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Gastric cancer have poor prognosis and majority of patients resistant to 5-FU/DDP based first-line chemotherapy in China. There was no recommended second-line chemotherapy for advanced gastric cancer. Taxane is promising in gastric cancer. Nanoparticle Albumin-Bound Paclitaxel (Abraxane,ABI-007) has good convenience to use and been approved in breast cancer in many countries. The investigator then initiated a prospective phase Ib/IIa clinical trial with nab-paclitaxel plus TS-1 as the second-line treatment in advanced gastric cancer to observe the safety and efficacy.
This study is a two-stage design. Stage 1
The investigator should evaluate two recommend dose and tolerability of nab-paclitaxel plus S-1 after one course of treatment as 3+1 design:
nab-paclitaxel should be given intravenously on days 1 and 8 at a dose as follows, Treatment should be repeated every 3 weeks: Treatment arm A:125 mg /m2; Treatment arm B:100 mg /m2; Treatment arm C: 80 mg /m2; S-1 should be given orally twice a day as follows for 14 consecutive days, followed by a 1-week rest. Treatment should be repeated every 3 weeks. BSA < 1.5 m2,40mg,bid;BSA ≥ 1.5 m2,50mg,bid.
The investigator should determine whether to continue the original regimen; compare the safety and pharmacokinetic results with original profile of combination therapy to select the best therapy programs (RD, recommended dose).
Stage 2 According to two-stage design (Simon,1989), re-entry subjects to the recommended dose group to a total of 25 valid cases. If 11 patients achieve response, then enter the second phase of total 66 patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Nanoparticle Albumin-Bound Paclitaxel | Experimental | The study evaluate 3 dose level of nab-paclitaxel:100 mg /m2;125 mg /m2;80 mg /m2; |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nanoparticle Albumin-Bound Paclitaxel | Drug | this study evaluate 3 dose level of nab-paclitaxel:100 mg /m2;125 mg /m2;80 mg /m2; |
|
| Measure | Description | Time Frame |
|---|---|---|
| adverse events | participants will be followed for the duration of hospital stay, an expected average of 3 weeks | during the treatment in the hosptital,an expected average of 3 weeks |
| Objective response rate | CT/MRI will be performed every 2 cycles of treatment for efficacy evaluation | 6 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| progression free survival | the follow-up visit of PFS will be performed every 6 weeks | 1 year |
| overall survival of participants | OS means that from the first dose of treatment drug to death or lost, the follow-up visit will be performed every 3 months till death or lost |
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Inclusion Criteria:
Signed informed consent form
Age 18-75 years;
Histologically or cytologically confirmed gastric cancer;
Advanced or recurrent, metastatic disease;
Performance Status- Eastern Cooperative Oncology Group (ECOG) 0-1;
Life expectancy of at least 12 weeks;
At least have one measurable disease(according to RECIST, Response Evaluation Criteria in Solid Tumors )
Subjects who have received one prior regimen for gastric carcinoma and developed disease progression or recurrence within 6 months after the end of systemic adjuvant treatment. The regimen must have contained fluorouracil(e.g. 5-FU,capecitabine) and/or cisplatin;
Haematopoietic status:
Hepatic status:
Renal status:
- Creatinine ≤1.5 times ULN or calculated creatinine clearance, using the Cockcroft-Gault formula, ≥40 mL/min;
Able to swallow and retain oral medication;without malabsorption syndrome, or disease significantly affecting gastrointestinal function, such as ulcerative colitis and Crohn's disease;
Cardiovascular: Baseline LVEF 50% measured by echocardiography (ECHO) ;
Negative serum pregnancy test (For women of childbearing potential);Fertile patients must use effective contraception.
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lin Shen | Beijing | Beijing Municipality | 100142 | China |
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| ID | Term |
|---|---|
| D013660 | Taxes |
| ID | Term |
|---|---|
| D004467 | Economics |
| D004472 | Health Care Economics and Organizations |
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| 2 years |
| biomarkers | If the tumour samples available, to identify the molecular characteristics(such as SPARK,ABCG2,β-Tubulin III,PDGFRA,etc) of responding tumours by immunohistochemical, FISH, genomic and proteomic analysis; To study biomarkers expression before and during therapy and establish correlations with clinical outcome and toxicity; | 6 weeks |