- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01647776
Screening and Risk Factors of Colon Neoplasia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Colorectal carcinoma is currently the second most common fatal cancer in the United States, and is largely preventable through the use of screening in the asymptomatic population. Although colonoscopy is considered to be the most accurate 'gold standard' screening test, there are a significant proportion of eligible patients who decline colonoscopy or in whom colonoscopy is not readily available. More recently, testing for aberrant molecular/genetic markers in stool DNA (sDNA) is emerging as a promising alternative to colonoscopy, and some professional society guidelines have endorsed the use of sDNA testing in the early detection of colorectal cancer. However, despite some guidelines that endorse sDNA testing primarily for the detection of colorectal cancer, data on the efficacy of sDNA testing for advanced adenomas, and hence prevention of colorectal cancer, are limited.
Colon carcinogenesis is a multifactorial and multistep process that involves both genetic and environmental influences. Diet clearly plays an important role. However, despite extensive research, there has been limited success in identifying such specific dietary and nutritional factors. In particular, a number of within-population studies, including several randomized trials, have yielded conflicting results and cast serious doubt on the hypothesized central role of dietary fat and fiber in colon carcinogenesis. In contrast, there is increasing evidence relating colon neoplasia to obesity, type 2 diabetes and related metabolic abnormalities. These results, together with the marked and consistent similarities in the dietary and lifestyle risk factors for type 2 diabetes and colon neoplasia have led to the notion that insulin resistance resulting from energy imbalance (excess energy intake, physical inactivity, and obesity) may be the underlying link between these two entities. Indeed, the insulin resistance-colon neoplasia hypothesis could account for many of the dietary and lifestyle risk factors of colon neoplasia and for its high incidence in Western countries. The fact that the incidences of obesity, insulin resistance syndrome, and type 2 diabetes are escalating at epidemic pace in the Western societies makes the exploration of the insulin resistance-colon neoplasia hypothesis a subject of pressing priority.
A Food Frequency Questionnaire (FFQ), a Meat Preparation Questionnaire (MPQ), and a Physical Activity Questionnaire (PAQ), all developed at the University of Arizona Cancer Center will be used to collect dietary and physical activity data.The FFQ, MPQ and PAQ questionnaires will be self-administered by each subject according to detailed written instructions, and they are mailed to the participant with the consent forms. Subjects will be asked to donate whole blood and urine samples on the day of routine colonoscopy exams. These samples will be looked at for disease markers. Stool samples will be collected to evaluate its use at detecting colon polyps using the sDNA Test and 2 FIT tests (fecal immunochemical test).
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44106
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- patients undergoing routine colonoscopy at University Hospitals, Cleveland Ohio
Exclusion Criteria:
- Unable to give written consents
- Unable to fill the questionnaires
- A history of polyps within the past 10 years (except hyperplastic polyps)
- Family history of Familial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
- Personal history of inflammatory bowel disease
- Personal diagnosis of any cancer, with the exception of non-melanoma skin cancer
- Any major colon surgeries (e.g. resectioning)
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Individuals without colon polyps
|
Stool DNA test is done prior to the colonoscopy.
Other Names:
During the standard of care colonoscopy biopsies of rectal and colon mucosa will be taken for analysis of 15-PGDH pathway factors [levels of prostaglandin E2 (PG E2), and mRNA for 15-PGDH, COX-1 and COX-2 expression] as markers of risk of developing adenoma.
A Food Frequency Questionnaire (FFQ), a Meat Preparation Questionnaire (MPQ), and a Physical Activity Questionnaire (PAQ), all developed at the University of Arizona Cancer Center will be used to collect dietary and physical activity data.
Risk Factor Questionnaire (RFQ) developed by the University of Southern California will be used to collect general risk information.
Stool (sDNA) test patient satisfaction survey.
Other Names:
|
Individuals with colon polyps
|
Stool DNA test is done prior to the colonoscopy.
Other Names:
During the standard of care colonoscopy biopsies of rectal and colon mucosa will be taken for analysis of 15-PGDH pathway factors [levels of prostaglandin E2 (PG E2), and mRNA for 15-PGDH, COX-1 and COX-2 expression] as markers of risk of developing adenoma.
A Food Frequency Questionnaire (FFQ), a Meat Preparation Questionnaire (MPQ), and a Physical Activity Questionnaire (PAQ), all developed at the University of Arizona Cancer Center will be used to collect dietary and physical activity data.
Risk Factor Questionnaire (RFQ) developed by the University of Southern California will be used to collect general risk information.
