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NCT Number: NCT07152678

Brachytherapy With Radiotherapy and Immunotherapy: Guided HDR Trial in Esophageal Squamous Cell Carcinoma

The goal of this clinical trial is to learn if adding high-dose-rate (HDR) brachytherapy can improve outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who have already received external beam radiotherapy (EBRT), chemotherapy, and the immune therapy drug nivolumab.

The main questions it aims to answer are:

* Does HDR brachytherapy reduce the chance of the cancer coming back in the esophagus or nearby areas within 12 months? * What side effects or safety issues occur when HDR brachytherapy is given after EBRT, chemotherapy, and nivolumab?

Participants will:

* Receive 1-2 sessions of HDR brachytherapy delivered through a thin tube placed inside the esophagus, within three weeks after starting nivolumab. * Continue nivolumab and be monitored with regular follow-up visits, imaging tests, and blood samples to check treatment response and safety.

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Key information

Conditions

Esophageal Cancer Carcinoma Carcinoma, Squamous Cell Digestive System Diseases Digestive System Neoplasms Esophageal Diseases Esophageal Neoplasms Esophageal Squamous Cell Carcinoma Gastrointestinal Diseases Gastrointestinal Neoplasms Head and Neck Neoplasms Neoplasms Neoplasms by Histologic Type Neoplasms by Site Neoplasms, Glandular and Epithelial Neoplasms, Squamous Cell

Age range

18 year–85 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Primary location

National Taiwan University Hospital Yunlin Branch

Huwei, Yunlin County, 632, Taiwan

Location status: Recruiting

About this study

This is a single-arm, phase II clinical trial designed to evaluate the efficacy and safety of high-dose-rate (HDR) esophageal brachytherapy in combination with external beam radiotherapy (EBRT), chemotherapy, and immune checkpoint inhibition with nivolumab in patients with locally advanced esophageal squamous cell carcinoma (ESCC).

Eligible patients include those with stage III-IVB ESCC who have previously received EBRT with concurrent platinum-fluoropyrimidine chemotherapy and who have initiated nivolumab therapy. HDR brachytherapy (5-12 Gy in 1-2 fractions) will be administered within three weeks following the start of nivolumab.

The primary endpoint is the 12-month cumulative incidence of locoregional failure. Secondary endpoints include overall survival, progression-free survival, overall response rate, disease control rate, safety and tolerability, tube-dependence-free survival, tumor-infiltrating lymphocyte density, and circulating tumor DNA dynamics.

The rationale for this trial is that HDR brachytherapy offers precise dose escalation directly to the esophageal tumor, which may improve locoregional control beyond EBRT alone. In addition, the combination of localized high-dose irradiation with systemic immune checkpoint inhibition has the potential to enhance antitumor immunity, thereby improving clinical outcomes in this high-risk population.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age of 18-85 years, with ECOG performance 0-2.
  • Locally-advanced esophageal squamous cell carcinoma with clinical stage III, IVA with biopsy proven.
  • Prior treatment with EBRT (40-50.4 Gy in 20-28 fractions) and platinum + fluoropyrimidine chemotherapy, with residual or progressive disease, and deemed inoperable or unable to undergo surgery.
  • No prior exposure to ICIs and had received first cycle of nivolumab after CCRT.
  • Biopsy proven with PD-L1 [tumor cell (TC) ≥ 1%]
  • Required at least one measurable or non-measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1.
  • Patients with limited stage IVB disease (e.g., non-visceral lymph node metastasis) may be enrolled if the primary tumor is locally dominant and suitable for brachytherapy, based on investigator's discretion.

Exclusion criteria

  • Current or past history of severe hypersensitivity to any other antibody products.
  • Patients with any metastasis in the brain or meninx that is symptomatic or requires treatment.
  • Patients with active, known or suspected autoimmune disease
  • Stenosis of esophageal lumen that cannot performed brachytherapy
  • Involvement of tracheal mucosa or bronchial mucosa.
  • The distribution of the lesions of interest exceeds 10 cm range.
  • The patient is participating in other interventional clinical trials associated with immunotherapy.
  • The patient is scheduled to undergo esophagostomy.

