FOLFOX pré-operatório versus quimioterapia adaptada ao risco pós-operatório em pacientes com câncer retal localmente avançado
FOLFOX pré-operatório versus quimioterapia adaptada ao risco pós-operatório em pacientes com câncer retal localmente avançado e baixo risco de falha local: um estudo randomizado de fase III do grupo alemão de estudos de câncer retal
This is a multicenter, prospective, randomized, stratified, controlled, open-label study comparing preoperative FOLFOX versus postoperative risk-adapted chemotherapy in patients with locally advanced rectal cancer and low risk for local failure
Visão geral do estudo
Status
Status
Condições
Condições
Intervenção / Tratamento
Intervenção / Tratamento
Descrição detalhada
Patients with locally advanced rectal cancer are generally treated with preoperative 5-FU- or capecitabine-based chemo-radiotherapy (CRT) and total mesorectal excision (TME) surgery in order to decrease the rate of local failure. In patients with low risk for local failure in the middle third of the rectum (cT3a/b, N-) as determined with quality controlled MRI, the German S3 guidelines and the ESMO clinical practice guidelines state that neoadjuvant radiotherapy may be omitted. However, distant failure rate is still substantial in the range of 20-25% in these patients highlighting the need for more effective systemic treatment.
The hereby proposed ACO/ARO/AIO-18.2 randomized trial incorporates three novel aspects: (1) patient selection relies on strict and quality controlled MRI features and therefore identifies a cohort without imminent need for radiotherapy, (2) the sequence of chemotherapy and surgery is changed in a way that chemotherapy is administered preoperatively to increase the rate of patients treated with chemotherapy, and (3) three months of neoadjuvant FOLFOX or XELOX (instead of up to 6 months adjuvant chemotherapy) are used as a sole perioperative treatment in order to administer effective doses of the presumably most effective perioperative treatment at an early time point during the course of disease.
Thus, patients with locally advanced rectal cancer but low risk for local failure (cT1/2N+ in all thirds of the rectum, cT3a/b N- in the middle third, and cT3-4 Nany in the upper third) will be included and randomized between three months of neoadjuvant FOLFOX/XELOX in Arm A and primary resection of the tumor followed by risk (i.e. stage) adapted chemotherapy in Arm B.
Tipo de estudo
Tipo de estudo
Inscrição (Real)
Inscrição
Estágio
Estágio
- Fase 3
Contactos e Locais
Locais de estudo
-
-
-
Mannheim, Alemanha, 68167
- Unversity Hospital Mannheim
-
-
Critérios de participação
Critérios de elegibilidade
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
-
Male and female patients with histologically confirmed diagnosis of rectal adenocarcinoma localised 0 - 16 cm from the anocutaneous line as measured by rigid rectoscopy (i.e. lower, middle and upper third of the rectum), depending on MRI-defined inclusion criteria (see below).
-
Staging requirements: High-resolution magnetic resonance imaging (MRI) of the pelvis is the mandatory local staging procedure.
-
Transrectal endoscopic ultrasound (EUS) is used to help discriminate between T1/2 and early T3 tumors.
-
MRI-defined inclusion criteria:
i. Lower third (0-6 cm):
- cT1/2 with clear cN+ based on defined MRI criteria or T3a-b (i.e. maximum infiltration into the perirectal fat of 5mm), provided CRM > 2mm and EMVI-** ii. Middle third (≥ 6-12 cm):
- cT1/2 with clear cN+ provided CRM- and EMVI-**
- cT3 irrespective of the depth of invasion into the perirectal fat, provided no evidence that tumor is adjacent to (defined as within 2 mm of) the mesorectal fascia on MRI (i.e. CRM > 2 mm), N0 or N1, EMVI-** iii. Upper third (≥ 12-16 cm):
- cT1/2 with clear cN+, irrespective of CRM and EMVI
- any cT3-4 irrespective of nodal status, CRM and EMVI.
