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
調査の概要
状態
詳細な説明
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.
研究の種類
入学 (実際)
段階
- フェーズ2
連絡先と場所
研究場所
-
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Alabama
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Birmingham、Alabama、アメリカ、35233
- University of Alabama at Birmingham Cancer Center
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Connecticut
-
New Britain、Connecticut、アメリカ、06050
- The Hospital of Central Connecticut
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-
Georgia
-
Atlanta、Georgia、アメリカ、30322
- Emory University Hospital/Winship Cancer Institute
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Decatur、Georgia、アメリカ、30033
- Atlanta VA Medical Center
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Macon、Georgia、アメリカ、31201
- Medical Center of Central Georgia
-
-
Illinois
-
Aurora、Illinois、アメリカ、60504
- Rush - Copley Medical Center
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Berwyn、Illinois、アメリカ、60402
- MacNeal Hospital and Cancer Center
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Chicago、Illinois、アメリカ、60611
- Northwestern University
-
Chicago、Illinois、アメリカ、60625
- Swedish Covenant Hospital
-
Chicago、Illinois、アメリカ、60611
- Hematology and Oncology Associates
-
Chicago、Illinois、アメリカ、60657
- Presence Saint Joseph Hospital-Chicago
-
Chicago、Illinois、アメリカ、60612
- Jesse Brown Veterans Affairs Medical Center
-
Chicago、Illinois、アメリカ、60616
- Mercy Hospital and Medical Center
-
Effingham、Illinois、アメリカ、62401
- Saint Anthony Memorial Hospital
-
Highland Park、Illinois、アメリカ、60035
- Hematology Oncology Associates of Illinois-Highland Park
-
Hinsdale、Illinois、アメリカ、60521
- Hinsdale Hematology Oncology Associates Incorporated
-
Joliet、Illinois、アメリカ、60435
- Joliet Oncology-Hematology Associates Limited
-
Joliet、Illinois、アメリカ、60432
- Midwest Center for Hematology Oncology
-
Libertyville、Illinois、アメリカ、60048
- NorthShore Hematology Oncology-Libertyville
-
Moline、Illinois、アメリカ、61265
- Garneau, Stewart C MD (UIA Investigator)
-
Moline、Illinois、アメリカ、61265
- Porubcin, Michael MD (UIA Investigator)
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Moline、Illinois、アメリカ、61265
- Spector, David MD (UIA Investigator)
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Moline、Illinois、アメリカ、61265
- Trinity Medical Center
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Moline、Illinois、アメリカ、61265
- Sharis, Christine M MD (UIA Investigator)
-
Moline、Illinois、アメリカ、61265
- Stoffel, Thomas J MD (UIA Investigator)
-
Moline、Illinois、アメリカ、61265
- Vigliotti, Antonio, P.G. M.D. (UIA Investigator)
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Naperville、Illinois、アメリカ、60563
- DuPage Medical Group-Ogden
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Niles、Illinois、アメリカ、60714
- Illinois Cancer Specialists-Niles
-
Skokie、Illinois、アメリカ、60076
- Hematology Oncology Associates of Illinois - Skokie
-
Skokie、Illinois、アメリカ、60076
- Edward H Kaplan MD and Associates
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Urbana、Illinois、アメリカ、61801
- Carle Cancer Center
-
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Indiana
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Michigan City、Indiana、アメリカ、46360
- Franciscan Saint Anthony Health-Michigan City
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Iowa
-
Bettendorf、Iowa、アメリカ、52722
- Constantinou, Costas L MD (UIA Investigator)
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Sioux City、Iowa、アメリカ、51101
- Siouxland Regional Cancer Center
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Sioux City、Iowa、アメリカ、51102
- Mercy Medical Center-Sioux City
-
Sioux City、Iowa、アメリカ、51104
- Saint Luke's Regional Medical Center
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-
Michigan
-
Kalamazoo、Michigan、アメリカ、49007
- West Michigan Cancer Center
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Kalamazoo、Michigan、アメリカ、49007
- Bronson Methodist Hospital
-
Kalamazoo、Michigan、アメリカ、49048
- Borgess Medical Center
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-
Minnesota
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Burnsville、Minnesota、アメリカ、55337
- Fairview Ridges Hospital
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Coon Rapids、Minnesota、アメリカ、55433
- Mercy Hospital
-
Edina、Minnesota、アメリカ、55435
