RATIONALE: Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop tumor cells from dividing so they stop growing or die. Celecoxib may increase the effectiveness of a chemotherapy drug by making tumor cells more sensitive to the drug. Celecoxib may also stop the growth of tumor cells by stopping blood flow to the tumor and/or may block the enzymes necessary for their growth. Combining celecoxib with paclitaxel and carboplatin before surgery may shrink the tumor so that it can be removed during surgery. Giving celecoxib alone after surgery may kill any remaining tumor cells.

PURPOSE: This phase II trial is studying the effectiveness of combining celecoxib with paclitaxel and carboplatin in treating patients who are undergoing surgery for esophageal cancer.

Condition	Treatment or Intervention	Phase
Adenocarcinoma of the Esophagus squamous cell carcinoma of the esophagus stage I esophageal cancer stage II esophageal cancer stage III esophageal cancer	Drug: carboplatin  Drug: celecoxib  Drug: paclitaxel  Procedure: adjuvant therapy  Procedure: anti-cytokine therapy  Procedure: antiangiogenesis therapy  Procedure: biological response modifier therapy  Procedure: chemosensitization/potentiation  Procedure: chemotherapy  Procedure: conventional surgery  Procedure: enzyme inhibitor therapy  Procedure: growth factor antagonist therapy  Procedure: neoadjuvant therapy  Procedure: surgery	Phase II

Further Study Details: 

OBJECTIVES: Primary

• Determine the rate of complete pathological response and/or minimal residual microscopic disease in patients with squamous cell or adenocarcinoma of the esophagus treated with preoperative celecoxib, paclitaxel, and carboplatin.

Secondary

• Determine the clinical response rate of patients treated with this regimen.
• Determine the chemotherapy-related toxicity of this regimen in these patients.
• Determine the time to progression, disease-free survival, and overall survival of patients treated with this regimen.

OUTLINE: Patients receive paclitaxel IV over 3 hours and carboplatin IV over 1 hour on days 1 and 22. Patients also receive oral celecoxib twice daily beginning 3-7 days before the first dose of chemotherapy and continuing until the morning of planned surgical resection (between day 43 and 50). Approximately 28-56 days after resection, patients resume oral celecoxib twice daily and continue for 3 years in the absence of disease progression or unacceptable toxicity.

Patients are followed periodically.

PROJECTED ACCRUAL: A total of 27-39 patients will be accrued for this study within 18 months.

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

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed esophageal cancer of 1 of the following cellular types:
• Squamous cell
• Adenocarcinoma
• Potentially resectable disease
• No distant metastases

PATIENT CHARACTERISTICS: Age

• 18 and over

Performance status

• Karnofsky 80-100%

Life expectancy

• Not specified

Hematopoietic

• WBC at least 3,000/mm^3
• Platelet count at least 100,000/mm^3
• No bleeding disorder

Hepatic

• Bilirubin normal
• AST and ALT less than 2.5 times upper limit of normal (ULN)
• Alkaline phosphatase no greater than 2.5 times ULN

Renal

• Creatinine no greater than 2.0 mg/dL

Cardiovascular

• No significant history of unstable cardiovascular disease
• No inadequately controlled hypertension
• No angina
• No myocardial infarction within the past 6 months
• No ventricular cardiac arrhythmias requiring medication
• No congestive heart failure that would preclude study therapy

Pulmonary

• Pulmonary function acceptable for surgery
• No interstitial pneumonia
• No interstitial fibrosis

Gastrointestinal

• No history of peptic ulcer disease
• No irritable bowel syndrome
• No inflammatory bowel disease
• No chronic diarrhea
• No bowel obstruction within the past 5 years

Other

• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• No known hypersensitivity or allergic reactions to COX-2 inhibitors, sulfonamides, NSAIDs, or salicylates
• No hypersensitivity to paclitaxel or carboplatin
• No other serious underlying medical condition that would preclude study therapy
• No significant psychiatric illness that would preclude study compliance
• No uncontrolled diabetes mellitus
• No uncontrolled infection
• HIV negative

PRIOR CONCURRENT THERAPY: Biologic therapy

• Not specified

Chemotherapy

• Not specified

Endocrine therapy

• No concurrent chronic steroid use except inhaled mometasone or fluticasone

Radiotherapy

• Not specified

Surgery

• Not specified

Other

• More than 3 weeks since other prior clinical trial therapy
• At least 72 hours since prior nonsteroidal anti-inflammatory drugs (NSAIDs)
• No concurrent chronic NSAID use (7 or more days of continuous therapy per month OR 3 or more days of therapy per week)
• No other concurrent investigational agents
• No concurrent enzyme-inducing anticonvulsants (e.g., phenytoin or phenobarbital)
• No other concurrent cyclo-oxygenase (COX)-2 inhibitors
• No concurrent lithium or fluconazole
• Concurrent low-dose aspirin (325 mg/day or less) allowed for cardiovascular prophylaxis

New York
      New York Weill Cornell Cancer Center at Cornell University, New York,  New York,  10021,  United States; Recruiting

Study chairs or principal investigators

Nasser K. Altorki, MD,  Study Chair,  Cornell University Medical College   

Study ID Numbers:  CDR0000316464; NYWCCC-0902-463; NCT00066716
Record last reviewed:  December 2004
Last Updated:  January 7, 2005
Record first received:  August 6, 2003
ClinicalTrials.gov Identifier:  NCT00066716
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08