Esophageal Cancer Clinical Trial
— PROTECTOfficial title:
PROton Versus Photon Therapy for Esophageal Cancer - a Trimodality Strategy (PROTECT) A Multicenter International Randomized Phase III Study of Neoadjuvant Proton Versus Photon Chemoradiotherapy in Locally Advanced Esophageal Cancer
NCT number | NCT05055648 |
Other study ID # | DCPT101008134 |
Secondary ID | |
Status | Recruiting |
Phase | N/A |
First received | |
Last updated | |
Start date | May 1, 2022 |
Est. completion date | May 1, 2030 |
The PROTECT trial will test the hypothesis that proton (PT) -enabled radiation dose reductions to sensitive, normal tissues will result in lower rates of treatment-related pulmonary complications in esophageal cancer compared to standard photon therapy (XT).
Status | Recruiting |
Enrollment | 396 |
Est. completion date | May 1, 2030 |
Est. primary completion date | May 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patients with histologically verified squamous cell carcinoma or adenocarcinoma (including signet cell carcinoma and large cell carcinoma, not further specified) of the esophagus (E) or gastro-esophageal junction (GEJ). - FDG PET/CT performed. - Tumor stage according to TNM (8th edition): cT1-4a and/or cN+, cM0. - Age =18 years. - Performance status WHO =2. - Adequate laboratory findings: hematological: hemoglobin > 90 g/L, absolute neutrophil count (ANC) = 1,5 x 109/L, platelets = 75 x 109/L hepatic: bilirubin = 1.5 x upper limit of normal (ULN), ALAT = 3 x ULN renal: creatinine = 1.5 x ULN, GFR (may be calculated) > 30 ml/min - MDT decision on suitability to undergo curatively intended nCXT or nCPT followed by surgery. - Planned transthoracic esophagectomy or gastrectomy being open, minimally invasive of combination of both. - Ability to adhere to procedures for study and follow-up. - Patients with low risk cancers with a life expectancy above 5 years (e.g. low risk prostate cancer) are allowed in the study. Adequately treated diagnoses such as cervix uteri carcinoma in situ, in situ urothelial carcinoma or localized non-melanoma skin cancer are allowed, regardless of time of diagnosis. - Patients of childbearing potential: pregnancy prevention according to the standards of each country. Patients of childbearing potential must present a negative pregnancy test. Patients and their partners must use effective contraception. Patients of childbearing potential included in the study must use oral contraceptives, intrauterine devices, depot injection of progestin subdermal implantation, a hormonal vaginal ring, or transdermal patch during the study treatment and one month after. Exclusion Criteria: Patients who meet one or more of the following exclusion criteria cannot be included in the study: - Prior thoracic XT or PT, chemotherapy or surgical resection in the esophageal/gastric region (previous EMR or ESD is allowed). - Tumor < 3 cm from oropharyngeal sphincter. - Planned transhiatal resection - Patients with other previous malignancies are excluded unless a complete remission or complete resection was achieved at least 5 years prior to study entry. - Any unstable systemic disease (including clinically significant lung and cardiovascular disease, unstable angina, New York Heart Association (NYHA) grade III-IV congestive heart, severe hepatic, renal or metabolic disease or active inflammatory bowel disease). - Symptomatic peripheral neuropathy greater than grade 1 (scored according to CTCAE v5.0). - Any other serious or uncontrolled illness, which, in the opinion of the investigator, makes it undesirable for the patient to enter the trial. - Unable to understand and digest study patient information or comply with study treatment and safety instructions. - Gastro-esophageal stent within the irradiated volume. |
Country | Name | City | State |
---|---|---|---|
Belgium | Catholic University of Leuven | Leuven | |
Denmark | Aarhus University Hospital (AUH) | Aarhus | |
France | Centre Léon Bérard (CLB) | Lyon | |
France | Centre Antoine Lacassagne (CAL) | Nice | |
France | Institut Curie | Paris | |
Germany | Technische Universität Dresden (TUD) | Dresden | |
Italy | Centro Nazionale di Adroterapia Oncologica (CNAO) | Pavia | |
Italy | Azienda Provinciale Per I Servizi Sanitari (APSS) | Trento | |
Netherlands | Academisch Ziekenhuis Groningen (UMCG) | Groningen | |
