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External-Beam Radiation Therapy, Capecitabine, and Sorafenib in Treating Patients With Locally Advanced Rectal Cancer

Primary Purpose

Colorectal Cancer

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
capecitabine
sorafenib tosylate
radiation therapy
Sponsored by
Swiss Group for Clinical Cancer Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring adenocarcinoma of the rectum, stage II rectal cancer, stage III rectal cancer

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS:

  • Histologically confirmed locally advanced adenocarcinoma of the rectum (with or without nodal involvement) requiring surgery

    • Stage mrT3-4, and/or mrN1-2, M0 disease
  • Tumor with K-ras gene mutation as assessed locally
  • No distant metastases

PATIENT CHARACTERISTICS:

  • WHO performance status 0-1
  • Neutrophil count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 10.0 g/dL
  • Creatinine clearance ≥ 50mL/min
  • AST ≤ 2.5 times upper limit of normal (ULN)
  • Total bilirubin ≤ 1.5 times ULN
  • PT/INR or PTT ≤ 1.5 times ULN
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective barrier contraception during and for 12 months after completion of study therapy
  • Is compliant and geographic proximity allows for proper staging and follow-up
  • No other malignancy within the past 5 years except adequately treated cervical carcinoma in situ or localized nonmelanoma skin cancer
  • No psychiatric disorder that would preclude understanding study-related information, giving informed consent, or complying with oral drug intake
  • No clinically significant (i.e., active) cardiac disease (e.g., congestive heart failure, symptomatic coronary artery disease, or cardiac arrhythmia [even if controlled with medication]) or myocardial infarction within the past 12 months
  • No uncontrolled hypertension
  • No evidence or history of bleeding diathesis
  • No lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome
  • No serious or underlying condition (e.g., active autoimmune disease, uncontrolled diabetes, or uncontrolled infection) that, in the judgement of the investigator, could preclude the ability of the patient to participate in the study
  • No known hypersensitivity to study drugs or to any other component of the study drugs

PRIOR CONCURRENT THERAPY:

  • No prior treatment for rectal cancer
  • No prior organ allografts
  • More than 4 weeks since prior major surgery other than colostomy
  • More than 30 days since prior treatment in a clinical trial
  • No other concurrent experimental drugs or anticancer therapy
  • No concurrent brivudine, lamivudine, ribavirin, or any other nucleoside analogue
  • No concurrent drugs contraindicated for use with the study drugs
  • No other concurrent radiotherapy
  • No concurrent anticoagulation therapy other than low molecular weight heparin

Sites / Locations

  • Szent Laszlo Korhaz
  • Saint Claraspital AG
  • Universitaetsspital-Basel
  • Istituto Oncologico della Svizzera Italiana - Ospedale Regionale Bellinzona e Valli
  • Inselspital, Bern
  • Spitalzentrum Biel
  • Kantonsspital Bruderholz
  • Kantonsspital Graubuenden
  • Hopital Cantonal Universitaire de Geneva HUG
  • Kantonsspital Luzern
  • OnkoZentrum Luzern at Klinik St. Anna
  • Kantonsspital - St. Gallen
  • SpitalSTS AG Simmental-Thun-Saanenland
  • Kantonsspital Winterthur
  • Onkozentrum - Klinik im Park
  • Onkozentrum Hirslanden
  • UniversitaetsSpital Zuerich
  • Stadtspital Triemli

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm A: Sorafenib & Capecitabine & RT

Arm Description

Sorafenib: day 1 to 33 (5 weeks, including Saturday and Sunday) every 24 hours, immediately or within two hours after RT according to the dose escalation table during phase I, and the recommended dose during phase IIa. The intake stops at the last day of RT. On nonradiotherapy days (e.g. Saturday, Sunday), the tablets have to be taken at the same time as during the week. Capecitabine: day 1 to 33 (5 weeks, including Saturday and Sunday) according to dose escalation table during phase I, and at the recommended dose during phase IIa. The intake stops in the evening of the last day of RT. External beam RT: Monday through Friday for 5 weeks starting on day 1 (daily fraction 1.8 Gy, final dose 45 Gy) each day at the same time (e.g. 11:00 a.m. daily). Surgery: 6 weeks (± 1 week) after radiochemotherapy (RCT) has been completed

Outcomes

Primary Outcome Measures

Dose-limiting toxicity of the treatment combination (Phase I)
Pathological near complete or complete tumor response (Dworak grade 3 and 4) (Phase II)

Secondary Outcome Measures

R0 and R1 resection
Postoperative complications
Time to distant failure
Disease-free survival
Adverse events as assessed by NCI CTCAE v3.0

Full Information

First Posted
March 25, 2009
Last Updated
May 14, 2019
Sponsor
Swiss Group for Clinical Cancer Research
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1. Study Identification

Unique Protocol Identification Number
NCT00869570
Brief Title
External-Beam Radiation Therapy, Capecitabine, and Sorafenib in Treating Patients With Locally Advanced Rectal Cancer
Official Title
Neoadjuvant Radiotherapy Combined With Capecitabine and Sorafenib in Patients With Advanced, K-ras Mutated Rectal Cancer. A Multicenter Phase I/IIa Trial.
Study Type
Interventional

