RATIONALE: Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cetuximab may also stop the growth of esophageal cancer by blocking blood flow to the tumor and by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cisplatin and irinotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving cetuximab together with combination chemotherapy and radiation therapy may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving cetuximab together with combination chemotherapy and radiation therapy works in treating patients with locally advanced esophageal cancer that cannot be removed by surgery.

Condition	Treatment or Intervention	Phase
Adenocarcinoma of the Esophagus squamous cell carcinoma of the esophagus stage III esophageal cancer	Drug: cetuximab  Drug: cisplatin  Drug: irinotecan  Procedure: anti-cytokine therapy  Procedure: antiangiogenesis therapy  Procedure: antibody therapy  Procedure: biological response modifier therapy  Procedure: chemosensitization/potentiation  Procedure: chemotherapy  Procedure: enzyme inhibitor therapy  Procedure: growth factor antagonist therapy  Procedure: monoclonal antibody therapy  Procedure: protein tyrosine kinase inhibitor therapy  Procedure: radiation therapy  Procedure: radiosensitization	Phase II

Further Study Details: 

OBJECTIVES: Primary

• Determine the 2-year overall survival of patients with previously untreated, clinically unresectable, locally advanced squamous cell carcinoma or adenocarcinoma of the esophagus treated with cetuximab, cisplatin, irinotecan, and thoracic radiotherapy.

Secondary

• Determine the toxicity profile of this regimen in these patients.
• Determine the probability of objective response (confirmed and unconfirmed, complete and partial) in patients with measurable disease treated with this regimen.
• Determine the time to progression in patients with measurable disease treated with this regimen.
• Correlate, preliminarily, gene expression (RNA) levels and germline polymorphisms of genes involved in DNA repair (e.g., ECRCC-1 and XRCC-1), drug metabolism (e.g., UGT1A1), and the epidermal growth factor receptor (EGFR) pathway (e.g., EGFR, interleukin-8, and vascular endothelial growth factor) with response, time to progression, overall survival, and toxicity in patients treated with this regimen.

OUTLINE: This is a multicenter study.

Patients receive cetuximab IV over 1-2 hours on days 1, 8, and 15. Patients also receive cisplatin IV and irinotecan IV over 30 minutes on days 1 and 8. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Beginning on day 1 of course 3, patients undergo thoracic radiotherapy once daily 5 days a week for 5-6 weeks (total of 28 treatments).

After completion of study treatment, patients are followed at 4 weeks and then every 3-6 months for up to 5 years after study entry.

PROJECTED ACCRUAL: A total of 75-100 patients (75 with adenocarcinoma and 25 with squamous cell carcinoma) will be accrued for this study.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed primary squamous cell carcinoma or adenocarcinoma of the thoracic esophagus (≥ 20 cm from the incisors*) or the gastroesophageal junction (confined to ≤ 2 cm into the gastric cardia)
• Disease confined to the esophagus or peri-esophageal soft tissue
• T4, M0 disease
• Surgically unresectable disease by esophageal endoscopic ultrasonography OR medically unresectable disease NOTE: *Patients with primary disease < 26 cm from the incisors must undergo bronchoscopy AND have negative cytology within the past 4 weeks
• Measurable or non-measurable disease by x-ray, CT scan and/or MRI, or physical examination within the past 4 weeks (for measurable disease) or within the past 6 weeks (for non-measurable disease)
• Tumor specimens available
• No recurrent disease

PATIENT CHARACTERISTICS: Age

• 18 and over

Performance status

• Zubrod 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count ≥ 1,500/mm^3
• WBC ≥ 3,000/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 10.0 g/dL

Hepatic

• Albumin normal
• Bilirubin normal
• Alkaline phosphatase normal
• SGOT or SGPT ≤ 2.5 times upper limit of normal

Renal

• Creatinine clearance > 50 mL/min

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception
• No prior severe reaction to monoclonal antibodies
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY: Biologic therapy

• Not specified

Chemotherapy

• No prior chemotherapy for esophageal cancer

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy for esophageal cancer
• No concurrent intensity modulated radiotherapy
• No concurrent cobalt-60

Surgery

• No prior surgical resection or attempted surgical resection of esophageal cancer

Please refer to this study by ClinicalTrials.gov identifier  NCT00109850

Study chairs or principal investigators

Charles R. Thomas, MD,  Study Chair,  University of Texas   
Charles D. Blanke, MD,  Oregon Health and Science University   
James L. Abbruzzese, MD,  M.D. Anderson Cancer Center   
Lisa Hammond, MD,  University of Texas   
Vivek Mehta, MD,  Swedish Cancer Institute at Swedish Medical Center - First Hill Campus   

Study ID Numbers:  CDR0000426442; SWOG-S0414; NCT00109850
Record last reviewed:  May 2005
Last Updated:  May 11, 2005
Record first received:  May 3, 2005
ClinicalTrials.gov Identifier:  NCT00109850
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-05-17