-
Spiral-CT of the abdomen and chest to exclude distant metastases.
-
Aged at least 18 years. No upper age limit.
-
WHO/ECOG Performance Status ≤1.
-
Adequate haematological, hepatic, renal and metabolic function parameters:
-
Leukocytes ≥ 3.000/mm³, ANC ≥ 2.000/mm³, platelets ≥ 100.000/mm³, Hb > 9 g/dl
-
Serum creatinine ≤ 1.5 x upper limit of normal
-
Bilirubin ≤ 2.0 mg/dl, SGOT-SGPT, and AP ≤ 3 x upper limit of normal.
-
QTc interval (Bazett**) ≤ 440 ms
-
Informed consent of the patient.
"**" Formula for QTc interval calculation (Bazett): QTc= ((QT) ̅" (ms)" )/√(RR (sec))= ((QT) ̅" (ms)" )/√(60/(frequency (1/min)))
Exclusion Criteria:
- Distant metastases (to be excluded by CT scan of the thorax and abdomen).
- Prior antineoplastic therapy for rectal cancer.
- Prior radiotherapy of the pelvic region.
- Major surgery within the last 4 weeks prior to inclusion.
- Subject pregnant or breast feeding, or planning to become pregnant within 6 months after the end of treatment.
- Subject (male or female) is not willing to use highly effective*** methods of contraception during treatment and for 6 months (male or female) after the end of treatment Male patients treated with Oxaliplatin should take legal advice concerning sperm conservation before start of therapy and should additionally use a condom during treatment period. Their female partner of childbearing potential should also use an appropriate contraceptive measure.
- On-treatment participation in a clinical study in the period 30 days prior to inclusion.
- Previous or current drug abuse.
- Other concomitant antineoplastic therapy.
- Serious concurrent diseases, including neurologic or psychiatric disorders (incl. dementia and uncontrolled seizures), active, uncontrolled infections, active, disseminated coagulation disorder.
- Clinically significant cardiovascular disease in (incl. myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) ≤ 6 months before enrolment.
- Chronic diarrhea (> grade 1 according NCI CTCAE).
- Prior or concurrent malignancy ≤ 3 years prior to enrolment in study (Exception: non-melanoma skin cancer or cervical carcinoma FIGO stage 0-1), if the patient is continuously disease-free.
- Known allergic reactions or hypersensitivity on study medication or to any of the other excipients.
- Evidence of peripheral sensory neuropathy > grade 1 according to CTCAE version 5.0 (see appendix).
- Severe kidney dysfunction (creatinine clearance < 30 ml/min).
- Recent or concurrent treatment with brivudine.
- Pernicious or other megaloblastic anaemia caused by vitamin B12 deficiency.
- Known dihydropyrimidine dehydrogenase deficiency.
- Psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule (these conditions should be discussed with the patient before registration in the trial).
"***"highly effective (i.e. failure rate of <1% per year when used consistently and correctly) methods: intravaginal and transdermal combined (estrogen and progestogen containing) hormonal contraception; injectable and implantable progestogen-only hormonal contraception; intrauterine device (IUD); intrauterine hormone-releasing system (IUS); bilateral tubal occlusion; vasectomized partner; sexual abstinence (complete abstinence is defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments).
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Número de braços
Armas e Intervenções
Grupo de Participantes / BraçoGrupo de Participantes / Braço |
Intervenção / TratamentoIntervenção / Tratamento |
|---|---|
|
Experimental: A (experimental arm)
The experimental arm A starts with 6 cycles of mFOLFOX or 4 cycles of XELOX. Surgery is scheduled four or six weeks after day 1 of the last mFOLFOX or XELOX cycle, respectively. No postoperative chemotherapy is planned |
neoadjuvant application Folinic acid: 400 mg/m2, 2h i.v., on day 1 Oxaliplatin: 85 mg/m2, 2-6h i.v., on day 1 5-FU: 2400 mg/m2, 46-48h i.v., on day 1. Cycles are repeated on day 15. A total of 6 cycles are administered.
