA for patients with treatment-resistant colorectal cancer. Patients who received standard 5-fluoruracil based chemotherapy pus ziv-aflibercept lived significantly longer than those patients who received standard 5-fluoruracil alone.

In this research study, investigators will see if adding ziv-aflibercept to standard chemotherapy (mFOLFOX6) works better than mFOLFOX6 chemotherapy alone in patients with metastatic or unresectable esophagogastric cancer.
Detailed Description
If patients agree to participate in this research study, they will be asked to undergo some screening tests or procedures to find out if they are eligible. Many of these tests and procedures are likely to be part of regular cancer care and may be done even if it turns out that patients do not take part in this research study. If patients have had some of these tests or procedures recently, they may or may not have to be repeated. These tests and procedures include: a medical history, physical examination, EKG, CT, Blood tests, pregnancy test, urine test, additional blood tests for research and a collection of archival tumor tissue. The screening tests will be reviewed by the doctor and the study team and if the patient meets the eligibility criteria for this study, they will begin treatment. If the patient does not meet the eligibility criteria, they will not be able to participate in this research study.

After the screening procedures confirm that a participant is eligible to participate in the research study, they will be "randomized" into one of two groups. A participant will receive either:

mFOLFOX6 with Ziv-aflibercept -or- mFOLFOX6 with Placebo (A Placebo contains no medicine)

Randomization means that a participant is put into a group by chance (like flipping a coin). Neither the participant nor the research doctor will choose what group the participant will be in. Randomization will be 2:1 (twice as many of the participants in this study will receive mFOLFOX6+Ziv-aflibercept). This study is "blinded", which means neither the patient nor the doctor will know if the patient is getting the investigational drug or the placebo with the mFOLFOX6.

Before a participant begins mFOLFOX6 chemotherapy, they will have a central venous line inserted for the intravenous (in a vein) chemotherapy administration. This is called a "port" or vascular access device. Insertion of the port is a minor outpatient surgical procedure that is performed by a surgeon or interventional radiologist depending on where it is done. The doctor will arrange for the participant to have this procedure done before the participant begins.

mFOLFOX6 is a combination of chemotherapy including oxaliplatin, leucovorin, and 5-FU. The oxaliplatin and leucovorin are given intravenously over 2 hours. The 5-FU is also given intravenously. The participant will get a shot of 5-FU by the infusion nurse and then will be hooked up to a portable pump which will infuse the rest of the 5-FU slowly over the next 46-48 hours. The participant can either disconnect the pump at home, or return to the infusion unit to have it disconnected. The participant, the caregivers and the nurse will discuss the best option for disconnecting the pump and the patient will receive instructions on how to do this at home, if applicable.

Ziv-aflibercept/Placebo will be given over 1 hour intravenously.
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: N/A
Minimum Age: 18 Years
Gender: Both
Criteria: Inclusion Criteria:

- Confirmed adenocarcinoma of esophagus, GE junction or gastric origin

- Disease is not amenable to curative resection and is unresectable, locally advanced or metastatic

- Have not received any prior chemotherapy, investigative or biologic agents for esophagogastric cancer except in the neoadjuvant or adjuvant setting

- Any major surgery must be completed at least 4 weeks prior to study entry, minor procedures must be completed at least 2 weeks prior to study entry

- Vascular access device insertion should be performed at least 1 week prior to study entry. A central line is recommended for all participants

- Willing to use adequate contraception prior to study entry, for the duration of study participation and for 3 months after the last dose of Ziv-aflibercept/placebo

Exclusion Criteria:

- History of hypertension unless adequately controlled

- Evidence of active bleeding from primary tumor at time of study entry

- Pregnant or breastfeeding

- Squamous cell carcinoma histology

- Prior treatment for advanced or metastatic disease

- Palliative radiation to < 25% of bone marrow must have been completed 2 weeks prior to study entry, palliative RT to > 25% must have been completed 4 weeks prior to study entry

- Known allergy to study agents

- Known dihydropyrimidine dehydrogenase deficiency or thymidylate kinase gene polymorphism predisposing participant to 5-FU toxicity

- History of symptomatic congestive heart failure

- Clinically significant peripheral arterial disease

- Grade 2 or higher sensory or motor neuropathy

- Serious unhealed wound, ulcers or bone fractures

- History of HIV positivity or hepatitis B or C

- History of abdominal fistula, wound dehiscence, GI perforation, intra abdominal abscess, uncontrolled GI bleeding or diverticulitis that required hospitalization within 6 months of study entry

- History of arterial thrombotic events

- History of CNS hemorrhage in past 6 months

- Use of warfarin

- History of prior or synchronous malignancy except if treated with curative intent more than 3 years prior to enrollment, or adequately treated non-melanoma skin cancers, cervical carcinoma in situ or prostatic intraepithelial neoplasia without evidence of prostate cancer

- Uncontrolled non-malignant illness

- Uncontrolled psychiatric illness
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Status: Recruiting
Contact: Peter Enzinger, MD - 617-632-5960
Massachusetts General Hospital
Boston, Massachusetts, United States
Status: Recruiting
Contact: Eunice Kwak, MD - 617-724-4000
Start Date
September 2013
Dana-Farber Cancer Institute
Dana-Farber Cancer Institute
Record processing date processed this data on July 28, 2015 page