- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT00321685
Bevacizumab, Radiation Therapy, and Combination Chemotherapy in Treating Patients Who Are Undergoing Surgery for Locally Advanced Nonmetastatic Rectal Cancer
Phase II Study of Preoperative Radiation With Concurrent Capecitabine, Oxaliplatin and Bevacizumab Followed by Surgery and Postoperative 5-FU, Leucovorin, Oxaliplatin (FOLFOX) and Bevacizumab in Patients With Locally Advanced Rectal Cancer
Studieoversigt
Status
Detaljeret beskrivelse
PRIMARY OBJECTIVES:
I. To evaluate the pathological complete response rate in patients with T3 and T4 rectal cancers when treated preoperatively with capecitabine, oxaliplatin, bevacizumab, and concurrent radiotherapy (XRT).
II. To evaluate the resection rate for T3 and T4 rectal cancers and the expected versus actual type of resection (abdominoperinal resection [APR] vs. low anterior resection [LAR] vs. LAR/coloanal anastomosis).
III. To make preliminary observations of patient survival and patterns of recurrence for this treatment combination.
IV. To gain additional experience regarding the toxicity and tolerability of this preoperative and postoperative regimen.
OUTLINE:
PREOPERATIVE CHEMORADIOTHERAPY: Patients undergo radiotherapy (total dose to the tumor bed was 5040 cGy) once daily (QD) 5 days a week and receive capecitabine 825 mg/m^2 orally (PO) twice daily (BID) 5 days a week for 5.5 weeks. Patients also receive oxaliplatin 50 mg/m^2 intravenously (IV) over 2 hours on days 1, 8, 15, 22, and 29 and bevacizumab 5 mg/kg IV over 30-90 minutes on days 1, 15, and 29 during radiotherapy.
SURGERY: Approximately 6-8 weeks after completion of chemoradiotherapy, patients undergo surgical resection. Patients whose tumors are not completely resected or who have metastatic disease discontinue protocol therapy.
POSTOPERATIVE CHEMOTHERAPY: Approximately 4-12 weeks after surgery, patients receive oxaliplatin IV over 2 hours, leucovorin calcium 400 mg/m^2 IV over 2 hours, and bevacizumab 5 mg/kg IV over 30-90 minutes on day 1. Patients also receive fluorouracil 2400 mg/m^2 IV continuously over 46 hours beginning on day 1. Treatment repeats every 2 weeks for 9 courses in the absence of disease progression or unacceptable toxicity. Patients then receive up to 3 additional courses of leucovorin calcium, fluorouracil, and bevacizumab.
After completion of study treatment, patients are followed up periodically for 10 years.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Fase 2
Kontakter og lokationer
Studiesteder
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Alabama
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Birmingham, Alabama, Forenede Stater, 35233
- University of Alabama at Birmingham Cancer Center
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Connecticut
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New Britain, Connecticut, Forenede Stater, 06050
- The Hospital of Central Connecticut
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Georgia
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Atlanta, Georgia, Forenede Stater, 30322
- Emory University Hospital/Winship Cancer Institute
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Decatur, Georgia, Forenede Stater, 30033
- Atlanta VA Medical Center
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Macon, Georgia, Forenede Stater, 31201
- Medical Center of Central Georgia
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Illinois
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Aurora, Illinois, Forenede Stater, 60504
- Rush - Copley Medical Center
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Berwyn, Illinois, Forenede Stater, 60402
- MacNeal Hospital and Cancer Center
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Chicago, Illinois, Forenede Stater, 60611
- Northwestern University
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Chicago, Illinois, Forenede Stater, 60625
- Swedish Covenant Hospital
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Chicago, Illinois, Forenede Stater, 60611
- Hematology and Oncology Associates
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Chicago, Illinois, Forenede Stater, 60657
- Presence Saint Joseph Hospital-Chicago
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Chicago, Illinois, Forenede Stater, 60612
- Jesse Brown Veterans Affairs Medical Center
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Chicago, Illinois, Forenede Stater, 60616
- Mercy Hospital and Medical Center
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Effingham, Illinois, Forenede Stater, 62401
- Saint Anthony Memorial Hospital
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Highland Park, Illinois, Forenede Stater, 60035
- Hematology Oncology Associates of Illinois-Highland Park
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Hinsdale, Illinois, Forenede Stater, 60521