Netherlands | Stichting Maastricht Radiation Oncology (MAASTRO) | Maastricht | |
Switzerland | Paul Scherrer Institute (PSI) | Villigen | |
United Kingdom | University College London Hospital (UCLH) | London | |
United Kingdom | The Christie NHS foundation trust | Manchester |
Lead Sponsor | Collaborator |
---|---|
University of Aarhus | Aarhus University Hospital, Academisch Ziekenhuis Groningen, Agenzia Nazionale per i Servizi Sanitari Regionali, Centre Antoine Lacassagne, Centre Leon Berard, CNAO National Center of Oncological Hadrontherapy, HollandPTC, IBA worldwide, Institut Curie, KU Leuven, Maastro Clinic, The Netherlands, Paul Scherrer Institut, Center for Proton Therapy, Technische Universität Dresden, The Christie NHS Foundation Trust, University College London Hospitals, University College, London, University of Leeds, Varian- A Siemens Healthineer Company |
Belgium, Denmark, France, Germany, Italy, Netherlands, Switzerland, United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Total toxicity burden (TTB) | The combined toxicity scale TTB used in the trial by Lin et al (Lin 2020) | from randomization until 90 days after surgery | |
Other | Concordance of observed pulmonary complications with predicted complications from NTCP models | Comparison of observed and predicted toxicity rates | up to 5 years | |
Other | Blood biomarkers as predictors for treatment failure | circulating tumor DNA | up to 5 years | |
Other | Proportion of patients receiving adjuvant immunotherapy | The actual number of patients starting adjuvant immunotherapy will be recorded | up to 5 years | |
Other | Cost-effectiveness of proton therapy relative to photon therapy | Incremental cost effectiveness ratios (ICERs), cost per QALY gained, cost per complication avoided, and cost per total toxicity burden avoided will be reported. | up to 5 years | |
Other | FDG/PET CT as predictors for treatment failure | Correlation between diagnostic PET, planning PET-CT and PET at 12 months | 12 months | |
Other | Concordance of observed cardiac complications with predicted | Comparison of observed and predicted toxicity rates | Up to 5 years | |
Primary | Pulmonary complications | Incidence of pulmonary complications during and following nCPT or nCXT and surgery | from randomization until 90 days after surgery | |
Secondary | Early toxicity | Predefined items = grade 2 scored by Common Terminology Criteria for Adverse Events (CTCAE) v5.0 | from start of nCPT or nCXT until surgery | |
Secondary | Late toxicity | Predefined items = grade 2 scored by Common Terminology Criteria for Adverse Events (CTCAE) v5.0 | up to 5 years | |
Secondary | Postoperative complications | Predefined items scored by Clavien-Dindo and Comprehensive Complications Index (CCI) | from surgery until 90 days after surgery | |
Secondary | Major cardiovascular events (MACE) | Predefined cardiovascular events scored by MACE | up to 5 years | |
Secondary | Patient-reported outcome measures | EORTC quality of life questionnaire | up to 5 years | |
Secondary | Compliance with trimodality treatment | The proportion of patients complying with trimodality treatment in each arm | 3 months | |
Secondary | Pathological response | tumor regression grade for the primary tumor scored according to Mandard score. | immediately after surgery | |
Secondary | Cumulative incidence of loco-regional failure | Locoregional failure evaluated according to RECIST with all failures within the irradiated volume counting as events. | from date of randomization up to 5 years | |
Secondary | Pattern of failure | First site of failure will be divided in loco-regional lymph node failures, loco-regional failures in anastomosis, and distant extra-cranial and intra-cranial failures. All loco-regional failures will be divided in failures inside and outside the treatment volume, which is defined to be within the specified treatment dose. | up to 5 years | |
Secondary | Disease-free survival (DFS) | Disease control evaluated according to RECIST with any recurrence (locoregional or distant) as well as death from any cause, whatever occurs first, will be considered as events. | up to 5 years | |
Secondary | Overall survival (OS) | Death from all causes will considered as events | up to 5 years |
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