- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03532204
Oligometastases of the LIVer Treated With Chemotherapy With ou Without Extracranial Stereotactic Body Radiation Therapy in Patients With Colorectal Cancer (OLIVER)
The role of radiotherapy in metastatic cancer has historically been limited to palliation while metastasectomy or radiofrequency has emerged as playing a major role in disease control. Although resection is the standard of care for liver metastasis, 80-90% of patients are not resectable at diagnosis in particular because of the presence of oligometastases. Factors that favour a truly oligometastatic state include a long latent interval between the treatment of the primary tumor and the appearance of metastases.
Oligometastatic cancer is a very heterogeneous disease with respect to several factors including the location of the primary tumor. With the advent of extracranial stereotactic body radiation therapy (SBRT), higher biological equivalent doses can be safely delivered in 3 to 5 fractions, thus potentially ablating all the tissue in the treated area while protecting more efficiently the hosting organ and healthy tissues surrounding the tumors.
In patients with liver oligometastases, in-field local control rates at 2 years range from 70% to 90% with less than 5% severe grade 3 or higher toxicity rates. Retrospective studies indicate that roughly 20% of the patients remain disease-free 2 to 4 years after SBRT.
For patients treated with SBRT some authors found that half of the patients had either no metastatic progression or very little progression in terms of number and site of metastases. The patterns of failure after SBRT for oligometastases in one organ showed that 73% of patients eventually developed new metastases with higher than 80% occurring as new metastases in the same index organ. These findings support the idea of an oligometastatic state in which aggressive local therapy could improve progression-free survival (PFS).
With this phase III study, we sought to evaluate the impact of SBRT on PFS at 2 years in patients with synchronous or metachronous liver-only oligometastases from colorectal cancers patients after a first line chemotherapy for metastatic disease but not having progressed during first line chemotherapy and up to 1 year
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Male or female with age ≥18 years and <85 years;
- Patient with histologically proven colorectal cancer;
- Patient with a curative surgical treatment (R0) of the primary tumor performed;
- Oligometastatic disease defined as 1 to 3 liver-only metastases (measurable lesion as per RECIST 1.1);
- Patient unfit for surgery or with unresectable metastases;
- Maximal diameter of largest metastasis: 30 mm;
- Patient naïve of chemotherapy in the metastatic setting or after a first-line of chemotherapy for metastatic disease but not having progressed up to 1 year (i.e. slowly progressing disease);
- WHO status 0-1;
- Adequate liver function: bilirubin <3 mg/dL, albumin >2.5 g/dL;
- Adequate hematological function: absolute neutrophil count (ANC) >1.5 x 10⁹/L; platelets >100 x 10⁹/L, hemoglobin (Hb) >9 g/dL;
- Normal PT (>70%) and PTT except if the patient uses anticoagulants;
- Liver enzymes <3 times upper limit of normal;
- Renal function must be adequate for infusion of iv. contrast agent for CT-scan according to the local policy;
- Woman of childbearing potential and male patients must agree to use adequate contraception for the duration of study and up to 3 months following completion of therapy;
- Patient who have received the information sheet, dated and signed the informed consent form;
- Affiliated to the social security system.
Exclusion Criteria:
- Healthy liver volume<700 mL
- Life expectancy <3 months;
- Patient fit for metastasectomy or hepatectomy;
- Extrahepatic metastases;
- Cirrhosis with Child Pugh score B or C;
- More than one line of chemotherapy in the metastatic setting or rapidly progressing disease;
- Previous local treatment of liver metastases;
- Treatment with any other investigational agent against cancer;
- Malignancies other than mCRC within 5 years prior to randomization, except for adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated surgically with curative intent, and ductal carcinoma in situ treated surgically with curative intent;
- Pregnant woman or breast feeding mother;
- Patient deprived of liberty or placed under the authority of a tutor. Patient with any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial. Patient unable to understand the purpose of the study (language, etc.).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Chemotherapy + SBRT
Patients will received 2 courses of chemotherapy before SBRT if no hepatic or extra-hepatic progression identified. All liver metastases will be irradiated. 4 doses prescription are allowed (according to the center, and the technique uded and the dosimetric constraints): 3x15 Gy, 4 x 15 Gy, 5 x10 Gy or 5 x 8 Gy. The remaining courses of chemotherapy 2 to 3 weeks after completion of SBRT will be administered |
Patients will received 2 courses of chemotherapy before SBRT if no hepatic or extra-hepatic progression identified. All liver metastases will be irradiated. 4 doses prescription are allowed (according to the center, and the technique uded and the dosimetric constraints): 3x15 Gy, 4 x 15 Gy, 5 x10 Gy or 5 x 8 Gy. The remaining courses of chemotherapy 2 to 3 weeks after completion of SBRT will be administered
At investigator's discretion
|
Active Comparator: Chemotherapy
Patients will receive chemotherapy as initially scheduled
|
At investigator's discretion
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression Free Survival
Time Frame: 1 year
|
To evaluate the impact of SBRT on Progression-Free Survival (PFS) at 1 year according to RECIST 1.1
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Local Control rate
Time Frame: 1 and 3 years
|
Defined as the time from the date of randomization to the date of a documented loco-regional event
|
1 and 3 years
|
Overall survival
Time Frame: 3 years
|
Defined as the time from the date of randomization to the date of documented death of any cause
|
3 years
|
Cancer specific survival
Time Frame: 3 years
|
Defined as the time from the date of randomization to the date of documented death from cancer or complication from treatment
|
3 years
|
CTCAE Toxicity Assessment
Time Frame: up to 24 weeks
|
Acute/ late toxicity will be assessed according to the flowchart and performed based on CTCAE V4
|
up to 24 weeks
|
Quality of life EORTC QLQ C30
Time Frame: up to 24 weeks
|
Will be assessed using self-administered questionnaires EORTC QLQ C30
|
up to 24 weeks
|
Quality of life EORTC QLQ CR29
Time Frame: up to 24 weeks
|
Will be assessed using self-administered questionnaire QLQ CR29
|
up to 24 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Stéphanie SERVAGI, MD, INSTITUT JEAN GODINOT, REIMS
- Principal Investigator: Gilles CREHANGE, MD, Centre Georges François Leclerc, DIJON
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- UC-0107/1602
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.
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