Stool (sDNA) test patient satisfaction survey.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Stool DNA (sDNA) Feasibility and Compliance
Time Frame: within 12 weeks prior to the colonoscopy
|
For this aim, we will recruit a sub-sample of the study participants to perform the sDNA test for aberrantly methylated markers in addition to their colonoscopy to assess willingness to participate, compliance with test protocol and patient satisfaction to determine potential for a larger study to evaluate the effectiveness of this test for detection of colon adenomas.
|
within 12 weeks prior to the colonoscopy
|
Efficacy of sDNA testing for the detection of advanced adenomas
Time Frame: prior to the colonoscopy
|
For the sDNA test aims, the primary goals are to assess the sensitivity and specificity of sDNA testing for the detection of advanced adenomas, and to compare the performance of the Exact sDNA Panel with that of FIT.
The sensitivity and specificity of sDNA and FIT will be estimated based on the concordance and discordance of advanced adenomas detected against that of colonoscopy as the gold standard
|
prior to the colonoscopy
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Concordance/discordance between tissue and stool DNA aberrant methylation markers
Time Frame: Stool sample within 2 weeks of colonoscopy
|
Biopsies of rectal and colon mucosa collected at the beginning of the colonoscopy for analysis of 15-PGDH pathway factors [levels of prostaglandin E2 (PG E2), and mRNA for 15-PGDH, COX-1 and COX-2 expression] as markers of risk of developing adenoma.
|
Stool sample within 2 weeks of colonoscopy
|
Persistence of positive sDNA testing after removal of advanced adenomas
Time Frame: at 12 months after initial colonoscopy
|
For this aim we will follow-up participants who have had positive sDNA tests and at least one advanced adenoma removed during colonoscopy.
At 12 months after their initial sDNA test and colonoscopy, we will ask them to repeat the sDNA test in addition to colonoscopy recommended by their physician as standard of care.
|
at 12 months after initial colonoscopy
|
Assess the frequency of missed or occult colonic and upper gastrointestinal neoplasia in patients with initially normal colonoscopies and persistently positive sDNA testing.
Time Frame: at 12 months after initial colonoscopy
|
For this aim we will follow-up participants who have had positive sDNA tests and negative colonoscopy (i.e., no adenomatous polyps observed at initial colonoscopy).
At 12 months after their initial sDNA test and colonoscopy, we will ask them to repeat the sDNA test.
If this second sDNA test is also positive, the participant will be offered the opportunity to have both a colonoscopy and an upper GI endoscopy (also called esophagogastroduodenoscopy or EGD)
|
at 12 months after initial colonoscopy
|
Insulin Resistance Syndrome
Time Frame: at the time of the colonoscopy
|
Use latent structural equation models to fully incorporate information on the overall relations among insulin resistance syndrome pathway factors and colon polyps, including both direct and indirect effects as well as interactions between these factors.
|
at the time of the colonoscopy
|
Analyses stratified by ethnicity (Caucasians versus African Americans), and gender.
Time Frame: at the time of the colonoscopy
|
The analysis by ethnicity is of particular interest in sDNA testing as there is evidence that large right-sided adenomas are more prevalent among African Americans, and this ethnic population is less likely to receive screening colonoscopy as compared to Caucasians.
Furthermore, the ability of sDNA and FIT for the detection of nonadvanced adenomas will be evaluated.
These lesions will be defined as adenomas that are less than 1 cm in diameter and without evidence of high grade dysplasia.
|
at the time of the colonoscopy
|
Examine the impact of candidate gene variants in the insulin-GH-IGF-IRS axis on colon polyps.
Time Frame: at the time of the colonoscopy
|
Evaluate whether each of the following candidate gene polymorphisms and their haplotypes are linked to colon polyps: 1) Insulin; 2) Growth Hormone; 3) IGF-1; and 4) IRS-1.
|
at the time of the colonoscopy
|
Evaluate the association of dietary patterns, glycemic index (GI) and glycemic load (GL) with colon polyps.
Time Frame: at 12 months
|
Conceptually, dietary patterns represent a broader picture of human diet, and thus may be more predictive of disease risk than individual foods or nutrients.
In addition, there is growing evidence relating GI and/or GL to risks of obesity, type 2 diabetes as well as colon neoplasia.
Therefore, we hypothesize that high dietary GL and/or GI, and/or a Western dietary pattern defined by a diverse array of dietary factors are associated with increased risk of colon polyps.
|
at 12 months
|
Synthesize the information on candidate genes and diet by looking at their joint effects on colon polyps
Time Frame: at the time of the colonoscopy
|
1) investigate their potential joint actions [i.e., gene-diet and gene-gene]; 2) use a latent structural equation modeling approach to comprehensively evaluate these factors' potential direct as well as indirect (mediated by insulin resistance syndrome) impact, on colon polyps.
|
at the time of the colonoscopy
|
To investigate the association of activated (phosphorylated) IRS1, AKT and mTOR with colon adenomas.
Time Frame: at the time of the colonoscopy
|
We will compare the immunohistochemistry of phosphorylated IRS1, AKT and mTOR in colon adenoma tissues with that in colon tissues from healthy control patients.
Investigate the effect of obesity on the activation of the IRS1, AKT and mTOR by stratifying our cases and controls into lean and obese individuals.
