- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01302613
Altered Chemotherapy Sequencing During Neoadjuvant Therapy for Patients With Stage II or III Rectal Adenocarcinoma
August 19, 2020 updated by: University of Texas Southwestern Medical Center
A Pilot and Phase II Study of Altered Chemotherapy Sequencing During Neoadjuvant Therapy for Patients With Stage II or III Rectal Adenocarcinoma
The primary objective of the pilot portion of this study is to establish the safety and tolerability of an extended treatment break period in patients who have undergone neoadjuvant chemoradiotherapy as well as use of systemic therapy during this break.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
The proposed protocol aims to continue tumor-directed therapy during the typical "break period" in an effort to improve on both local tumor response as well as distant disease control.
First, the duration from completion of chemoradiotherapy would increase from 6-8 weeks to 9-11 weeks.
As noted above, this may allow for further cell death with resultant pathologic downstaging.
Secondly, the protocol calls for continued systemic therapy during the 9-11 week period, thus allowing continuation of therapies directed towards both the primary as well as distant sites of disease.
The primary aim of this pilot study would be to establish the feasibility of this intensified neoadjuvant approach, especially with respect to tolerability of the subsequent pelvic surgery.
A subsequent phase II portion will evaluate the efficacy of this treatment approach.
Study Type
Interventional
Phase
- Phase 2
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Texas
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Dallas, Texas, United States, 75390
- UT Southwestern Medical Center
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Signed study-specific informed consent form
- Age > 18 years old
- Zubrod performance status 0-1
- Biopsy proven primary malignancy
- AJCC Stage II or III disease (T3-4 and/or N1-2 disease) as determined by endoscopic ultrasound and/or MRI staging
- Pretreatment rectal endoscopic ultrasound and pelvic MRI, colonoscopy, CT of chest, abdomen, and pelvis, and laboratory values as discussed below
Exclusion Criteria:
- History of inflammatory bowel disease
- Previous pelvic radiotherapy
- A major psychiatric illness which would limit understanding of the proposed protocol treatment and consent process.
- Men and women of reproductive potential must agree to use an effective contraception method
- Pregnant or lactating women
Severe, active co-morbidity, defined as
- Unstable angina and/or CHF requiring hospitalization within the last six months
- Transmural myocardial infarction within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
- Presence of metastatic disease, including liver metastases
- Laboratory values out of range
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: arm one
RT + Chemo + surgery
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Capecitabine will be delivered concurrently with the radiation therapy, at a dose of 1650 mg/m2 divided in even BID doses.
It will only be taken on the days of radiation treatment (Monday-Friday, except for holidays).
The A.M. dose of the capecitabine must be taken at least one hour prior to the radiation treatment.
5-FU 400 mg/m2, iv bolus on day 1 followed by 2400 mg/m2 iv over 46 hours of each cycle.
A cycle is delivered every two weeks.
Three cycles will be given prior to the surgery.
Five additional cycles will be given after surgery.
Leucovorin 400 mg/m2, IV, over 2 hours before 5-FU on day 1 of each cycle.
A cycle is delivered every two weeks.
Three cycles will be given prior to the surgery.
Five additional cycles will be given after surgery.
Oxaliplatin 85mg/m2 IV on day 1 of each cycle.
A cycle is delivered every two weeks.
Three cycles will be given prior to the surgery.
Five additional cycles will be given after surgery.
28-30 fractions of radiation, given once a day, five days per week (Monday-Friday, except for holidays).
The prescribed fraction dose is 180 cGy; the total radiation dose is thus 5040-5400 cGy.
The primary treatment fields will be treated with 25 fractions of 180 cGy/fraction with a "boost" of 3-5 fractions of 180 cGy subsequently delivered.
Optimal surgical technique involving use of total mesorectal excision (TME) is mandated.
The type of surgery, either low anterior resection with sparing of the sphincter mechanism or sphincter-eliminating abdominoperineal resection (APR), will be at the discretion of the attending surgeon.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The primary study endpoint for the phase I portion of this study is to assess surgical complications through the Clavien grading system.
Time Frame: 90 days
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The adverse events will be followed prospectively from the date of surgery for 90 days.
Dose-limiting toxicity (DLT) will be defined as > grade 3 anastomotic stricture or leak, infection (including pelvic abscess or wound infection), small bowel obstruction, or fistualization.
Any other post-operative complication thought related directly to the surgical intervention that is a grade 3 or higher Clavien complication will also be considered dose-limiting toxicity.
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90 days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The primary endpoint of the phase II portion of the study is complete pathologic response.
Time Frame: 9 to 11 weeks
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9 to 11 weeks after the completion of the initial chemoradiotherapy.
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9 to 11 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
March 1, 2011
Primary Completion (Actual)
November 1, 2012
Study Completion (Actual)
November 1, 2012
Study Registration Dates
First Submitted
February 21, 2011
First Submitted That Met QC Criteria
February 23, 2011
First Posted (Estimate)
February 24, 2011
Study Record Updates
Last Update Posted (Actual)
August 20, 2020
Last Update Submitted That Met QC Criteria
August 19, 2020
Last Verified
February 1, 2019
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Carcinoma
- Neoplasms, Glandular and Epithelial
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Colorectal Neoplasms
- Adenocarcinoma
- Rectal Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Protective Agents
- Micronutrients
- Vitamins
- Antidotes
- Vitamin B Complex
- Capecitabine
- Oxaliplatin
- Leucovorin
Other Study ID Numbers
- STU 082010-335
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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