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for people ages 18 years and up
at San Francisco, California and other locations
study started
Principal Investigator



RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy after surgery may kill any remaining tumor cells following surgery. It is not yet known which chemotherapy and radiation therapy regimen is more effective in treating stomach or esophageal cancer.

PURPOSE: Randomized phase III trial to compare two different chemotherapy and radiation therapy regimens in treating patients who have undergone surgery for stomach or esophageal cancer.

Official Title

Phase III Intergroup Trial of Adjuvant Chemoradiation After Resection of Gastric or Gastroesophageal Adenocarcinoma



  • Compare overall survival in patients with resected gastric adenocarcinoma treated with epirubicin, cisplatin, and infusional fluorouracil (5-FU) vs 5-FU bolus and leucovorin calcium before and after 5-FU plus radiotherapy.
  • Compare disease-free survival and local and distant recurrence rates in these patients treated with these regimens.
  • Correlate the expression of putative prognostic markers (including TS, ERCC-1, MSI, E-cadherin, EGFR, p27, COX-2, and c-erbB-2) with overall survival of patients treated with these regimens.
  • Correlate specific germline polymorphisms related to chemotherapy metabolism and resistance (including UGT2B7 [epirubicin], GST [cisplatin], ERCCI [cisplatin], XRCC1 [cisplatin], TS [5-FU], DPD [5-FU], and EGFR polymorphisms) with treatment-related toxicity and overall survival of these patients.
  • Correlate serum levels of insulin-like growth factor-1 (IGF-1), IGF-2, and IGF-binding protein 3 with overall survival of patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to depth of tumor penetration (T1 or T2 vs T3 vs T4), lymph node involvement (0 vs 1-3), and extent of lymphadenectomy (D1 or D2 vs D0 or unknown). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive leucovorin calcium IV and fluorouracil (5-FU) IV on days 1-5 of courses 1, 3, and 4. Courses repeat every 28 days. During course 2, patients undergo radiotherapy 5 days a week and receive 5-FU IV continuously for 5 weeks. Patients rest for 28-35 days between course 2 and 3.
  • Arm II: Patients receive epirubicin IV over 3-15 minutes and cisplatin IV over 1 hour on day 1 and 5-FU IV continuously on days 1-21 during course 1. Beginning 1 week later, patients undergo radiotherapy 5 days a week and receive 5-FU IV continuously for 5 weeks. Patients rest for 28-35 days before beginning course 2 of chemotherapy. Patients then receive epirubicin, cisplatin, and 5-FU as in course 1. Treatment repeats every 21 days for 2 courses.

Patients are followed every 3 months for 2 years, every 4 months for 2 years, and then annually for 3 years.

PROJECTED ACCRUAL: A total of 824 patients will be accrued for this study.


Esophageal Cancer Gastric Cancer stage I gastric cancer stage II gastric cancer stage III gastric cancer adenocarcinoma of the stomach adenocarcinoma of the esophagus stage I esophageal cancer stage II esophageal cancer stage III esophageal cancer Cisplatin Fluorouracil Epirubicin Levoleucovorin Leucovorin


For people ages 18 years and up

  1. Required Tumor Parameters

    1.1 Patients must have histologically diagnosed adenocarcinoma of the stomach or gastroesophageal junction. Adenocarcinomas of the esophagus that are not involving the gastroesophageal junction are not eligible.

    1.2 Patients must have had en bloc resection of all known tumor. The surgical resection must have been done with a curative intent.

    1.3 Patients must have tumor extension beyond muscularis propria and/or nodal involvement without evidence of M1 disease.

    • Patients can have stages IB if there is evidence of either node-positive (N1)disease or tumor extension beyond the muscularis propria (i.e., T1, N1, M0 patients are eligible but patients with T2, N0, M0 are allowed only if there is extension beyond the muscularis propria).
    • Patients can have stages II, IIIA, IIIB or stage IV with M0 (i.e., T4N2M0).
    • Stages 0, IA, or any stage with M1 are not allowed. (see Appendix I for TNM staging guide).

    1.4 Patients with known unresected cancer, recurrent cancer, microscopic evidence of tumor at the distal or proximal line of stomach resection, noncontiguous resection of tumor, or M1 (metastatic) disease are ineligible.

  2. Prior Therapy

    2.1 No prior therapy (except hormonal or biologic) for other malignancies is allowed except for adequately treated basal cell or squamous cell skin cancer, noninvasive carcinoma in situ which has been fully resected, or other cancer for which the patient has been disease free for five years.

    2.2 Patients who have had any previous chemotherapy or radiotherapy are ineligible.

  3. Patient Characteristics

    3.1 Patients must have an ECOG (CTC) performance status of 0, 1 or 2.

    3.2 Patients are required to have an adequate total caloric intake to allow them to maintain their post-surgical body weight. Patients must have documentation of stable weight (or less than 2 pounds weight loss) for at least one week prior to registration.

    3.3 All patients must be evaluated by a radiation oncologist (prior to enrollment) to ensure that the patient is an appropriate candidate for radiation therapy.

    3.4 Patients may not have unilateral renal function (only one functioning kidney) as determined by CT scan with contrast, urogram, renal scan, or other study.

    3.5 Pregnant or lactating women may not participate. Men and women of reproductive potential may not participate unless they have agreed to use an effective contraceptive method or practice abstinence while in this study.