Evaluate the effects of serum levels of insulin, glucose, and insulin resistance index (HOMA-IR) on the activation of the IRS1, AKT and mTOR in colonic tissue.
|
at the time of the colonoscopy
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Joseph E Willis, MD, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CASE1207
- SPORE 2 (Other Identifier: Case Comprehensive Cancer Center)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Colon Cancer
-
National Cancer Institute (NCI)NSABP Foundation IncCompletedColon Adenocarcinoma | Stage IIIA Colon Cancer AJCC v7 | Stage IIIB Colon Cancer AJCC v7 | Stage IIIC Colon Cancer AJCC v7 | Stage IIA Colon Cancer AJCC v7 | Stage IIB Colon Cancer AJCC v7 | Stage IIC Colon Cancer AJCC v7United States
-
Gruppo Oncologico del Nord-OvestSeagen Inc.; Servier; Foundation MedicineRecruitingStage II Colon Cancer | Stage III Colon Cancer | HER2-positive Colon Cancer | RAS Wild-type Colon CancerItaly
-
Case Comprehensive Cancer CenterCompletedStage IIA Rectal Cancer | Stage IIB Rectal Cancer | Stage IIC Rectal Cancer | Stage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon Cancer | Recurrent Colon Cancer | Recurrent Rectal Cancer | Stage IVA Colon Cancer | Stage IVA Rectal Cancer and other conditionsUnited States
-
Vanderbilt-Ingram Cancer CenterNational Cancer Institute (NCI)CompletedFatigue | Depressive Symptoms | Stage IIA Rectal Cancer | Stage IIB Rectal Cancer | Stage IIC Rectal Cancer | Stage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Psychosocial Effects of Cancer and Its Treatment | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon... and other conditionsUnited States
-
National Cancer Institute (NCI)CompletedStage IIA Rectal Cancer | Stage IIB Rectal Cancer | Stage IIC Rectal Cancer | Stage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon Cancer | Recurrent Colon Cancer | Recurrent Rectal Cancer | Stage I Colon Cancer | Stage... and other conditionsUnited States
-
Alliance for Clinical Trials in OncologyNational Cancer Institute (NCI)RecruitingStage III Colon Cancer AJCC v8 | Colon Adenocarcinoma | Microsatellite Stable Colon Carcinoma | Stage IIB Colon Cancer AJCC v8 | Stage IIC Colon Cancer AJCC v8United States
-
Hospital da Senhora da OliveiraCompletedColon Cancer | Colon Adenoma | Colon Polyp | Colon Rectal CancerPortugal
-
National Cancer Institute (NCI)CompletedStage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon Cancer | Recurrent Colon Cancer | Recurrent Rectal Cancer | Stage IVA Colon Cancer | Stage IVA Rectal Cancer | Stage IVB Colon Cancer | Stage IVB Rectal CancerUnited States
-
Howard S. Hochster, MDRecruitingStage IV Colon Cancer AJCC v8 | Stage IVA Colon Cancer AJCC v8 | Stage IVB Colon Cancer AJCC v8 | Stage IVC Colon Cancer AJCC v8 | Metastatic Colon CarcinomaUnited States
-
NorgineXolomon Tree S.L.CompletedColon Cancer | Colon Disease | Colon CleansingSpain, Portugal
Clinical Trials on Stool DNA Test
-
Sixth Affiliated Hospital, Sun Yat-sen UniversityChanghai Hospital; Tianjin Nankai HospitalRecruitingColorectal Cancer | Colorectal Adenomatous PolypChina
-
Alaska Native Tribal Health ConsortiumMayo ClinicRecruitingColorectal CancerUnited States
-
Sixth Affiliated Hospital, Sun Yat-sen UniversityChanghai Hospital; Peking University People's Hospital; Peking University Cancer... and other collaboratorsUnknownColorectal Cancer | Colorectal Adenomatous Polyp | ScreeningChina
-
University of Washington, the Collaborative Health...Cystic Fibrosis FoundationRecruitingColorectal Cancer | Adenoma | Cystic FibrosisUnited States
-
Changhai HospitalUnknownColorectal Cancer | Adenoma | Colorectal Neoplasm | Adenomatous Polyps | Serrated Polyp | Advanced Adenoma
-
Zhejiang UniversityNew Horizon Health Technology Co., Ltd; Beijing Mingze Technology Co., Ltd.CompletedColorectal Cancer | Adenoma | Adenomatous Polyps | Advanced AdenomaChina
-
Changhai HospitalGuangdong Provincial Hospital of Traditional Chinese Medicine; Affiliated Hospital... and other collaboratorsCompletedColorectal Cancer | Adenoma | Colorectal Neoplasm | Advanced Adenoma | Serrated LesionChina
-
Assiut UniversityRecruiting
-
Sohag UniversityNot yet recruitingIn Early Pregnancy
-
Sohag UniversityRecruitingDyspepsia Abdominal Burning Pain Diarrhea DysenteryEgypt