- Hinsdale Hematology Oncology Associates Incorporated
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Joliet, Illinois, Forenede Stater, 60435
- Joliet Oncology-Hematology Associates Limited
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Joliet, Illinois, Forenede Stater, 60432
- Midwest Center for Hematology Oncology
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Libertyville, Illinois, Forenede Stater, 60048
- NorthShore Hematology Oncology-Libertyville
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Moline, Illinois, Forenede Stater, 61265
- Garneau, Stewart C MD (UIA Investigator)
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Moline, Illinois, Forenede Stater, 61265
- Porubcin, Michael MD (UIA Investigator)
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Moline, Illinois, Forenede Stater, 61265
- Spector, David MD (UIA Investigator)
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Moline, Illinois, Forenede Stater, 61265
- Trinity Medical Center
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Moline, Illinois, Forenede Stater, 61265
- Sharis, Christine M MD (UIA Investigator)
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Moline, Illinois, Forenede Stater, 61265
- Stoffel, Thomas J MD (UIA Investigator)
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Moline, Illinois, Forenede Stater, 61265
- Vigliotti, Antonio, P.G. M.D. (UIA Investigator)
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Naperville, Illinois, Forenede Stater, 60563
- DuPage Medical Group-Ogden
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Niles, Illinois, Forenede Stater, 60714
- Illinois Cancer Specialists-Niles
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Skokie, Illinois, Forenede Stater, 60076
- Hematology Oncology Associates of Illinois - Skokie
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Skokie, Illinois, Forenede Stater, 60076
- Edward H Kaplan MD and Associates
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Urbana, Illinois, Forenede Stater, 61801
- Carle Cancer Center
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Indiana
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Michigan City, Indiana, Forenede Stater, 46360
- Franciscan Saint Anthony Health-Michigan City
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Iowa
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Bettendorf, Iowa, Forenede Stater, 52722
- Constantinou, Costas L MD (UIA Investigator)
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Sioux City, Iowa, Forenede Stater, 51101
- Siouxland Regional Cancer Center
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Sioux City, Iowa, Forenede Stater, 51102
- Mercy Medical Center-Sioux City
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Sioux City, Iowa, Forenede Stater, 51104
- Saint Luke's Regional Medical Center
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Michigan
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Kalamazoo, Michigan, Forenede Stater, 49007
- West Michigan Cancer Center
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Kalamazoo, Michigan, Forenede Stater, 49007
- Bronson Methodist Hospital
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Kalamazoo, Michigan, Forenede Stater, 49048
- Borgess Medical Center
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Minnesota
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Burnsville, Minnesota, Forenede Stater, 55337
- Fairview Ridges Hospital
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Coon Rapids, Minnesota, Forenede Stater, 55433
- Mercy Hospital
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Edina, Minnesota, Forenede Stater, 55435
- Fairview-Southdale Hospital
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Fridley, Minnesota, Forenede Stater, 55432
- Unity Hospital
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Hutchinson, Minnesota, Forenede Stater, 55350
- Hutchinson Area Health Care
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Litchfield, Minnesota, Forenede Stater, 55355
- Meeker County Memorial Hospital
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Maplewood, Minnesota, Forenede Stater, 55109
- Saint John's Hospital - Healtheast
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Maplewood, Minnesota, Forenede Stater, 55109
- Minnesota Oncology Hematology PA-Maplewood
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Minneapolis, Minnesota, Forenede Stater, 55415
- Hennepin County Medical Center
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Minneapolis, Minnesota, Forenede Stater, 55407
- Abbott-Northwestern Hospital
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Minneapolis, Minnesota, Forenede Stater, 55407
- Virginia Piper Cancer Institute
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Robbinsdale, Minnesota, Forenede Stater, 55422
