Paclitaxel With or Without Cixutumumab as Second-Line Therapy in Treating Patients With Metastatic Esophageal Cancer or Gastroesophageal Junction Cancer

PRIMARY OBJECTIVES:

I. To evaluate the progression-free survival of paclitaxel plus cixutumumab (IMC-A12) versus
paclitaxel alone as second-line therapy in patients with metastatic esophagus or
gastroesophageal (GE) junction cancer.

SECONDARY OBJECTIVES:

I. To evaluate the overall survival of paclitaxel plus cixutumumab (IMC-A12) versus
paclitaxel alone in this patient population.

II. To evaluate the response rate of paclitaxel plus cixutumumab (IMC-A12) versus paclitaxel
alone in this patient population.

III. To evaluate the toxicity of cixutumumab (IMC-A12) plus paclitaxel versus paclitaxel
alone in this patient population.

IV. Exploratory analyses will assess potentially relevant cixutumumab (IMC-A12)
pharmacodynamic biomarkers obtained from serum samples, including but not limited to,
insulin-like growth factor (IGF)-I, IGF-II, insulin-like growth factor binding protein
(IGFBP)-2, and IGFBP-3.

OUTLINE: Patients are equally randomized to 1 of 2 treatment arms.

ARM I: Patients receive paclitaxel intravenously (IV) over 1 hour at a dose of 80 mg/m^2 on
days 1, 8, and 15 of every 28 day cycle.

ARM II: Patients receive cixutumumab IV over 1 hour at a dose of 10 mg/kg on days 1 and 15 of
every 28 day cycle and paclitaxel as in Arm I.

In both arms, courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years.

Inclusion Criteria:

- Life expectancy >= 12 weeks

- Women must not be pregnant or breast-feeding due to potential harm to fetus from
cixutumumab (IMC-A12) and paclitaxel; all females of childbearing potential must have
a blood test or urine study within 48 hours prior to registration to rule out
pregnancy

- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method or birth control; abstinence) for the duration of study
therapy and for 3 months after the last dose of cixutumumab (IMC-A12); should a woman
become pregnant or suspect she is pregnant while participating in this study, she
should inform her treating physician immediately

- Patients must have measurable disease

- Patients must have metastatic disease of the esophagus or gastroesophageal junction

- Histologic, cytologic or radiologic documentation of metastatic squamous cell
carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction;
radiologic, endoscopic, histologic or cytologic evidence of locally recurrent or
locally residual (post-resection) disease is also permitted

- For the purposes of this study, undifferentiated adenocarcinomas and
adenosquamous tumors will be considered as adenocarcinomas; in addition, tumors
involving the gastroesophageal junction will be defined by the Siewert
classification

- Patients with gastroesophageal junction tumors who are eligible:

- Adenocarcinoma of the esophageal junction (AEG) Type I: adenocarcinoma of the
distal esophagus which usually arises from an area with specialized intestinal
metaplasia of the esophagus, i.e., Barrett's esophagus, and may infiltrate the
esophagogastric junction from above

- AEG Type II: true carcinoma of the cardia arising from the cardiac epithelium or
short segments with intestinal metaplasia at the esophagogastric junction

- Patients with gastroesophageal junction tumors who are NOT eligible:

- AEG Type III: subcardial gastric carcinoma which infiltrates the esophagogastric
junction and distal esophagus from below

- Patients must have received and progressed on one and only one line of prior systemic
therapy for esophagus or esophagogastric cancer; this could have included one regimen
for metastatic disease, or one regimen with radiotherapy for initially locally
advanced disease; prior radiation therapy is permitted

- If patients progress or recur within 6 months of neoadjuvant/adjuvant therapy,
this will be considered one line of therapy; for patients progressing or
recurring more than 6 months after neoadjuvant/adjuvant therapy, they will need
to receive one line of therapy for recurrent disease to be eligible

- If patients receive one regimen in which a chemotherapy agent is dropped for
toxicity without progression, this treatment will be considered one line of
therapy; however, substitution or addition of a new agent will be considered a
second line of therapy

- Eastern Cooperative Oncology Group (ECOG) performance status 0-2

- Leukocytes > 3,000/mcL

- Absolute neutrophil count >= 1,500/mcL

- Hemoglobin >= 9 g/dL

- Platelets >= 100,000/mcL

- Total bilirubin =< institutional upper limit of normal (ULN)

- Aspartate transaminase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine
transaminase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 X institutional
ULN

- Creatinine =< 1.5 X institutional ULN or creatinine clearance >= 60 mL/min/1.73m^2 for
patients with creatinine levels above institutional normal

- Patients must have fasting serum glucose =< 160 mg/dL (8.8 mmol/L) or =< ULN, and
hemoglobin A1C =< 7% (0.07 International System of Units [SI units]) within 14 days of
registration; if baseline nonfasting glucose =< 160 mg/dL (8.8 mmol/L), fasting
glucose measurement is not required

- Registration no fewer than 28 days from last chemotherapy

- A "currently active" second malignancy other than non-melanoma skin cancers are not to
be registered; patients are not considered to have a "currently active" malignancy if
they have completed therapy and are considered by their physician to be at less than
30% risk of relapse

Exclusion Criteria:

- Patients have received prior taxane or anti-insulin growth factor receptor (IGFR)
therapy

- Patients must not have any of the following conditions:

- Poorly controlled diabetes mellitus; patients with a history of diabetes mellitus
are allowed to participate, provided that their blood glucose is within normal
range (fasting glucose =< 160 mg/dL [8.8 mmol/L] or below the ULN and hemoglobin
A1C =< 7% [0.07 SI units]) and that they are on a stable dietary or therapeutic
regimen for this condition

- Recent major surgery, hormonal therapy (other than replacement) or chemotherapy,
within 4 weeks prior to entering the study or those who have not recovered from
adverse events

- History of allergic reactions attributed to compounds of similar chemical or
biologic composition to cixutumumab (IMC-A12)

- Psychiatric illness that would prevent the patient from giving informed consent

- Medical conditions such as active/uncontrolled infection (including HIV) or cardiac
disease that would make this protocol unreasonably hazardous for the patient in the
opinion of the treating physician; cardiac disease may include uncontrolled high blood
pressure, unstable angina, or serious uncontrolled cardiac arrhythmia