NBTXR3, Chemotherapy, and Radiation Therapy for the Treatment of Esophageal Cancer

PRIMARY OBJECTIVE: I. To determine the recommended phase II dose (RP2D) of hafnium oxide-containing nanoparticles NBTXR3 (NBTXR3) activated by radiotherapy with concurrent chemotherapy, per standard of care, for treatment naive patients with adenocarcinoma of the esophagus. SECONDARY OBJECTIVES: I. To evaluate the safety and feasibility of radiation with NBTXR3 in patients with adenocarcinoma of the esophagus. II. To evaluate the anti-tumor response of chemoradiation with NBTXR3 in patients with adenocarcinoma of the esophagus. III. To evaluate time-to-event outcomes after chemoradiation with NBTXR3 in patients with adenocarcinoma of the esophagus. EXPLORATORY OBJECTIVES: I. To evaluate the body kinetic profile of intratumorally/intranodally injected NBTXR3. II. To evaluate time to event outcomes for patients with clinical staging of locally advanced, unresectable disease. III. To evaluate surgical outcomes in patients who undergo surgery after study treatment. IV. To evaluate radiomic measurements with outcomes. V. To assess immune-related biomarkers of response. OUTLINE: This is a dose-escalation study of NBTXR3. Patients receive NBTXR3 intratumorally (IT) or intranodally (IN) on day 1. Beginning day 15, patients undergo intensity-modulated radiation therapy (IMRT) 5 days per week for 6 weeks for a total of 28 fractions in the absence of disease progression or unacceptable toxicity. Beginning on day 15, concurrent with IMRT, patients receive a chemotherapy regimen consisting of either fluorouracil and oxaliplatin with or without leucovorin, oxaliplatin and capecitabine, docetaxel and fluorouracil with or without leucovorin, docetaxel and paclitaxel, or carboplatin and paclitaxel per physician discretion. After completion of study treatment, patients are followed up every 3 months for 1 year.