- North Memorial Medical Health Center
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Saint Louis Park, Minnesota, Forenede Stater, 55416
- Park Nicollet Clinic - Saint Louis Park
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Saint Louis Park, Minnesota, Forenede Stater, 55416
- Metro Minnesota Community Oncology Research Consortium
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Saint Paul, Minnesota, Forenede Stater, 55101
- Regions Hospital
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Saint Paul, Minnesota, Forenede Stater, 55102
- United Hospital
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Saint Paul, Minnesota, Forenede Stater, 55102
- Saint Joseph's Hospital - Healtheast
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Shakopee, Minnesota, Forenede Stater, 55379
- Saint Francis Regional Medical Center
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Waconia, Minnesota, Forenede Stater, 55387
- Ridgeview Medical Center
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Woodbury, Minnesota, Forenede Stater, 55125
- Minnesota Oncology Hematology PA-Woodbury
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Woodbury, Minnesota, Forenede Stater, 55125
- Woodwinds Health Campus
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Nebraska
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Lincoln, Nebraska, Forenede Stater, 68510
- Nebraska Cancer Research Center
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Omaha, Nebraska, Forenede Stater, 68124
- Alegent Health Bergan Mercy Medical Center
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Omaha, Nebraska, Forenede Stater, 68122
- Alegent Health Immanuel Medical Center
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Omaha, Nebraska, Forenede Stater, 68131
- Creighton University Medical Center
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Omaha, Nebraska, Forenede Stater, 68106
- Missouri Valley Cancer Consortium
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New Jersey
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Mount Holly, New Jersey, Forenede Stater, 08060
- Virtua Memorial
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Sparta, New Jersey, Forenede Stater, 07871
- Sparta Cancer Treatment Center
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Voorhees, New Jersey, Forenede Stater, 08043
- Virtua Voorhees
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Woodbury, New Jersey, Forenede Stater, 08096
- Inspira Medical Center Woodbury
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New York
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Bronx, New York, Forenede Stater, 10467
- Montefiore Medical Center - Moses Campus
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Bronx, New York, Forenede Stater, 10466
- Montefiore Medical Center-Wakefield Campus
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Ohio
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Akron, Ohio, Forenede Stater, 44304
- Summa Akron City Hospital/Cooper Cancer Center
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Barberton, Ohio, Forenede Stater, 44203
- Summa Barberton Hospital
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Bellefontaine, Ohio, Forenede Stater, 43311
- Mary Rutan Hospital
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Chillicothe, Ohio, Forenede Stater, 45601
- Adena Regional Medical Center
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Columbus, Ohio, Forenede Stater, 43214
- Riverside Methodist Hospital
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Columbus, Ohio, Forenede Stater, 43228
- Doctors Hospital
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Columbus, Ohio, Forenede Stater, 43215
- Grant Medical Center
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Columbus, Ohio, Forenede Stater, 43222
- Mount Carmel Health Center West
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Delaware, Ohio, Forenede Stater, 43015
- Grady Memorial Hospital
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Lancaster, Ohio, Forenede Stater, 43130
- Fairfield Medical Center
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Lima, Ohio, Forenede Stater, 45801
- Saint Rita's Medical Center
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Marietta, Ohio, Forenede Stater, 45750
- Marietta Memorial Hospital
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Newark, Ohio, Forenede Stater, 43055
- Licking Memorial Hospital
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Springfield, Ohio, Forenede Stater, 45505
- Springfield Regional Medical Center
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Westerville, Ohio, Forenede Stater, 43081
- Saint Ann's Hospital
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Zanesville, Ohio, Forenede Stater, 43701
- Genesis Healthcare System Cancer Care Center
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Oklahoma
