Developing ctDNA Guided Adjuvant Therapy for Gastrooesophageal Cancer

Recruiting now · Phase 2

Conditions studied: Gastrooesophageal Cancer

In brief

Multicentre, single arm, open label UK phase II trial to assess the efficacy of trastuzumab deruxtecan in reducing micrometastatic disease burden in HER2 positive GOA patients who are ctDNA positive after chemotherapy and surgery. 25 patients will be recruited from approximately 15 NHS secondary care sites.

Key facts

Study ID

NCT05965479

Run by

University of Southampton

People needed

25

Starts

2024-04-10

Expected to finish

2028-04-30

Last updated by the study team

2024-11-12

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Pathologically documented adenocarcinoma of the stomach (clinical stage before surgery of AJCC I-III), gastroesophageal junction, or lower oesophagus (to include Type I Siewert only), with HER2 overexpression (IHC 3+ or IHC 2+/ISH+) based on local tissue testing results.
• ctDNA positive after surgery as per Signatera assay
• Capable of giving signed informed consent prior to any mandatory study specific procedures, sampling, or analyses and which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
• Male and female participants must be at least 18 years of age at the time of signing the ICF.
• Treated with neoadjuvant chemotherapy before surgery for at least six weeks.
• Surgical resection with clear margins (R0).
• Recovered from surgery in the opinion of the investigator.
• No previous treatment with trastuzumab or other HER2 directed therapy.
• No evidence of metastatic disease on post-surgical CT.
• Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
• Has LVEF ≥ 50% by either echocardiogram (ECHO) or multigated acquisition (MUGA) scan within 28 days before treatment.
• Has adequate organ and bone marrow function within 14 days before treatment allocation as below:
• Platelet count ≥ 100x109/L (Platelet transfusion is not allowed within 1 week prior to screening assessment, use of thrombopoietin receptor agonists is not allowed within 2 weeks prior to screening assessment)
• Haemoglobin ≥ 80 g/L. Participants requiring transfusions or growth factor support to maintain haemoglobin ≥ 80 g/L are not eligible. (Red blood cell transfusions is not allowed within 1 week prior to screening assessment)
• Absolute neutrophil count ≥ 1.5 x 109/L (granulocyte-colony stimulating factor [G-CSF] administration is not allowed within 1 week prior to screening assessment
• ALT/AST ≤ 3 x ULN
• Total bilirubin ≤ 1.5 x ULN or < 3 x ULN in the presence of documented Gilbert's Syndrome (unconjugated hyperbilirubinemia)
• Serum albumin ≥ 3.0 g/dl
• Creatinine clearance ≥ 50 mL/min as calculated using the Cockcroft-Gault equation
• Adequate clotting function International Normalized Ratio (INR) or prothrombin time and either partial thromboplastin or activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN.
• Reproduction:
• Evidence of post-menopausal status or negative serum pregnancy test for females of childbearing potential who are sexually active with a non-sterilised male partner.
• For women of childbearing potential, a negative result for serum pregnancy test (test must have a sensitivity of at least 25 mIU/mL) must be available at the screening visit and urine beta-human chorionic gonadotropin (β-HCG) pregnancy test prior to each administration of IMP.
• Women of childbearing potential are defined as those who are not surgically sterile (i.e., underwent bilateral salpingectomy, bilateral oophorectomy, or complete hysterectomy) or post-menopausal.
• I. Women aged <50 years will be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the post-menopausal range for the site.