    • The effects of therapeutic radiotherapy are known to be teratogenic.
    • The effects of Epirubicin, Cisplatin, and 5-FU on a developing human fetus at the recommended therapeutic dose are less well known.
    • For this reason and because DNA alkylating agents are known to be teratogenic,women of childbearing potential and men must agree to use adequate contraception(hormonal or barrier method of birth control) prior to study entry and for the duration of study participation.
    • Should a woman become pregnant or suspect she is pregnant while participating on this study, she should inform her treating physician immediately. Because the risk of toxicity in nursing infants secondary to Epirubicin, Cisplatin, and 5-FU treatment of the mother is unknown but may be harmful, breastfeeding should be discontinued.

    3.6 Patients with any of the following cardiac conditions are ineligible:

    • Uncontrolled high blood pressure
    • Unstable angina
    • Symptomatic congestive heart failure
    • Myocardial infarction < 6 months prior to registration
    • Serious uncontrolled cardiac arrhythmia
    • New York Heart Association classification III or IV.

    3.7 No uncontrolled serious medical or psychiatric illness which would prevent compliance with treatment or adequate informed consent.

    3.8 Patients with active infectious process are ineligible.

    3.9 Patients with grade 2 or greater peripheral neuropathy at baseline are ineligible.

  4. Required Initial Laboratory Values:

    • Granulocytes ≥ 1,500/μl
    • Platelet count ≥ 100,000/μl
    • Creatinine ≤ 1.5 mg/dl
    • Bilirubin ≤ 2.0 mg/dl
    • AST ≤ 3x upper limits of normal


  • Kaiser Permanente - Deer Valley
    Antioch, California, 94531, USA
  • East Bay Radiation Oncology Center
    Castro Valley, California, 94546, USA
  • Eden Medical Center
    Castro Valley, California, 94546, USA
  • Valley Medical Oncology Consultants - Castro Valley
    Castro Valley, California, 94546, USA
  • Kaiser Permanente - Fremont
    Fremont, California, 94538, USA
  • Valley Medical Oncology
    Fremont, California, 94538, USA
  • Kaiser Permanente Medical Center - Hayward
    Hayward, California, 94545, USA
  • Contra Costa Regional Medical Center
    Martinez, California, 94553, USA
  • Memorial Medical Center
    Modesto, California, 95355, USA
  • Camino Medical Group - Treatment Center
    Mountain View, California, 94040, USA
  • El Camino Hospital Cancer Center
    Mountain View, California, 94040, USA
  • Highland General Hospital
    Oakland, California, 94602, USA
  • Alta Bates Summit Medical Center - Summit Campus
    Oakland, California, 94609, USA
  • Bay Area Breast Surgeons, Incorporated
    Oakland, California, 94609, USA
  • CCOP - Bay Area Tumor Institute
    Oakland, California, 94609, USA
  • Larry G Strieff MD Medical Corporation
    Oakland, California, 94609, USA
  • Tom K Lee, Incorporated
    Oakland, California, 94609, USA
  • Kaiser Permanente Medical Center - Oakland
    Oakland, California, 94611, USA
  • Valley Care Medical Center
    Pleasanton, California, 94588, USA
  • Valley Medical Oncology Consultants - Pleasanton
    Pleasanton, California, 94588, USA
  • Kaiser Permanente Medical Center - Redwood City
    Redwood City, California, 94063, USA
  • Kaiser Permanente Medical Center - Richmond
    Richmond, California, 94801, USA
  • Kaiser Permanente Medical Center - Roseville
    Roseville, California, 95661, USA
  • South Sacramento Kaiser-Permanente Medical Center
    Sacramento, California, 95823, USA
  • Kaiser Permanente Medical Center - Sacramento
    Sacramento, California, 95825, USA
  • Kaiser Permanente Medical Center - San Francisco Geary Campus
    San Francisco, California, 94115, USA
  • Kaiser Permanente Medical Center - Santa Teresa
    San Jose, California, 95119, USA
  • Doctors Medical Center - San Pablo Campus
    San Pablo, California, 94806, USA
  • Kaiser Foundation Hospital - San Rafael
    San Rafael, California, 94903, USA
  • Kaiser Permanente Medical Center - Santa Clara Kiely Campus
    Santa Clara, California, 95051, USA
  • Kaiser Permanente Medical Center - Santa Rosa
    Santa Rosa, California, 95403, USA
  • Kaiser Permanente Medical Center - South San Francisco
    South San Francisco, California, 94080, USA
  • Kaiser Permanente Medical Facility - Stockton
    Stockton, California, 95210, USA
  • Kaiser Permanente Medical Center - Vallejo
    Vallejo, California, 94589, USA
  • Kaiser Permanente Medical Center - Walnut Creek
    Walnut Creek, California, 94596, USA
  • Providence Saint Joseph Medical Center - Burbank
    Burbank, California, 91505, USA
  • City of Hope Comprehensive Cancer Center
    Duarte, California, 91010, USA
  • Glendale Memorial Hospital Comprehensive Cancer Center
    Glendale, California, 91204, USA
  • Rebecca and John Moores UCSD Cancer Center
    La Jolla, California, 92093, USA
  • Community Hospital of the Monterey Peninsula Comprehensive Cancer Center
    Monterey, California, 93940, USA


in progress, not accepting new patients
Start Date
Alliance for Clinical Trials in Oncology
Phase 3
Lead Scientist
Chia-Ching Wang
Study Type
Last Updated
June 2016