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Tulsa, Oklahoma, Forenede Stater, 74136
- Natalie Warren Bryant Cancer Center at Saint Francis
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Pennsylvania
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Allentown, Pennsylvania, Forenede Stater, 18103
- Lehigh Valley Hospital-Cedar Crest
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Darby, Pennsylvania, Forenede Stater, 19023-1291
- Mercy Fitzgerald Hospital
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East Stroudsburg, Pennsylvania, Forenede Stater, 18301
- Pocono Medical Center
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Ephrata, Pennsylvania, Forenede Stater, 17522
- Ephrata Cancer Center
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Media, Pennsylvania, Forenede Stater, 19063
- Riddle Memorial Hospital
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Philadelphia, Pennsylvania, Forenede Stater, 19111
- Fox Chase Cancer Center
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Philadelphia, Pennsylvania, Forenede Stater, 19107
- Thomas Jefferson University Hospital
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Philadelphia, Pennsylvania, Forenede Stater, 19141
- Einstein Medical Center Philadelphia
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Philadelphia, Pennsylvania, Forenede Stater, 19114
- Aria Health-Torresdale Campus
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Scranton, Pennsylvania, Forenede Stater, 18508
- Hematology and Oncology Associates of North East Pennsylvania
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Upland, Pennsylvania, Forenede Stater, 19013
- Associates In Hematology Oncology PC-Upland
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South Dakota
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Sioux Falls, South Dakota, Forenede Stater, 57105
- Avera Cancer Institute
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Sioux Falls, South Dakota, Forenede Stater, 57117-5134
- Sanford USD Medical Center - Sioux Falls
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Sioux Falls, South Dakota, Forenede Stater, 57104
- Sanford Cancer Center Oncology Clinic
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Sioux Falls, South Dakota, Forenede Stater, 57105
- Medical X-Ray Center
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Sioux Falls, South Dakota, Forenede Stater, 57105
- Avera McKennan Hospital and University Health Center
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Texas
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Dallas, Texas, Forenede Stater, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Wisconsin
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La Crosse, Wisconsin, Forenede Stater, 54601
- Gundersen Lutheran Medical Center
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Milwaukee, Wisconsin, Forenede Stater, 53226
- Froedtert and The Medical College of Wisconsin
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Patients must have histologically confirmed, locally advanced, non-metastatic primary T3 or T4 adenocarcinoma of the rectum
- Patients must not have evidence of tumor outside of the pelvis including liver metastases, peritoneal seeding, or metastatic inguinal lymphadenopathy
- Patients must not have intra-operative radiotherapy (IORT) or brachytherapy treatment to the pelvis
- The distal border of the tumor must be at or below the peritoneal reflection, defined as within 12 centimeters of the anal verge by proctoscopic examination
- Transmural penetration of tumor through the muscularis propria must be demonstrated by either of the following: computed tomography (CT) scan plus endorectal ultrasound, or a magnetic resonance imaging (MRI); an endorectal coil or pelvic MRI is allowed
- For the patient to be eligible, the surgeon must prospectively define the tumor as either initially resectable or potentially resectable after pre-operative chemoradiation; clinically resectable tumors are defined as completely resectable with negative margins based on routine examination of the non-anesthetized patient; patients whose tumors are not resectable are not eligible; before pre-operative (op) treatment, the surgeon should estimate and record the type of resection anticipated: pelvic exenteration, posterior pelvic exenteration, APR, LAR, or LAR/coloanal anastomosis
Patients with tumors that are clinically fixed, clinical stage T4N0-2, M0 are eligible if it is believed that their tumors are potentially resectable after chemoradiation; based on the following:
- Clinically fixed tumors on rectal examination with tumor adherent to the pelvic sidewall or sacrum
- Sciatica attributed to sacral root invasion with CT scan/MRI evidence of the lack of clear tissue plane will be considered evidence of fixation