- Fairview-Southdale Hospital
-
Fridley、Minnesota、アメリカ、55432
- Unity Hospital
-
Hutchinson、Minnesota、アメリカ、55350
- Hutchinson Area Health Care
-
Litchfield、Minnesota、アメリカ、55355
- Meeker County Memorial Hospital
-
Maplewood、Minnesota、アメリカ、55109
- Saint John's Hospital - Healtheast
-
Maplewood、Minnesota、アメリカ、55109
- Minnesota Oncology Hematology PA-Maplewood
-
Minneapolis、Minnesota、アメリカ、55415
- Hennepin County Medical Center
-
Minneapolis、Minnesota、アメリカ、55407
- Abbott-Northwestern Hospital
-
Minneapolis、Minnesota、アメリカ、55407
- Virginia Piper Cancer Institute
-
Robbinsdale、Minnesota、アメリカ、55422
- North Memorial Medical Health Center
-
Saint Louis Park、Minnesota、アメリカ、55416
- Park Nicollet Clinic - Saint Louis Park
-
Saint Louis Park、Minnesota、アメリカ、55416
- Metro Minnesota Community Oncology Research Consortium
-
Saint Paul、Minnesota、アメリカ、55101
- Regions Hospital
-
Saint Paul、Minnesota、アメリカ、55102
- United Hospital
-
Saint Paul、Minnesota、アメリカ、55102
- Saint Joseph's Hospital - Healtheast
-
Shakopee、Minnesota、アメリカ、55379
- Saint Francis Regional Medical Center
-
Waconia、Minnesota、アメリカ、55387
- Ridgeview Medical Center
-
Woodbury、Minnesota、アメリカ、55125
- Minnesota Oncology Hematology PA-Woodbury
-
Woodbury、Minnesota、アメリカ、55125
- Woodwinds Health Campus
-
-
Nebraska
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Lincoln、Nebraska、アメリカ、68510
- Nebraska Cancer Research Center
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Omaha、Nebraska、アメリカ、68124
- Alegent Health Bergan Mercy Medical Center
-
Omaha、Nebraska、アメリカ、68122
- Alegent Health Immanuel Medical Center
-
Omaha、Nebraska、アメリカ、68131
- Creighton University Medical Center
-
Omaha、Nebraska、アメリカ、68106
- Missouri Valley Cancer Consortium
-
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New Jersey
-
Mount Holly、New Jersey、アメリカ、08060
- Virtua Memorial
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Sparta、New Jersey、アメリカ、07871
- Sparta Cancer Treatment Center
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Voorhees、New Jersey、アメリカ、08043
- Virtua Voorhees
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Woodbury、New Jersey、アメリカ、08096
- Inspira Medical Center Woodbury
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New York
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Bronx、New York、アメリカ、10467
- Montefiore Medical Center - Moses Campus
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Bronx、New York、アメリカ、10466
- Montefiore Medical Center-Wakefield Campus
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Ohio
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Akron、Ohio、アメリカ、44304
- Summa Akron City Hospital/Cooper Cancer Center
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Barberton、Ohio、アメリカ、44203
- Summa Barberton Hospital
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Bellefontaine、Ohio、アメリカ、43311
- Mary Rutan Hospital
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Chillicothe、Ohio、アメリカ、45601
- Adena Regional Medical Center
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Columbus、Ohio、アメリカ、43214
- Riverside Methodist Hospital
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Columbus、Ohio、アメリカ、43228
- Doctors Hospital
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Columbus、Ohio、アメリカ、43215
- Grant Medical Center
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Columbus、Ohio、アメリカ、43222
- Mount Carmel Health Center West
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Delaware、Ohio、アメリカ、43015
- Grady Memorial Hospital
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Lancaster、Ohio、アメリカ、43130
- Fairfield Medical Center
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Lima、Ohio、アメリカ、45801
- Saint Rita's Medical Center
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Marietta、Ohio、アメリカ、45750
- Marietta Memorial Hospital
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Newark、Ohio、アメリカ、43055
- Licking Memorial Hospital
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Springfield、Ohio、アメリカ、45505
- Springfield Regional Medical Center
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Westerville、Ohio、アメリカ、43081
- Saint Ann's Hospital
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Zanesville、Ohio、アメリカ、43701
- Genesis Healthcare System Cancer Care Center
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Oklahoma
