This phase II trial is studying how well giving irinotecan together with cisplatin works in
treating patients who are undergoing surgical resection for locally advanced cancer of the
stomach or gastroesophageal junction. Drugs used in chemotherapy, such as irinotecan and
cisplatin, work in different ways to stop tumor cells from dividing so they stop growing or
die. Combining more than one chemotherapy drug and giving them before surgery may shrink the
tumor so that it can be removed during surgery.
I. To evaluate the correlation of FDG-PET/CT imaging early in the preoperative treatment
program of locally advanced gastric cancer with histologic response assessment and patient
outcome, defined as overall and progression-free survival.
I. To evaluate the efficacy and safety of preoperative chemotherapy with irinotecan and
cisplatin in the treatment of locally advanced gastric cancer.
II. To examine the biology of locally advanced gastric cancer and the response to
chemotherapy by DNA microarray technology and by histopathology.
III. To obtain preliminary data on biodistribution, dosimetry and explore the potential
clinical usefulness of FLT PET in patients with locally advanced gastric cancer undergoing a
novel combination neoadjuvant chemotherapy.
OUTLINE: This is an open-label, nonrandomized, multicenter study.
Neoadjuvant chemotherapy: Patients receive cisplatin IV over 30 minutes followed by
irinotecan IV over 30 minutes on days 1, 8, 22, and 29. Treatment repeats every 6 weeks for
2 courses in the absence of disease progression or unacceptable toxicity.
Surgery: Within 4 weeks after completion of neoadjuvant chemotherapy, patients undergo
radical subtotal or total gastrectomy with lymph node dissection.
Patients undergo fluorodeoxyglucose FDG-PET/CT at baseline. Some patients undergo additional
FDG-PET/CT scans in weeks 3 and 6. Approximately 5 patients undergo fluorothymidine
FLT-PET/CT at baseline, during week 3, and/or before surgical resection.
Patients are followed every 3 months for 2 years, every 6 months for 2 years, and then
- Histologically confirmed adenocarcinoma of the stomach or gastroesophageal (GE)
- Tumors involving the GE junction must have the bulk of disease in the stomach
- Siewert's type II and III tumors involving the GE junction are eligible
- Tumors of the distal esophagus that extend less than 2 cm into the stomach are
- Locally advanced disease that is potentially curable by surgery
- Any T, N+, M0 or T3-T4, any N, M0 by staging CT scan and laparoscopy or
- No T1-T2, N0, M0 tumors
- No metastatic disease
- Any suspected sites of M1 disease must be proven to be M0
- Performance status - Karnofsky 60-100%
- Performance status - ECOG 0-2
- Absolute neutrophil count at least 1,500/mm^3
- Platelet count at least 100,000/mm^3
- Bilirubin no greater than 1.5 mg/dL
- Creatinine no greater than 1.5 mg/dL
- No history of active angina
- No New York Heart Association class III or IV heart disease
- No myocardial infarction within the past 6 months
- No history of significant ventricular arrhythmia requiring antiarrhythmic medication
- No history of clinically significant conduction system abnormality
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No concurrent serious infection
- No other uncontrolled medical illness that would preclude study participation
- No psychiatric illness that would preclude study compliance
- No clinically significant auditory impairment
- No pre-existing peripheral neuropathy grade 2 or greater
- No other active malignancy within the past 5 years except nonmelanoma skin cancer,
nonmetastatic prostate cancer, or carcinoma in situ of the cervix
- Able to tolerate the proposed study surgical procedure and chemotherapy regimen
- No prior biologic therapy for this disease
- No prior chemotherapy for this disease
- No other concurrent chemotherapy
- No prior radiotherapy for this disease
- See Disease Characteristics
- No concurrent vitamins, antioxidants, or herbal preparations or supplements
- A single daily multivitamin tablet is allowed