- Hydronephrosis on CT scan or intravenous pyelogram (IVP) or ureteric or bladder invasion as documented by cystoscopy and cytology or biopsy, or invasion into prostate
- Vaginal or uterine involvement
- Patients must have Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- A surgical evaluation must confirm patient's ability to tolerate the proposed surgical procedure
- Patients must have a caloric intake > 1500 kilocalories/day (d)
- Within 4 weeks prior to registration, the patient's absolute neutrophil count (ANC) level must be >= 1,500/mm^3
- Within 4 weeks prior to registration, the patients platelet level must be >= 100,000/mm^3
- Within 4 weeks prior to registration, serum creatinine must be < 1.5 X upper limit of normal (ULN); if serum creatinine > 1.5 x ULN, then creatinine clearance must be >= 50 mL/mm
- Within 4 weeks prior to registration, serum bilirubin must be =< 1.5 X ULN
- Within 4 weeks prior to registration, alkaline phosphatase (alk phos) must be < 2 x ULN
- Within 4 weeks prior to registration, serum glutamic oxaloacetic transaminase (SGOT) must be < 2 x ULN
- Carcinoembryonic antigen (CEA) must be determined prior to initiation of therapy
- Within 4 weeks prior to registration, urine protein/creatinine (UPC) ratio must be < 1; patients with a ratio of >= 1 must undergo a 24-hour urine collection which must be an adequate collection and must demonstrate < 1 gram (gm) of protein in order to participate
- Within 4 weeks prior to registration, albumin must be >= 2 gm/dl
- Absence of clinical evidence of high-grade (lumen diameter < 1 cm) large bowel obstruction, unless diverting colostomy has been performed
- Eligible patients of reproductive potential (both sexes) must agree to use an accepted and effective method of contraceptive during study therapy and for at least 6 months after the completion of bevacizumab
- Women must not be pregnant or breast-feeding; all females of childbearing potential must have a serum pregnancy test to rule out pregnancy within 2 weeks of registration
- Patients must have had no prior chemotherapy for rectal cancer or pelvic irradiation therapy
- Patients with prior malignancies, including pelvic cancer, are eligible if they have been disease free for > 5 years; patients with prior in situ carcinomas are eligible provided there was complete removal
- Patients must have no active inflammatory bowel disease or other serious medical illness or disease that might limit the patient's ability to receive protocol therapy
- Patients with a history of cerebrovascular accident (CVA)/transient ischemic attack (TIA) at any time, or myocardial infarction/unstable angina within 12 months of study entry are not eligible
- Patients with > grade 1 peripheral neuropathy are not eligible
- Patients must have urine protein/creatinine (UPC) ratio of < 1.0; patients with a UPC ratio >= 1.0 must undergo a 24-hour urine collection, which must be an adequate collection and must demonstrate < 1 gm of protein in order to participate
- Patients with a history of hypertension must measure < 150/90 mmHg and be on a stable regimen of anti-hypertensive therapy
- Patients with clinically significant peripheral vascular disease are not eligible
Patients must not have any of the following:
- Unstable angina (within 12 months of study entry)
- New York Heart Association (NYHA) grade II or higher congestive heart failure
- Evidence of bleeding diathesis/coagulopathy
- Serious non-healing wound or bone fracture
Patients with a history of the following within 28 days prior to registration are not eligible:
- Abdominal fistula
- Gastrointestinal perforation
- Intrabdominal abscess
Patients with a history of the following within 28 days prior to day 0 (first treatment day) are not eligible:
- Major surgical procedure
- Open biopsy
- Significant traumatic injury
- Patients must not have core biopsy within 7 days prior to day 0 (first treatment day)
Patients with prothrombin time (PT) (international normalized ratio [INR]) > 1.5 are not eligible, unless the patient is on full-dose anticoagulants; if so, the following criteria must be met for enrollment:
- The subject must have an in-range INR (usually between 2 and 3), be on a stable dose of warfarin or on a stable dose of low molecular weight heparin
- The subject must not have active bleeding or a pathological condition that is associated with a high risk of bleeding
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Treatment (bevacizumab and chemoradiotherapy)
See Detailed Description
|
Givet IV
Andre navne:
Givet IV
Andre navne:
Givet IV
Andre navne:
Givet PO
Andre navne:
Givet IV
Andre navne:
Gennemgå kirurgisk resektion
Gennemgå strålebehandling
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Pathologic Complete Response Rate
Tidsramme: Assessed at surgery time
|
Pathologic complete response to preoperative therapy was determined at the time of surgical resection.
