Liposomal iRInotecan, Carboplatin or oXaliplatin for Esophagogastric Cancer

The sample size to identify the best combination therapy is based on the following decision making strategy. With less or even zero neurotoxicity grade 2‐4 (defined as worst toxicity), the Nal‐IRI plus 5FU/LV (Fluorouracil/leucovorin)combination is expected to outperform the standard combination capecitabine plus oxaliplatin and may also outperform capecitabine plus carboplatin. To compensate for a higher neurotoxicity grade 2‐4 level, the capecitabine combinations should demonstrate increased progression free survival (PFS) according to the next schedule. Table 1. Decision making strategy Difference in % neurotoxicity grade 2‐4 Compensating Increase in PFS >10 ‐ 30% + 3 months >30 ‐ 50% + 4 months The total number to be included will be 269. Patients will be randomized to respectively the Nal‐IRI plus 5FU, the capecitabine plus carboplatin and capecitabine plus oxaliplatin group following a 2:2:1 scheme until 49 patients have been included in the capecitabine plus oxaliplatin group and following a 1:1:0 scheme 10 afterwards for the remaining patients. Taking into account 15% withdrawal of patients from the trial before start of study medication, the investigators will include 310 patients.