Outros nomes:
neoadjuvant application Capecitabine: 1,000 mg/m2 bid, po, on days 1-14 Oxaliplatin: 130 mg/m2, 2-6h i.v. day 1 Cycles are repeated on day 22. A total of 4 cycles are administered.
Outros nomes:
|
|
Comparador Ativo: B (control arm)
In the standard arm B, patients undergo surgical resection of the primary tumor followed by stage- (risk-)adapted adjuvant chemotherapy 4-8 weeks after surgery according to recommendations of the S3 guidelines in analogy to colon cancer. Details of the recommended protocols are provided in the protocol. |
adjuvant application Folinic acid: 400 mg/m2, 2h i.v., on day 1 Oxaliplatin: 85 mg/m2, 2-6h i.v., on day 1 5-FU: 2400 mg/m2, 46-48h i.v., on day 1. Cycles are repeated on day 15. A total of 6 cycles are administered.
Outros nomes:
adjuvant application Capecitabine: 1,000 mg/m2 bid, po, on days 1-14 Oxaliplatin: 130 mg/m2, 2-6h i.v. day 1 Cycles are repeated on day 22. A total of 4 cycles are administered.
Outros nomes:
adjuvant application Capecitabine: 1,250 mg/m2 bid, po, on days 1-14 Cycles are repeated on day 22. A total of 8 cycles are administered.
Outros nomes:
adjuvant application Folinic acid 2h i.v. 500 mg/m² 5-FU 2,600mg/m² (24h infusion) Days 1, 8, 15, 22, 29, 36; cycle is repeated day 57 (representing one cycle); a total of 3 cycles should be administered.
Outros nomes:
adjuvant application Folinic acid 2h i.v. 200 mg/m² days 1 and 2 5-FU 400mg/m² bolus followed by 600mg/m² 22h infusion days 1 and 2 The cycle is repeated day 15; a total of 12 cycles should be administered.
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
disease-free survival
Prazo: up to 3 years
|
time from randomisation to one of the following events: no surgery or non-radical (R2) surgery of the primary tumour, locoregional recurrence after R0/1 resection of the primary tumour, second primary colorectal or other cancer, metastatic disease or progression, or death from any cause, whichever occurred first. |
up to 3 years
|
Medidas de resultados secundários
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Acute and late toxicity
Prazo: From date of informed consent until the End of Treatment or 30 days after the last dose of study treatment
|
assessment of acute and late toxicity according to NCI CTCAE version 5.0 |
From date of informed consent until the End of Treatment or 30 days after the last dose of study treatment
|
|
Compliance (completion rate) of chemotherapy
Prazo: From date of randomization until end of chemotherapy, approx. 12 (arm A) respectively up to 34 (arm B) weeks after randomization
|
Rate of completion of administered chemotherapy |
From date of randomization until end of chemotherapy, approx. 12 (arm A) respectively up to 34 (arm B) weeks after randomization
|
|
Surgical morbidity and complications
Prazo: After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
Surgical morbidity and complications if surgery is performed and events occur |
After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
|
Pathological UICC-staging, including pCR (ypT0N0) rate
Prazo: After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
Pathological staging according UICC criteria, including detailed information about pathologically assessed complete response rate (ypT0N0) |
After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
|
R0 resection rate, Negative circumferential resection rate (CRM > 1mm)
Prazo: After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
defined as microscopically margin negative resection with no gross or microscopic tumor remains in the area of the primary tumor and/or samples regional lymph nodes based on evaluation by the local pathologist |
After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
|
Tumor regression grading according to Dworak in the experimental arm
Prazo: After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
Grading of tumor regression according to Dworak in the experimental arm |
After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
|
Rate of sphincter-sparing surgery
Prazo: After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
Rate of sphincter-sparing surgery if surgery is performed |
