- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving 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
Studieoversikt
Status
Detaljert 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.
Studietype
Registrering (Faktiske)
Fase
- Fase 2
Kontakter og plasseringer
Studiesteder
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Alabama
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Birmingham, Alabama, Forente stater, 35233
- University of Alabama at Birmingham Cancer Center
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Connecticut
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New Britain, Connecticut, Forente stater, 06050
- The Hospital of Central Connecticut
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Georgia
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Atlanta, Georgia, Forente stater, 30322
- Emory University Hospital/Winship Cancer Institute
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Decatur, Georgia, Forente stater, 30033
- Atlanta VA Medical Center
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Macon, Georgia, Forente stater, 31201
- Medical Center of Central Georgia
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Illinois
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Aurora, Illinois, Forente stater, 60504
- Rush - Copley Medical Center
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Berwyn, Illinois, Forente stater, 60402
- MacNeal Hospital and Cancer Center
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Chicago, Illinois, Forente stater, 60611
- Northwestern University
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Chicago, Illinois, Forente stater, 60625
- Swedish Covenant Hospital
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Chicago, Illinois, Forente stater, 60611
- Hematology and Oncology Associates
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Chicago, Illinois, Forente stater, 60657
- Presence Saint Joseph Hospital-Chicago
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Chicago, Illinois, Forente stater, 60612
- Jesse Brown Veterans Affairs Medical Center
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Chicago, Illinois, Forente stater, 60616
- Mercy Hospital and Medical Center
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Effingham, Illinois, Forente stater, 62401
- Saint Anthony Memorial Hospital
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Highland Park, Illinois, Forente stater, 60035
- Hematology Oncology Associates of Illinois-Highland Park
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Hinsdale, Illinois, Forente stater, 60521
- Hinsdale Hematology Oncology Associates Incorporated
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Joliet, Illinois, Forente stater, 60435
- Joliet Oncology-Hematology Associates Limited
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Joliet, Illinois, Forente stater, 60432
- Midwest Center for Hematology Oncology
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Libertyville, Illinois, Forente stater, 60048
- NorthShore Hematology Oncology-Libertyville
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Moline, Illinois, Forente stater, 61265
- Garneau, Stewart C MD (UIA Investigator)
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Moline, Illinois, Forente stater, 61265
- Porubcin, Michael MD (UIA Investigator)
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Moline, Illinois, Forente stater, 61265
- Spector, David MD (UIA Investigator)
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Moline, Illinois, Forente stater, 61265
- Trinity Medical Center
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Moline, Illinois, Forente stater, 61265
- Sharis, Christine M MD (UIA Investigator)
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Moline, Illinois, Forente stater, 61265
- Stoffel, Thomas J MD (UIA Investigator)
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Moline, Illinois, Forente stater, 61265
- Vigliotti, Antonio, P.G. M.D. (UIA Investigator)
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Naperville, Illinois, Forente stater, 60563
- DuPage Medical Group-Ogden
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Niles, Illinois, Forente stater, 60714
- Illinois Cancer Specialists-Niles
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Skokie, Illinois, Forente stater, 60076
- Hematology Oncology Associates of Illinois - Skokie
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Skokie, Illinois, Forente stater, 60076
- Edward H Kaplan MD and Associates
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Urbana, Illinois, Forente stater, 61801
- Carle Cancer Center
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Indiana
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Michigan City, Indiana, Forente stater, 46360
- Franciscan Saint Anthony Health-Michigan City
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Iowa
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Bettendorf, Iowa, Forente stater, 52722
- Constantinou, Costas L MD (UIA Investigator)
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Sioux City, Iowa, Forente stater, 51101
- Siouxland Regional Cancer Center
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Sioux City, Iowa, Forente stater, 51102
- Mercy Medical Center-Sioux City
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Sioux City, Iowa, Forente stater, 51104
- Saint Luke's Regional Medical Center
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Michigan
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Kalamazoo, Michigan, Forente stater, 49007
- West Michigan Cancer Center
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Kalamazoo, Michigan, Forente stater, 49007
- Bronson Methodist Hospital