You may not qualify if…

• Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AE's, or compromise the ability of the participant to give written informed consent.
• Participants with a medical history of myocardial infarction within 6 months before treatment or symptomatic CHF (New York Heart Association Class II to IV), unstable angina pectoris, clinically important cardiac arrhythmias, or a recent (<6 months) cardiovascular event, including myocardial infarction, unstable angina pectoris, and stroke. Participants with troponin levels above ULN at screening (as defined by the manufacturer)m and without myocardial related symptoms, should have a cardiologic consultation before enrolment to rule out myocardial infarction.
• Corrected QT interval (QTcF) prolongation to > 470 msec (females) or > 450 msec (males) based on average of the screening triplicate 12-lead ECG
• History of (non-infectious) ILD/pneumonitis, current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening.
• Any of the following:
• Lung-specific intercurrent clinically significant illnesses including, but not limited to, any underlying pulmonary disorder (e.g., clinically significant pulmonary emboli within 3 months of treatment, severe asthma, severe chronic obstructive pulmonary disease, restrictive lung disease, clinically significant pleural effusion etc.)
• Any autoimmune, connective tissue, or inflammatory disorders with pulmonary involvement (e.g., rheumatoid arthritis, Sjogren's, sarcoidosis etc.), where there is documented, or a suspicion of, pulmonary involvement at the time of screening
• Prior pneumonectomy (complete)
• Uncontrolled infection requiring intravenous (IV) antibiotics, antivirals, or antifungals
• Multiple primary malignancies within the prior 3 years, except adequately resected non-melanoma skin cancer, curatively treated in situ disease, or other solid tumours curatively treated.
• A pleural effusion, ascites or pericardial effusion that requires drainage, peritoneal shunt.
• Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia) not yet resolved to Grade ≤1 or baseline. The following exemption will apply; stable chronic G2 toxicity which in the opinion of the investigator is not reasonably expected to be exacerbated by treatment with study drugs.
• Known allergy or hypersensitivity to T-DXd or any of the study drug components
• History of severe hypersensitivity reactions or other monoclonal antibodies
• Pregnant or breastfeeding female participants, or participants who are planning to become pregnant
• Involvement in the planning and/or conduct of the study
• Has substance abuse or any other medical conditions, that may, in the opinion of the investigator, interfere with the subjects participation in the clinical study or evaluation of the clinical study results
• Receipt of live, attenuated vaccine within 30 days prior to the first dose of trastuzumab deruxtecan. Note: Patients, if enrolled, should not receive live vaccine during the study and up to 30 days after the last dose of IMP
• Active primary immunodeficiency, known human immunodeficiency virus (HIV) infection, or active hepatitis B or C infection. Patients positive for hepatitis (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
• Judgement by the Investigator that the participant should not participate in the study, if the participant is unlikely to comply with study procedures, restrictions, and requirements.

Where it is running

• Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital — Preston, United Kingdom (enrolling)
• University Hospitals Coventry and Warwickshire, University Hospital Coventry — Coventry, Warwickshire, United Kingdom (enrolling)
• Belfast Health and Social Care Trust, Belfast City Hospital — Belfast, United Kingdom (enrolling)
• Cambridge University Hospital NHS Foundation Trust, Addenbrookes Hospital — Cambridge, United Kingdom (enrolling)
• University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital — Derby, United Kingdom (enrolling)
• NHS Tayside, Ninewells Hospital — Dundee, United Kingdom (enrolling)
• Hull University Teaching Hospitals NHS Trust, Castel Hill Hospital — Hull, United Kingdom (enrolling)
• Leeds Teaching Hospitals NHS Trust, St James's University Hospital — Leeds, United Kingdom (enrolling)
• University College London Hospitals NHS Foundation Trust, University College Hospital London — London, United Kingdom (enrolling)
• Guys & St Thomas NHS Foundation Trust, Guy's Hospital — London, United Kingdom (enrolling)
• The Christie NHS Foundation Trust — Manchester, United Kingdom (enrolling)
• Oxford University Hospitals NHS Trust, Churchill Hospital — Oxford, United Kingdom (enrolling)
• Velindre University NHS Trust, Velindre Cancer Centre — Whitchurch, United Kingdom
• Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital — Guildford, Surrey, United Kingdom

Full record on ClinicalTrials.gov

Trial information comes from ClinicalTrials.gov and is refreshed daily. TrialsForMe does not provide medical care and does not run the studies it lists.