After surgery, approx. 2 (arm B) respectively 20 (arm A) weeks after randomization
|
|
Rate of W&W with or without local regrowth
Prazo: Up to 5 years after end of treatment
|
Number of performed watch&wait approaches with or without local regrowth compared to planned and performed surgery |
Up to 5 years after end of treatment
|
|
Cumulative incidence of local and distant recurrences
Prazo: Up to 5 years after end of treatment
|
Total number of local and distant recurrences, if they occur |
Up to 5 years after end of treatment
|
|
Overall survival
Prazo: Up to at least 3 years and until 5 years
|
Overall survival is defined as the time interval between the date of randomization and the date of death of any cause. Patients who are still alive when last traced will be censored at the date of last follow-up |
Up to at least 3 years and until 5 years
|
|
Patient reported outcome: Quality of life according to questionnaire EORTC-QLQ-C30
Prazo: From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
Quality of life scores according to validated questionnaires EORTC-QLQ-C30, based on treatment arm, and surgical procedures. 30 questions; score values from 1 (not at all) to 4 (very much) respectively from 1 (very poor) to 7 (excellent). Score outcome depends on score type. |
From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
|
Patient reported outcome: Quality of life according to questionnaire EORTC-QLQ-CR29
Prazo: From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
Quality of life scores according to validated questionnaires EORTC-QLQ-CR29, based on treatment arm, and surgical procedures. 29 questions; score values from 1 (not at all) to 4 (very much). Score outcome depends on score type. |
From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
|
Patient reported outcome: Functional outcome according to Wexner score
Prazo: From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
Functional score according to validated Wexner score, based on treatment arm, and surgical procedures. 5 questions; five score values from "never" to "1 per day or more often". The more often the worse the outcome. |
From date of randomization until the date of first documented progression or date of death from any cause, whichever occured first, assessed up to approximately 68 months
|
Colaboradores e Investigadores
Patrocinador
Patrocinador
Colaboradores
Colaboradores
Investigadores
Investigadores
- Investigador principal: Ralf-Dieter Hofheinz, Prof. Dr., Universitätsmedizin Mannheim
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Início do estudo
Conclusão Primária (Real)
Conclusão Primária
Conclusão do estudo (Real)
Conclusão do estudo
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Primeira postagem
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última Atualização Postada
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Neoplasias por local
- Neoplasias
- Doenças Intestinais
- Neoplasias gastrointestinais
- Neoplasias do Aparelho Digestivo
- Doenças do aparelho digestivo
- Doenças Gastrointestinais
- Neoplasias Colorretais
- Neoplasias Intestinais
- Doenças retais
- Neoplasias retais
- Produtos químicos orgânicos
- Compostos heterocíclicos, 1 anel
- Compostos heterocíclicos
- Compostos heterocíclicos, 2 anel
- Compostos heterocíclicos, anel fundido
- Preparações farmacêuticas
- Terapêutica
- Ácidos nucleicos, nucleotídeos e nucleosídeos
- Ações e usos químicos
- Enzimas e coenzimas
- Complexos de coordenação
- Desoxicitidina
- Citidina
- Nucleosídeos de pirimidina
- Pirimidinas
- Usos especializados de produtos químicos
- Auxílios farmacêuticos
- Nucleosídeos
- Formiltetra -hidrofolatos
- Tetra -hidrofolatos
- Ácido fólico
- Pterins
- Pteridinas
- Uracil
- Pirimidinonas
- Coenzimas
- Desoxirribonucleosídeos
- Terapia de modalidade combinada
- Capecitabina
- Oxaliplatina
- Fluorouracila
- Leucovorina
- Adjuvantes, farmacêuticos
- Terapia neoadjuvante
- Xelox
Outros números de identificação do estudo
Outros números de identificação do estudo
- ACO/ARO/AIO-18.2
- 2018 (Concessão/Contrato do NIH dos EUA)
- 2018-001356-35 (Número EudraCT)
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .