Chemoradiotherapy for Esophageal Cancer

(PaRCUS Trial)

Overseen by Marc Kerba, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: AHS Cancer Control Alberta

Disqualifiers: Previous chest radiotherapy, Active malignancies, Pregnancy, others

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial tests if adding certain chemotherapy drugs to radiation therapy can better relieve swallowing difficulties and improve quality of life for patients with advanced esophageal cancer who can't undergo surgery. These drugs are commonly used in treatment for esophageal cancer and have shown promising results in various studies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Carboplatin and Taxol (paclitaxel) with External Beam Radiation for esophageal cancer?

Research shows that using Carboplatin and Paclitaxel with radiation therapy can lead to high response rates in esophageal cancer, with some studies reporting a complete response in a significant number of patients. This combination has been shown to improve survival rates and is generally well tolerated, making it a promising treatment option. ^{1 2 3 4 5}

Is chemoradiotherapy with carboplatin and paclitaxel safe for esophageal cancer?

Chemoradiotherapy using carboplatin and paclitaxel is generally well tolerated in patients with esophageal cancer, with no episodes of severe infection-related fever reported in one study. This combination is considered an interesting and manageable treatment option for advanced cases. ^{1 3 4 6 7}

How is the chemoradiotherapy treatment for esophageal cancer with Carboplatin and Taxol different from other treatments?

This treatment combines Carboplatin and Taxol (paclitaxel) with external beam radiation, offering an alternative to the standard cisplatin-based chemoradiotherapy, which is known for significant toxicity. The combination aims to reduce side effects while maintaining effectiveness, making it a potentially safer option for patients with esophageal cancer. ^{1 2 4 6 7}

Research Team

Marc Kerba, MD

Principal Investigator

403 521 3164

Eligibility Criteria

This trial is for adults with advanced esophageal cancer who can eat some solids, have a decent performance status, and proper organ function. They must start treatment within two weeks of consent, not be pregnant or breastfeeding, use effective contraception, and cannot have had previous chest radiation or chemotherapy for esophageal cancer.

Inclusion Criteria

I can take care of myself but might not be able to do heavy physical work.

My esophageal cancer has been confirmed by a biopsy.

My condition cannot be cured due to its advanced stage or other health issues.

Exclusion Criteria

I have had radiation therapy to my chest before.

I have more than one type of cancer at the same time.

I cannot undergo certain treatments due to my health condition.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Carboplatin and paclitaxel chemotherapy on Days 1 and 8 concurrent with external beam radiation therapy of 30Gy/10 fractions over two weeks

2 weeks

2 visits (in-person)

Follow-up

Participants are monitored for safety, effectiveness, and quality of life improvements after treatment

6 months

Visits at 3 and 6 months

Treatment Details

Interventions

• Carboplatin and Taxol (paclitaxel) (Alkylating agents, Anti-tumor antibiotic)
• External Beam Radiation (Radiation)

Trial Overview The study tests if adding carboplatin and paclitaxel (chemotherapy drugs) to external beam radiation improves swallowing difficulties and life quality in patients with inoperable esophageal cancer compared to radiation alone.

Participant Groups

Group I: Chemotherapy with Concurrent Radiation Experimental Treatment 2 Interventions

Carboplatin and paclitaxel will be administered intravenously on Days 1 and 8 while radiation therapy is administered

Who Is Running the Clinical Trial?

AHS Cancer Control Alberta

Lead Sponsor

Trials

188

Recruited

26,900+

Dr. Peter Jamieson

AHS Cancer Control Alberta

Chief Medical Officer since 2024

MD from the University of Alberta

Andre Tremblay

AHS Cancer Control Alberta

Chief Executive Officer

BA in Political Science from the University of Victoria, MA in Political Science from the University of British Columbia

Findings from Research

In a Phase I study involving 12 patients with advanced esophageal cancer, the combination of UFT/leucovorin, carboplatin, and paclitaxel with radiation therapy showed preliminary efficacy, with 2 out of 3 patients achieving a pathologic complete response after treatment at the higher dose level.

The study identified maximum tolerated doses for the regimen, but also noted significant toxicity, including febrile neutropenia in multiple patients, indicating that while the treatment may be effective, it carries a risk of serious side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase I study of UFT/leucovorin, carboplatin, and paclitaxel in combination with external beam radiation therapy for advanced esophageal carcinoma. Czito, BG., Cohen, DP., Kelsey, CR., et al.[2015]

In a study of 38 patients with upper aerodigestive tract cancers, a novel chemotherapy regimen combining paclitaxel, carboplatin, and continuous infusion 5-fluorouracil showed a high overall response rate, with 25 out of 29 evaluable patients achieving major responses.