Pathologic complete response (pCR) is defined as no evidence of invasive cells on pathologic examination of the primary rectal cancer (or tissue from the area where the tumor had been if there is a complete clinical response).
Pathologic complete response rate is calculated as number of patients achieving pathologic complete response divided by all eligible and treated patients
|
Assessed at surgery time
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Resection Rate for T3 Rectal Cancers
Tidsramme: Assessed at surgery time
|
Resection rate is defined as number of patients with T3 rectal cancer who underwent curative surgical resection among all eligible and treated patients with T3 rectal cancers
|
Assessed at surgery time
|
|
Resection Rate for T4 Rectal Cancers
Tidsramme: Assessed at surgery time
|
Resection rate is defined as number of patients with T4 rectal cancer who underwent curative surgical resection among all eligible and treated patients with T4 rectal cancers
|
Assessed at surgery time
|
|
5-year Overall Survival Rate
Tidsramme: survival follow-up began after post-operative chemotherapy, assessed every 3 months for patients 3-5 years from registration, every 6 months for patients 5-10 years from registration and every 12 months for patients 10 years from registration
|
Overall survival is defined as time from registration to death from any cause.
5-year overall survival rate is estimated using Kaplan-Meier method.
|
survival follow-up began after post-operative chemotherapy, assessed every 3 months for patients 3-5 years from registration, every 6 months for patients 5-10 years from registration and every 12 months for patients 10 years from registration
|
|
5-year Recurrence-free Survival Rate
Tidsramme: recurrence follow-up began after post-operative chemotherapy, assessed every 3 months for patients 3-5 years from registration, every 6 months for patients 5-10 years from registration and every 12 months for patients 10 years from registration
|
Recurrence free survival is defined as time from surgery to disease recurrence or death without recurrence (whichever occurred first) among resected patients.
5-year recurrence-free survival rate is estimated using Kaplan-Meier method, with 90% confidence interval calculated using Greenwood's formula.
|
recurrence follow-up began after post-operative chemotherapy, assessed every 3 months for patients 3-5 years from registration, every 6 months for patients 5-10 years from registration and every 12 months for patients 10 years from registration
|
Samarbejdspartnere og efterforskere
Sponsor
Efterforskere
- Ledende efterforsker: Jerome C Landry, ECOG-ACRIN Cancer Research Group
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Sygdomme i fordøjelsessystemet
- Neoplasmer
- Neoplasmer efter sted
- Gastrointestinale neoplasmer
- Neoplasmer i fordøjelsessystemet
- Gastrointestinale sygdomme
- Tarmsygdomme
- Intestinale neoplasmer
- Endetarmssygdomme
- Kolorektale neoplasmer
- Rektale neoplasmer
- Lægemidlers fysiologiske virkninger
- Molekylære mekanismer for farmakologisk virkning
- Antimetabolitter, Antineoplastisk
- Antimetabolitter
- Antineoplastiske midler
- Immunsuppressive midler
- Immunologiske faktorer
- Beskyttelsesagenter
- Angiogenese-hæmmere
- Angiogenesemodulerende midler
- Vækststoffer
- Væksthæmmere
- Mikronæringsstoffer
- Vitaminer
- Knogletæthedsbevarende midler
- Calciumregulerende hormoner og midler
- Modgift
- Vitamin B kompleks
- Hæmatinik
- Antistoffer
- Fluorouracil
- Capecitabin
- Oxaliplatin
- Immunoglobuliner
- Bevacizumab
- Leucovorin
- Kalk
- Levoleucovorin
- Antistoffer, monoklonale
- Antineoplastiske midler, immunologiske
- Folsyre
- Calcium, diæt
- Immunoglobulin G
- Endotelvækstfaktorer
Andre undersøgelses-id-numre
- NCI-2009-01081 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- U10CA180820 (U.S. NIH-bevilling/kontrakt)
- U10CA021115 (U.S. NIH-bevilling/kontrakt)
- CDR0000471148
- ECOG-E3204
- E3204 (Anden identifikator: CTEP)
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