- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05352165
The Clinical Efficacy of Drug Sensitive Neoadjuvant Chemotherapy Based on Organoid Versus Traditional Neoadjuvant Chemotherapy in Advanced Rectal Cancer
A Prospective Multicenter Randomized Controlled Trial of the Clinical Efficacy of Neoadjuvant Therapy Based on Organoids Drug Sensitivity Versus Empirical Neoadjuvant Therapy in the Treatment of Advanced Rectal Cancer
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Based on the need for individualized treatment in the era of precision medicine, an in vitro model that can accurately predict the response of patients to treatment is urgently needed, so that suitable patients can receive effective treatment and patients whose treatments are ineffective can avoid adverse reactions. The emergence of tumor organoids technology makes this vision possible.
Tumor-organoid (Patient-Derived Organoids, PDOs) is a kind of micro-organ with a three-dimensional structure, which is cultivated in the environment of 3D matrix glue in vitro. Based on the individualized neoadjuvant therapy based on the drug sensitivity technology of tumor-organoid, the best neoadjuvant therapy can be selected and the clinical efficacy and drug tolerance can be quickly predicted, which is of great significance in the field of accurate tumor therapy. The preliminary study of our group also completed the organ-like library of more than 100 patients with local advanced rectal cancer. It was proved that the organoids of the organoids library had high homology with the original tumor tissue, and the detection period of drug sensitivity of organoids was less than 2 weeks, which was much less than 2 months of PDX drug sensitivity technology in mice, which did not affect the time window of clinical drug treatment, and the results of drug sensitivity were basically consistent with the clinical efficacy.
Therefore, we have reason to believe that tumor organoids chemosensitivity technology, as an economical, high-throughput, and efficient technology for tumor research, is expected to play an important role in clinical individualized treatment of tumors.
Our previous study found that tumor-based organoids drug sensitivity technology can be used as an effective and reliable clinical assistant tool to guide and assist doctors to formulate the best treatment strategy for tumor patients. Personalized neoadjuvant therapy has better clinical efficacy than standard whole-course neoadjuvant therapy.
Therefore, in this study, through a prospective, multicenter, multi-arm umbrella clinical study, patients with locally advanced rectal cancer who need neoadjuvant therapy are randomly divided into two groups: the organoids drug sensitivity group and the standard whole-course neoadjuvant therapy group. To compare the clinical efficacy of personalized neoadjuvant therapy based on tumor organoids chemosensitivity combined with standard long-term radiotherapy with the clinical efficacy of standard whole-course neoadjuvant therapy in locally advanced rectal cancer. This technology can be used in the clinical use of advanced rectal cancer new auxiliary decision-making system so that the standardization of comprehensive treatment of rectal cancer can be implemented in China, which is of great significance for the development of the national economy and the improvement of medical level in China.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jing Sun, PhD
- Phone Number: +86-21-64370045
- Email: sj11788@rjh.com.cn
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
1) Age: 18-75. 2) qualitative diagnosis: adenocarcinoma was confirmed by enteroscopic biopsy. 3) Localization diagnosis: the tumor is located in the rectum (the distance between the tumor and the anal margin ≤ 12cm).
4) plain scan of thoracoabdominal pelvis and enhanced CT or MRI evaluation of rectal cancer staging:
The primary tumor invades the muscular layer of the intestinal wall into the surrounding well-known structure, with or without lymph node metastasis in the proper rectal fascia.
b. TNM clinical or pathological stage of tumor: T3-T4N0-2M0. 5) physical condition (ECOG) score ≤ 1. 6) all patients agreed to receive adjuvant chemotherapy for 3 to 6 months after operation.
7) sign informed consent and participate in the project voluntarily.
Exclusion Criteria:
- 1) simultaneous or metachronous multiple primary malignant tumors. 2) preoperative imaging examination or pathological results showed that:
Lateral lymph node metastasis. b. Distant organ metastasis. 3) previous history of malignant tumors. 4) abnormal function of heart, lung, liver, kidney, hematopoiesis and bone marrow reserve, which can not tolerate neoadjuvant therapy and operation.
5) have mental illness or other serious cardiovascular disease. 6) pregnant or lactating women. 7) Emergency surgery (perforation, bleeding, intestinal obstruction, etc.). 8) BRAF mutation was found by gene detection.