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Kalamazoo, Michigan, Forente stater, 49048
- Borgess Medical Center
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Minnesota
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Burnsville, Minnesota, Forente stater, 55337
- Fairview Ridges Hospital
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Coon Rapids, Minnesota, Forente stater, 55433
- Mercy Hospital
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Edina, Minnesota, Forente stater, 55435
- Fairview-Southdale Hospital
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Fridley, Minnesota, Forente stater, 55432
- Unity Hospital
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Hutchinson, Minnesota, Forente stater, 55350
- Hutchinson Area Health Care
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Litchfield, Minnesota, Forente stater, 55355
- Meeker County Memorial Hospital
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Maplewood, Minnesota, Forente stater, 55109
- Saint John's Hospital - Healtheast
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Maplewood, Minnesota, Forente stater, 55109
- Minnesota Oncology Hematology PA-Maplewood
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Minneapolis, Minnesota, Forente stater, 55415
- Hennepin County Medical Center
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Minneapolis, Minnesota, Forente stater, 55407
- Abbott-Northwestern Hospital
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Minneapolis, Minnesota, Forente stater, 55407
- Virginia Piper Cancer Institute
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Robbinsdale, Minnesota, Forente stater, 55422
- North Memorial Medical Health Center
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Saint Louis Park, Minnesota, Forente stater, 55416
- Park Nicollet Clinic - Saint Louis Park
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Saint Louis Park, Minnesota, Forente stater, 55416
- Metro Minnesota Community Oncology Research Consortium
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Saint Paul, Minnesota, Forente stater, 55101
- Regions Hospital
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Saint Paul, Minnesota, Forente stater, 55102
- United Hospital
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Saint Paul, Minnesota, Forente stater, 55102
- Saint Joseph's Hospital - Healtheast
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Shakopee, Minnesota, Forente stater, 55379
- Saint Francis Regional Medical Center
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Waconia, Minnesota, Forente stater, 55387
- Ridgeview Medical Center
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Woodbury, Minnesota, Forente stater, 55125
- Minnesota Oncology Hematology PA-Woodbury
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Woodbury, Minnesota, Forente stater, 55125
- Woodwinds Health Campus
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Nebraska
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Lincoln, Nebraska, Forente stater, 68510
- Nebraska Cancer Research Center
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Omaha, Nebraska, Forente stater, 68124
- Alegent Health Bergan Mercy Medical Center
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Omaha, Nebraska, Forente stater, 68122
- Alegent Health Immanuel Medical Center
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Omaha, Nebraska, Forente stater, 68131
- Creighton University Medical Center
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Omaha, Nebraska, Forente stater, 68106
- Missouri Valley Cancer Consortium
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New Jersey
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Mount Holly, New Jersey, Forente stater, 08060
- Virtua Memorial
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Sparta, New Jersey, Forente stater, 07871
- Sparta Cancer Treatment Center
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Voorhees, New Jersey, Forente stater, 08043
- Virtua Voorhees
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Woodbury, New Jersey, Forente stater, 08096
- Inspira Medical Center Woodbury
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New York
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Bronx, New York, Forente stater, 10467
- Montefiore Medical Center - Moses Campus
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Bronx, New York, Forente stater, 10466
- Montefiore Medical Center-Wakefield Campus
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Ohio
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Akron, Ohio, Forente stater, 44304
- Summa Akron City Hospital/Cooper Cancer Center
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Barberton, Ohio, Forente stater, 44203
- Summa Barberton Hospital
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Bellefontaine, Ohio, Forente stater, 43311
- Mary Rutan Hospital
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Chillicothe, Ohio, Forente stater, 45601
- Adena Regional Medical Center
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Columbus, Ohio, Forente stater, 43214
- Riverside Methodist Hospital
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Columbus, Ohio, Forente stater, 43228
- Doctors Hospital
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Columbus, Ohio, Forente stater, 43215
- Grant Medical Center
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Columbus, Ohio, Forente stater, 43222
- Mount Carmel Health Center West
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Delaware, Ohio, Forente stater, 43015
- Grady Memorial Hospital
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Lancaster, Ohio, Forente stater, 43130
- Fairfield Medical Center
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Lima, Ohio, Forente stater, 45801
