Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer: Final results of a GERCOR phase II trial (ERaFOX).

Authors

null

L. Dahan

APHM La Timone, Marseille, France

L. Dahan , B. Chibaudel , F. Di Fiore , P. Artru , L. Mineur , M. Galais , O. Dupuis , V. Blondin , S. Abdiche , M. Attia , A. De Gramont , G. Lledo

Organizations

APHM La Timone, Marseille, France, GERCOR, Paris, France, Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France, Hôpital Privé Jean Mermoz, Lyon, France, Radiology and Oncology Centre, Institut Sainte-Catherine, Avignon, France, Centre François Baclesse, Caen, France, Clinique Victor Hugo, Le Mans, France, Universitary Hospital, Rouen, France, Hopital Robert Boulin, Libourne, France, Hôpital Saint-Antoine, Paris, France

Research Funding

Pharmaceutical/Biotech Company

Background: Chemoradiotherapy (CRT) for locally advanced cardia and esophageal cancer is based on 5-FU combined with cisplatin, which could be favourably replaced by oxaliplatin (Ox). Cetuximab (C) has demonstrated synergism with both radiotherapy (RT) and platinum-based chemotherapy. ERaFOX trial was evaluating the safety and efficacy of the addition of C to CRT with FOLFOX. Methods: Main inclusion criteria were: stage III squamous cell or adenocarcinoma of the esophagus or gastroesophageal junction; WHO PS 0-1; age 18-80 years; weight loss <15% in the last 6 months. Patients (pts) received 2 cycles of FOLFOX induction therapy (Ox 85 mg/m2/d1, folinic acid 400 mg/m2/d1, 5-FU 2,400 mg/m2/d1-2, q2w) plus C (first infusion 400 mg/m2 then 250 mg/m2, q1w), then RT 50.4 Gy (1.8Gy/d x 28 fractions) with FOLFOX plus C (same doses, except 5-FU 1,800mg/m2/d1-2). Tumor evaluation was performed at the end of CRT (RECIST and endoscopic ultrasonography). The primary endpoint was overall response rate (ORR), with a 50.0% threshold for efficacy (Simon Minimax two-stage design). Results: From Nov 2007 to Feb 2010, 80 pts were enrolled in 12 centers. The characteristics of the 79 eligible pts were (1 ineligible pt for stage IV disease): male/female 60/19, median age 63 (23-79), PS 0/1/ND 47/31/1, squamous/adenocarcinoma/undifferentiated 53/25/1; esophagus/cardia 74/5; median daily caloric intake 1720 Kcal (550-3160). 74 pts were treated by CRT (5 pts experienced anaphylaxis during the first cetuximab infusion). ORR (ITT) was achieved in 61 pts (77.2%; 95% CI 67.9-86.5). After a median follow-up of 19.4 months, median PFS/OS were 13.8/21.6 months. Nineteen (24.0%) pts experienced primitive resection. Pathological CR rate will be presented at the meeting. Most frequent grade 3-4 toxicities were: neutropenia (28.4%), dysphagia-esophagitis (13.5%), rash (10.8%) and allergy (8.9%). One toxic death (1.3%) occurred after CRT related to esophagitis with GI bleeding. Conclusions: Threshold for efficacy was reached with an ORR of 77.2%. Chemoradiotherapy with FOLFOX plus cetuximab should be compared to the same strategy without cetuximab in pts with locally advanced cardia or esophageal cancer.

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Abstract Details

Meeting

2011 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Esophageal, Gastric, or Small Bowel

Clinical Trial Registration Number

NCT00578201

Citation

J Clin Oncol 29: 2011 (suppl; abstr 4072)

Abstract #

4072

Poster Bd #

31F

Abstract Disclosures