UPCC 06225 Phase II Study of Neoadjuvant RP2 in Combination With Preoperative Flot for Patients With Stage II or Higher, Non-metastatic Gastroesophageal Adenocarcinoma

Investigating the Safety and Effectiveness of RP2, an Investigational Treatment, with Chemotherapy for Gastroesophageal Adenocarcinoma

Enrolling By Invitation
18 years or above
All
Phase 2
34 participants needed
1 Location

Brief description of study

The research study is being conducted to study whether performing injections of a new treatment, called RP2, directly into stomach and esophagus tumors along with standard chemotherapy (called FLOT) is safe and whether it does a better job of killing cancer before surgery compared to chemotherapy alone.

Detailed description of study

This is a single-arm, phase II study using a Simon two-stage optimal design with a 6 patient safety run-in evaluating the addition of intra-tumoral injections of RP2 to standard of care perioperative FLOT for patients with stage II or higher, non-metastatic esophageal, gastroesophageal junction (GEJ), or gastric adenocarcinoma. We hypothesize that the addition of RP2 to perioperative FLOT will be safe and will significantly improve pathologic complete response (pCR) rate compared to the historical weighted average of 12% observed with perioperative FLOT in the ESOPEC trial, MATTERHORN trial, and FLOT4 trial.

Eligibility of study

You may be eligible for this study if you meet the following criteria:

  • Conditions: Gastric Adenocarcinoma, Esophageal Adenocarcinoma, Gastroesophageal Junction Adenocarcinoma
  • Age: 18 years or above
  • Gender: All

Inclusion Criteria:

  • Patients must have histologically confirmed and clinically staged T2 or higher or node positive, non-metastatic esophageal, gastroesophageal junction, or gastric adenocarcinoma.
  • Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 1.
  • Patents must be deemed a surgical candidate by a thoracic surgeon, surgical oncologist, or surgeon who is qualified to perform the appropriate surgical procedure based on patient's primary tumor site.
  • Patients must have normal organ and bone marrow function, as defined below, less than or equal to 14 days prior to the initiation of study therapy:
    • Absolute neutrophil count (ANC) ≥ 1,500/microliter
    • Platelets ≥100,000/microliter
    • Total bilirubin ≤ the institutional upper limit of normal (ULN).
    • AST and ALT ≤ 2.5 times the institutional ULN
    • Serum creatinine ≤ 1.5 times the institutional ULN
    • Hemoglobin ≥ 9 g/dL

Exclusion Criteria

  • Has received prior chemotherapy, radiation therapy, or immunotherapy (anti-programmed cell death protein-1 (PD-1), anti-programmed death ligand-1 (PD-L1), or anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) for the current malignancy.
  • Per the investigator, has contraindications to receiving chemotherapy with FLOT.
  • Per the sub-investigator (gastroenterologist) responsible for intra-tumoral injections or the investigator, patient has contraindications to repeated upper endoscopy for intra-tumoral injections. These could include medical conditions that would, per the judgment of the sub-investigator or investigator, inappropriately increase the risk of upper endoscopy.
  • Conditions in which anticoagulant therapies cannot be safely stopped in the periprocedural period or patients on warfarin with a target international normalized ratio (INR) ≥ 2.5 that cannot be temporarily reversed to INR ≤ 1.7.
  • Active significant herpetic infections or prior complications of Herpes simplex virus-1 (HSV-1) infection (e.g., herpetic keratitis or encephalitis) or requires intermittent or chronic use of systemic (oral or intravenous [IV]) antivirals with known antiherpetic activity (e.g., acyclovir). Note: Patients with sporadic cold sores may be enrolled as long as no active cold sores are present at the time of first dose of study treatment.
  • Has received a live vaccine within 30 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacille Calmette-Guérin (BCG), and typhoid vaccine. Note: Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed, however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed. Available COVID-19 vaccines do not contain live virus and are allowed.
  • Has a condition requiring systemic treatment with corticosteroids (>10mg/day prednisone equivalents) or other immunosuppressive medications within 14 days of first study treatment administration.
    • Inhaled or topical steroids and adrenal replacement doses ≤ 10mg/day of prednisone equivalents are permitted.
  • Prior organ transplantation including allogeneic stem-cell transplantation.
  • Has a previous or concurrent malignancy. Exceptions include:
    • Non-melanoma skin cancer, in situ cervical cancer, superficial bladder cancer, or breast cancer in situ OR
    • Prior malignancy has been completely excised or removed and patient has been continuously disease free for > 5-years
  • Has a positive test result for hepatitis B virus surface antigen (HBsAg) or

    hepatitis C virus ribonucleic acid (HCV RNA) indicating acute or chronic infection with hepatitis B or hepatitis C. Testing will be performed as part of screening on the study.

    • Patients with a known history of hepatitis B or hepatitis C that have been effectively treated (with negative HBsAg and HCV RNA) will be eligible for enrollment on this criterion.
  • Has a known history of human immunodeficiency virus (HIV) with detectable viral

    load. HIV testing will not be performed as part of screening for the study.

    • Patients with known HIV infection with an undetectable viral load and who are on a stable highly active antiviral regimen per the investigator's assessment will eligible to enroll.
  • Has a psychiatric illness, substance use, or other social conditions that, in the

    judgment of the investigator, would limit compliance with study requirements.

This study investigates the safety and effectiveness of adding RP2, an investigational treatment, to the standard chemotherapy regimen, FLOT, for patients with stage II or higher, non-metastatic gastroesophageal adenocarcinoma. The purpose of this study is to determine if injecting RP2 directly into the tumors of the stomach and esophagus, combined with chemotherapy, is more effective in killing cancer cells before surgery than chemotherapy alone.

Participants will receive intra-tumoral injections of RP2 alongside standard chemotherapy treatment. The study involves a two-stage design with an initial safety run-in to ensure the combination of treatments is safe for patients. The investigational medication is administered in addition to the typical preoperative care provided to patients undergoing surgery for gastroesophageal adenocarcinoma.

  • Who can participate: Adults with stage II or higher, non-metastatic esophageal, gastroesophageal junction, or gastric adenocarcinoma can participate if they are surgical candidates with an ECOG performance status of 0-1, normal organ function, and no prior chemotherapy, radiation, or immunotherapy for their current cancer.
  • Study details: Participants will receive injections of the investigational treatment RP2 directly into their tumors, along with standard chemotherapy. This study aims to assess whether this combination is safe and more effective than chemotherapy alone.
Updated on 05 Jun 2026. Study ID: 25-0895
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