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: standard long-term therapy
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
Active Comparator: FOLFOX and standard long-term radiotherapy
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
Active Comparator: FOLFIRI and standard long-term radiotherapy
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
Active Comparator: 5-FU and standard long-term radiotherapy
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
Active Comparator: 5-FU and pembrolizumab and standard long-term radiotherapy
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
Active Comparator: Other individualized treatments
Other individualized treatments based on organoids drug sensitivity
|
The standard whole-course neoadjuvant therapy group was treated with neoadjuvant simultaneous radiotherapy and chemotherapy (Total Neoadjuvant Therapy, TNT) based on guidelines and clinical experience.
FOLFOX and standard long-term radiotherapy based on organoids drug sensitivity
FOLFIRI and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and standard long-term radiotherapy based on organoids drug sensitivity
5-FU and pembrolizumab and standard long-term radiotherapy based on organoids drug sensitivity
Other individualized treatments based on organoids drug sensitivity
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pathologic Complete Response
Time Frame: 3 years
|
Neoadjuvant therapy and postoperative pathology confirmed that the primary tumor was in complete remission (stage ypT0) and had no residual tumor cells, regardless of whether the regional lymph nodes were involved or not.
|
3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Postoperative complication
Time Frame: 3 years
|
Intra-abdominal bleeding, anastomotic leakage, intra-abdominal infection, intestinal obstruction, postoperative diarrhea, wound infection, pulmonary infection, cardiovascular accident, cerebrovascular accident, etc.
|
3 years
|
Tumor Regression Grading
Time Frame: 3 years
|
Tumor pathological reaction is graded after neoadjuvant therapy, usually according to the proportion of fibrosis and residual tumor in the tumor. The analytical system for evaluating treatment response recommended by NCCN is as follows: complete response-no living cancer cell residue, moderate reaction-single or small cluster cancer cell residue,mild reaction-residual cancer focus, interstitial fibrosi,adverse reaction-few or no cancer cell regression. |
3 years
|
Local recurrence
Time Frame: 3 years
|
Recurrence occurs in the surgical area, with or without the rise of tumor markers.
The tumor found in the anastomosis needs to be confirmed by pathological biopsy.
|
3 years
|
Distant metastasis
Time Frame: 3 years
|
CT or MRI or radionuclide scan can detect metastases in liver, lung and bone, with or without confirmed by pathology.
|
3 years
|
Treatment tolerance rate
Time Frame: 3 years
|
To evaluate the tolerance and completion of preoperative neoadjuvant therapy.
|
3 years
|
R0 resection rate
Time Frame: 3 years
|
R0 resection rate of laparoscopic radical surgery for rectal cancer after neoadjuvant therapy.
|
3 years
|
anus-saving rate
Time Frame: 3 years
|
anus-saving rate after radical resection of rectal cancer after neoadjuvant therapy
|
3 years
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jing Sun, PhD, Shanghai Minimally Invasive Surgery Center
Publications and helpful links
General Publications
- Ludmir EB, Palta M, Willett CG, Czito BG. Total neoadjuvant therapy for rectal cancer: An emerging option. Cancer. 2017 May 1;123(9):1497-1506. doi: 10.1002/cncr.30600. Epub 2017 Mar 10.
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33. doi: 10.3322/caac.21654. Epub 2021 Jan 12. Erratum In: CA Cancer J Clin. 2021 Jul;71(4):359.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.
- Sato T, Vries RG, Snippert HJ, van de Wetering M, Barker N, Stange DE, van Es JH, Abo A, Kujala P, Peters PJ, Clevers H. Single Lgr5 stem cells build crypt-villus structures in vitro without a mesenchymal niche. Nature. 2009 May 14;459(7244):262-5. doi: 10.1038/nature07935. Epub 2009 Mar 29.
- Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). 2021 Mar 17;134(7):783-791. doi: 10.1097/CM9.0000000000001474.
- Garcia-Aguilar J, Chow OS, Smith DD, Marcet JE, Cataldo PA, Varma MG, Kumar AS, Oommen S, Coutsoftides T, Hunt SR, Stamos MJ, Ternent CA, Herzig DO, Fichera A, Polite BN, Dietz DW, Patil S, Avila K; Timing of Rectal Cancer Response to Chemoradiation Consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 2015 Aug;16(8):957-66. doi: 10.1016/S1470-2045(15)00004-2. Epub 2015 Jul 14.
- Shamir ER, Ewald AJ. Three-dimensional organotypic culture: experimental models of mammalian biology and disease. Nat Rev Mol Cell Biol. 2014 Oct;15(10):647-64. doi: 10.1038/nrm3873. Epub 2014 Sep 17.
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
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms
- Neoplasms by Site
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Colorectal Neoplasms
- Rectal Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Immunological
- Fluorouracil
- Pembrolizumab
Other Study ID Numbers
- MISC-WXXR-001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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