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Tulsa、Oklahoma、アメリカ、74136
- Natalie Warren Bryant Cancer Center at Saint Francis
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Pennsylvania
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Allentown、Pennsylvania、アメリカ、18103
- Lehigh Valley Hospital-Cedar Crest
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Darby、Pennsylvania、アメリカ、19023-1291
- Mercy Fitzgerald Hospital
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East Stroudsburg、Pennsylvania、アメリカ、18301
- Pocono Medical Center
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Ephrata、Pennsylvania、アメリカ、17522
- Ephrata Cancer Center
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Media、Pennsylvania、アメリカ、19063
- Riddle Memorial Hospital
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Philadelphia、Pennsylvania、アメリカ、19111
- Fox Chase Cancer Center
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Philadelphia、Pennsylvania、アメリカ、19107
- Thomas Jefferson University Hospital
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Philadelphia、Pennsylvania、アメリカ、19141
- Einstein Medical Center Philadelphia
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Philadelphia、Pennsylvania、アメリカ、19114
- Aria Health-Torresdale Campus
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Scranton、Pennsylvania、アメリカ、18508
- Hematology and Oncology Associates of North East Pennsylvania
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Upland、Pennsylvania、アメリカ、19013
- Associates In Hematology Oncology PC-Upland
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South Dakota
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Sioux Falls、South Dakota、アメリカ、57105
- Avera Cancer Institute
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Sioux Falls、South Dakota、アメリカ、57117-5134
- Sanford USD Medical Center - Sioux Falls
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Sioux Falls、South Dakota、アメリカ、57104
- Sanford Cancer Center Oncology Clinic
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Sioux Falls、South Dakota、アメリカ、57105
- Medical X-Ray Center
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Sioux Falls、South Dakota、アメリカ、57105
- Avera McKennan Hospital and University Health Center
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Texas
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Dallas、Texas、アメリカ、75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Wisconsin
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La Crosse、Wisconsin、アメリカ、54601
- Gundersen Lutheran Medical Center
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Milwaukee、Wisconsin、アメリカ、53226
- Froedtert and The Medical College of Wisconsin
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
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
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:なし
- 介入モデル:単一グループの割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的:Treatment (bevacizumab and chemoradiotherapy)
See Detailed Description
|
与えられた IV
他の名前:
与えられた IV
他の名前:
与えられた IV
他の名前:
与えられたPO
他の名前:
与えられた IV
他の名前:
外科的切除を受ける
放射線治療を受ける
他の名前:
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Pathologic Complete Response Rate
時間枠: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
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Resection Rate for T3 Rectal Cancers
時間枠: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
時間枠: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
時間枠: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
時間枠: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
|
協力者と研究者
捜査官
- 主任研究者:Jerome C Landry、ECOG-ACRIN Cancer Research Group
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
- 消化器系疾患
- 新生物
- 部位別新生物
- 消化器腫瘍
- 消化器系腫瘍
- 消化器疾患
- 腸の病気
- 腸の腫瘍
- 直腸疾患
- 結腸直腸腫瘍
- 直腸腫瘍
- 薬の生理作用
- 薬理作用の分子機構
- 代謝拮抗薬、抗腫瘍薬
- 代謝拮抗剤
- 抗悪性腫瘍薬
- 免疫抑制剤
- 免疫学的要因
- 保護剤
- 血管新生阻害剤
- 血管新生調節剤
- 成長物質
- 成長阻害剤
- 微量栄養素
- ビタミン
- 骨密度維持剤
- カルシウム調節ホルモンおよびエージェント
- 解毒剤
- ビタミンB複合体
- 造血学
- 抗体
- フルオロウラシル
- カペシタビン
- オキサリプラチン
- 免疫グロブリン
- ベバシズマブ
- ロイコボリン
- カルシウム
- レボルコボリン
- 抗体、モノクローナル
- 抗悪性腫瘍剤、免疫
- 葉酸
- カルシウム、食事
- 免疫グロブリンG
- 内皮増殖因子
その他の研究ID番号
- NCI-2009-01081 (レジストリ識別子:CTRP (Clinical Trial Reporting Program))
- U10CA180820 (米国 NIH グラント/契約)
- U10CA021115 (米国 NIH グラント/契約)
- CDR0000471148
- ECOG-E3204
- E3204 (その他の識別子:CTEP)
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。