Treatment and study plan

Nivolumab (240 mg)

Drug

After the first cycle of nivolumab administered in the screening phase (1st cycle), nivolumab in the study phase was administered intravenously over 30 minutes at a dose of 240 mg every 2 weeks for at least 2 doses, with 1 cycle after to first brachytherapy (2nd cycle), and 1 more cycle after to second brachytherapy (3rd cycle) if feasible. (each cycle was 2 weeks), until disease progression assessed by the investigator per RECIST version 1.1, or unacceptable toxicity.

Brachytherapy

Radiation

Brachytherapy protocol starts within 3 weeks after first cycle of nivolumab was administered. After brachytherapy applicator placement, CT simulation scan(s) with dummy source in place will be done for further planning procedure, including adjustment of the applicator and 3D treatment planning. High-dose-rate (HDR) 5-Gy per fraction is delivered to the gross tumor volume (GTV) of esophageal tumor(s), second treatment if applicable will be finished within 2 weeks after the first fraction, a total of 5-12 Gy in 1-2 fractions will be delivered. GTV coverage D90 should equal 100% of prescription. Efforts should be made to spare the adjacent normal organ and to avoid hot spot on normal esophageal mucosa. It is NOT allowed to give concurrent chemotherapy on the days of HDR brachytherapy.

Primary outcomes

  1. Cumulative incidence of locoregional failure at 12 months

    Time frame: 12 months from initiation of HDR brachytherapy

    The proportion of patients who develop tumor recurrence or persistence in the esophagus or regional lymph nodes, as assessed by central review using endoscopy, CT and/or PET according to RECIST v1.1 and iRECIST criteria.

Secondary outcomes

  1. Overall Response Rate (ORR)

    Time frame: Up to 24 months

    Percentage of patients achieving complete response or partial response as best overall response, assessed by investigators per RECIST v1.1 and iRECIST.

  2. Overall Survival (OS)

    Time frame: Up to 24 months

    Time from enrollment to death from any cause.

  3. Progression-Free Survival (PFS)

    Time frame: Up to 24 months

    Time from enrollment to first documented tumor progression or death, whichever occurs first.

  4. Disease Control Rate (DCR)

    Time frame: Up to 24 months

    Percentage of patients achieving complete response, partial response, or stable disease, as best overall response per RECIST v1.1/iRECIST.

  5. Duration of Response (DoR)

    Time frame: Up to 24 months

    Time from the first documentation of complete or partial response to the first documented tumor progression or death.

  6. Cumulative incidence of distant failure

    Time frame: Up to 24 months

    Proportion of patients developing new distant metastases over the study period, accounting for competing risks.

  7. Safety and tolerability

    Time frame: From first study treatment through 90 days after last dose and up to 24 months for late effect

    Incidence and severity of adverse events (AEs), serious adverse events (SAEs), and immune-related adverse events, graded according to CTCAE v5.0.

  8. Tube-dependence-free survival

    Time frame: Up to 24 months

    Proportion of patients who remain alive without requiring feeding tube support (e.g., nasogastric or jejunostomy tube) for nutrition.

  9. Circulating tumor DNA (ctDNA) dynamics

    Time frame: Baseline and up to 24 months

    Change in ctDNA levels measured at baseline and during follow-up as an indicator of treatment response and disease progression.

  10. Tumor-infiltrating lymphocyte (TIL) density

    Time frame: Baseline to up to 12 weeks after HDR brachytherapy

    Change in tumor-infiltrating lymphocyte density in tumor biopsy samples collected before and after HDR brachytherapy.

Study contacts

Contact information is provided by the study sponsor or research team.

Yen-Ting Liu, MD

CONTACT

[email protected]

+886-2-33663366 ext. 24130

Sponsors and collaborators

Lead sponsor

National Taiwan University Hospital

Other

Registry information

Official study title

A Phase II Study of High-Dose-Rate Esophageal Brachytherapy After External Beam Radiotherapy and Nivolumab in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma

Acronym: BRIGHT-ESCC

Important dates

Study start
2025
Primary completion
2027
Study completion
2028
First posted
Sep 3, 2025
Registry last updated
Sep 3, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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