The regimen was particularly effective for localized esophageal cancer, with 69% of patients undergoing resection achieving a pathologic complete response, indicating strong efficacy when used alongside radiation therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paclitaxel, carboplatin, and long-term continuous 5-fluorouracil infusion in the treatment of upper aerodigestive malignancies: preliminary results of phase II trial. Hainsworth, JD., Meluch, AA., Greco, FA.[2015]

In a study of 201 patients with locally advanced esophageal squamous cell carcinoma, the chemotherapy regimen of carboplatin plus paclitaxel (TP) resulted in significantly higher rates of severe adverse events compared to carboplatin plus cisplatin (TC), particularly with a higher incidence of grade 3 or higher febrile neutropenia.

Despite the differences in safety, both TP and TC regimens showed comparable overall survival and progression-free survival rates, suggesting that TC is the preferred option due to its better safety profile without compromising efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of paclitaxel plus carboplatin versus paclitaxel plus cisplatin in neoadjuvant chemoradiotherapy for patients with locally advanced esophageal carcinoma: a retrospective study. Jiang, L., Zhu, J., Chen, X., et al.[2023]

In a phase II study involving 17 patients with advanced esophageal or gastric cancer, carboplatin and paclitaxel demonstrated promising efficacy, with partial responses observed in 3 out of 5 patients with esophageal cancer and 3 patients with gastric cancer.

The treatment regimen was well tolerated, with no cases of neutropenic fever reported, suggesting that outpatient administration of carboplatin and paclitaxel is a safe option for patients with advanced cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase II study of carboplatin and paclitaxel in the treatment of patients with advanced esophageal and gastric cancer. Philip, PA., Zalupski, MM., Gadgeel, S., et al.[2015]

In a study of 15 patients with locally advanced esophageal squamous cell carcinoma (SCC), the neoadjuvant chemoradiation regimen using weekly paclitaxel and carboplatin resulted in a clinical complete response rate of 66% and an overall complete response rate of 80%.

The treatment was generally well tolerated, with manageable toxicities, and led to a median overall survival of 14 months, suggesting it could be a new standard of care for this type of cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chemoradiation with Weekly Paclitaxel and Carboplatin in Esophageal Squamous Cell Carcinoma: A Prospective Study. Joseph, DM., Malik, MI., Jonnadula, J., et al.[2021]

A phase II clinical trial involving 50 patients with esophageal cancer showed that a treatment regimen of paclitaxel, carboplatin, and radiation, with or without surgery, is well tolerated and has promising efficacy, with 26% of patients achieving a complete response.

The median survival rates were encouraging, with 12 months for metastatic disease and over 44 months for localized disease treated with either surgery or definitive chemoradiotherapy, indicating that this alternative treatment may be effective for various stages of esophageal cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase II study of paclitaxel, carboplatin, and radiation with or without surgery for esophageal cancer. Wang, H., Ryu, J., Gandara, D., et al.[2015]

In a randomized clinical trial involving 321 patients with esophageal squamous cell carcinoma (ESCC), the overall survival rates after 3 years were similar across three treatment regimens: paclitaxel with fluorouracil (57.2%), cisplatin (60.1%), and carboplatin (56.5%), indicating no significant superiority of one regimen over the others.

The cisplatin regimen was associated with significantly higher rates of severe side effects, including neutropenia (60.8%), thrombocytopenia (13.1%), and gastrointestinal issues, compared to the fluorouracil and carboplatin groups, suggesting that while all regimens are effective, cisplatin may pose greater risks for adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of 3 Paclitaxel-Based Chemoradiotherapy Regimens for Patients With Locally Advanced Esophageal Squamous Cell Cancer: A Randomized Clinical Trial. Ai, D., Ye, J., Wei, S., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

A phase I study of UFT/leucovorin, carboplatin, and paclitaxel in combination with external beam radiation therapy for advanced esophageal carcinoma. [2015]

2. United States pubmed.ncbi.nlm.nih.gov

Paclitaxel, carboplatin, and long-term continuous 5-fluorouracil infusion in the treatment of upper aerodigestive malignancies: preliminary results of phase II trial. [2015]

3. England pubmed.ncbi.nlm.nih.gov

Safety and efficacy of paclitaxel plus carboplatin versus paclitaxel plus cisplatin in neoadjuvant chemoradiotherapy for patients with locally advanced esophageal carcinoma: a retrospective study. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

A phase II study of carboplatin and paclitaxel in the treatment of patients with advanced esophageal and gastric cancer. [2015]

5. India pubmed.ncbi.nlm.nih.gov

Chemoradiation with Weekly Paclitaxel and Carboplatin in Esophageal Squamous Cell Carcinoma: A Prospective Study. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

A phase II study of paclitaxel, carboplatin, and radiation with or without surgery for esophageal cancer. [2015]

7. United States pubmed.ncbi.nlm.nih.gov

Comparison of 3 Paclitaxel-Based Chemoradiotherapy Regimens for Patients With Locally Advanced Esophageal Squamous Cell Cancer: A Randomized Clinical Trial. [2022]