- Saint Rita's Medical Center
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Marietta, Ohio, Forente stater, 45750
- Marietta Memorial Hospital
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Newark, Ohio, Forente stater, 43055
- Licking Memorial Hospital
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Springfield, Ohio, Forente stater, 45505
- Springfield Regional Medical Center
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Westerville, Ohio, Forente stater, 43081
- Saint Ann's Hospital
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Zanesville, Ohio, Forente stater, 43701
- Genesis Healthcare System Cancer Care Center
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Oklahoma
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Tulsa, Oklahoma, Forente stater, 74136
- Natalie Warren Bryant Cancer Center at Saint Francis
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Pennsylvania
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Allentown, Pennsylvania, Forente stater, 18103
- Lehigh Valley Hospital-Cedar Crest
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Darby, Pennsylvania, Forente stater, 19023-1291
- Mercy Fitzgerald Hospital
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East Stroudsburg, Pennsylvania, Forente stater, 18301
- Pocono Medical Center
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Ephrata, Pennsylvania, Forente stater, 17522
- Ephrata Cancer Center
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Media, Pennsylvania, Forente stater, 19063
- Riddle Memorial Hospital
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Philadelphia, Pennsylvania, Forente stater, 19111
- Fox Chase Cancer Center
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Philadelphia, Pennsylvania, Forente stater, 19107
- Thomas Jefferson University Hospital
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Philadelphia, Pennsylvania, Forente stater, 19141
- Einstein Medical Center Philadelphia
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Philadelphia, Pennsylvania, Forente stater, 19114
- Aria Health-Torresdale Campus
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Scranton, Pennsylvania, Forente stater, 18508
- Hematology and Oncology Associates of North East Pennsylvania
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Upland, Pennsylvania, Forente stater, 19013
- Associates In Hematology Oncology PC-Upland
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South Dakota
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Sioux Falls, South Dakota, Forente stater, 57105
- Avera Cancer Institute
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Sioux Falls, South Dakota, Forente stater, 57117-5134
- Sanford USD Medical Center - Sioux Falls
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Sioux Falls, South Dakota, Forente stater, 57104
- Sanford Cancer Center Oncology Clinic
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Sioux Falls, South Dakota, Forente stater, 57105
- Medical X-Ray Center
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Sioux Falls, South Dakota, Forente stater, 57105
- Avera McKennan Hospital and University Health Center
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Texas
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Dallas, Texas, Forente stater, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Wisconsin
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La Crosse, Wisconsin, Forente stater, 54601
- Gundersen Lutheran Medical Center
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Milwaukee, Wisconsin, Forente stater, 53226
- Froedtert and The Medical College of Wisconsin
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
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 studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Eksperimentell: Treatment (bevacizumab and chemoradiotherapy)
See Detailed Description
|
Gitt IV
Andre navn:
Gitt IV
Andre navn:
Gitt IV
Andre navn:
Gitt PO
Andre navn:
Gitt IV
Andre navn:
Gjennomgå kirurgisk reseksjon
Gjennomgå strålebehandling
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
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 |
Tiltaksbeskrivelse |
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
|
Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Jerome C Landry, ECOG-ACRIN Cancer Research Group
Publikasjoner og nyttige lenker
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Sykdommer i fordøyelsessystemet
- Neoplasmer
- Neoplasmer etter nettsted
- Gastrointestinale neoplasmer
- Neoplasmer i fordøyelsessystemet
- Gastrointestinale sykdommer
- Tarmsykdommer
- Intestinale neoplasmer
- Rektale sykdommer
- Kolorektale neoplasmer
- Rektale neoplasmer
- Fysiologiske effekter av legemidler
- Molekylære mekanismer for farmakologisk virkning
- Antimetabolitter, antineoplastisk
- Antimetabolitter
- Antineoplastiske midler
- Immunsuppressive midler
- Immunologiske faktorer
- Beskyttende agenter
- Angiogenese-hemmere
- Angiogenesemodulerende midler
- Vekststoffer
- Veksthemmere
- Mikronæringsstoffer
- Vitaminer
- Bone Density Conservation Agents
- Kalsiumregulerende hormoner og midler
- Motgift
- Vitamin B kompleks
- Hematinikk
- Antistoffer
- Fluorouracil
- Capecitabin
- Oksaliplatin
- Immunoglobuliner
- Bevacizumab
- Leucovorin
- Kalsium
- Levoleucovorin
- Antistoffer, monoklonale
- Antineoplastiske midler, immunologiske
- Folsyre
- Kalsium, kosthold
- Immunoglobulin G
- Endotelvekstfaktorer
Andre studie-ID-numre
- NCI-2009-01081 (Registeridentifikator: CTRP (Clinical Trial Reporting Program))
- U10CA180820 (U.S. NIH-stipend/kontrakt)
- U10CA021115 (U.S. NIH-stipend/kontrakt)
- CDR0000471148
- ECOG-E3204
- E3204 (Annen identifikator: CTEP)
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