2. Study Status

Record Verification Date
May 2019
Overall Recruitment Status
Completed
Study Start Date
March 2009 (undefined)
Primary Completion Date
May 2013 (Actual)
Study Completion Date
September 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Swiss Group for Clinical Cancer Research

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving radiation therapy together with capecitabine and sorafenib before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. PURPOSE: This phase I/II trial is studying the side effects and best dose of capecitabine when given together with sorafenib and external-beam radiation therapy and to see how well it works in treating patients with locally advanced rectal cancer.
Detailed Description
OBJECTIVES: Determine the recommended dose of neoadjuvant capecitabine when given together with sorafenib tosylate and external-beam radiotherapy in patients with K-ras mutated, locally advanced rectal cancer. (Phase I) Assess the efficacy and safety of this regimen in these patients. (Phase II) OUTLINE: This is a multicenter, phase I, dose-escalation study of capecitabine followed by a phase II study. Patients receive oral capecitabine twice daily and oral sorafenib tosylate once daily on days 1-33. Patients also undergo external-beam radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33. Approximately 6 weeks after completion of neoadjuvant therapy, patients undergo surgery. After completion of study therapy, patients are followed at 8 weeks and then periodically for up to 3 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer
Keywords
adenocarcinoma of the rectum, stage II rectal cancer, stage III rectal cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
54 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: Sorafenib & Capecitabine & RT
Arm Type
Experimental
Arm Description
Sorafenib: day 1 to 33 (5 weeks, including Saturday and Sunday) every 24 hours, immediately or within two hours after RT according to the dose escalation table during phase I, and the recommended dose during phase IIa. The intake stops at the last day of RT. On nonradiotherapy days (e.g. Saturday, Sunday), the tablets have to be taken at the same time as during the week. Capecitabine: day 1 to 33 (5 weeks, including Saturday and Sunday) according to dose escalation table during phase I, and at the recommended dose during phase IIa. The intake stops in the evening of the last day of RT. External beam RT: Monday through Friday for 5 weeks starting on day 1 (daily fraction 1.8 Gy, final dose 45 Gy) each day at the same time (e.g. 11:00 a.m. daily). Surgery: 6 weeks (± 1 week) after radiochemotherapy (RCT) has been completed
Intervention Type
Drug
Intervention Name(s)
capecitabine
Other Intervention Name(s)
XELODA
Intervention Description
Phase II: 2 x 825 mg/m2 per day (during 5 weeks)
Intervention Type
Drug
Intervention Name(s)
sorafenib tosylate
Other Intervention Name(s)
BAY 43-9006
Intervention Description
Phase II: 1 x 400 mg per day (during 5 weeks)
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Intervention Description
Phase II: 1.8 Gy per day in 25 fractions (during 5 weeks)
Primary Outcome Measure Information:
Title
Dose-limiting toxicity of the treatment combination (Phase I)
Time Frame
during trial treatment (12 weeks)
Title
Pathological near complete or complete tumor response (Dworak grade 3 and 4) (Phase II)
Time Frame
after trial treatment (approx. 12 weeks).
Secondary Outcome Measure Information:
Title
R0 and R1 resection
Time Frame
after trial treatment (approx. 12 weeks)
Title
Postoperative complications
Time Frame
within 8 weeks after surgery
Title
Time to distant failure
Time Frame
during 3 years follow-up.
Title
Disease-free survival
Time Frame
during 3 years follow-up.
Title
Adverse events as assessed by NCI CTCAE v3.0
Time Frame
during trial treatment.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed locally advanced adenocarcinoma of the rectum (with or without nodal involvement) requiring surgery Stage mrT3-4, and/or mrN1-2, M0 disease Tumor with K-ras gene mutation as assessed locally No distant metastases PATIENT CHARACTERISTICS: WHO performance status 0-1 Neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 10.0 g/dL Creatinine clearance ≥ 50mL/min AST ≤ 2.5 times upper limit of normal (ULN) Total bilirubin ≤ 1.5 times ULN PT/INR or PTT ≤ 1.5 times ULN Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 12 months after completion of study therapy Is compliant and geographic proximity allows for proper staging and follow-up No other malignancy within the past 5 years except adequately treated cervical carcinoma in situ or localized nonmelanoma skin cancer No psychiatric disorder that would preclude understanding study-related information, giving informed consent, or complying with oral drug intake No clinically significant (i.e., active) cardiac disease (e.g., congestive heart failure, symptomatic coronary artery disease, or cardiac arrhythmia [even if controlled with medication]) or myocardial infarction within the past 12 months No uncontrolled hypertension No evidence or history of bleeding diathesis No lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome No serious or underlying condition (e.g., active autoimmune disease, uncontrolled diabetes, or uncontrolled infection) that, in the judgement of the investigator, could preclude the ability of the patient to participate in the study No known hypersensitivity to study drugs or to any other component of the study drugs PRIOR CONCURRENT THERAPY: No prior treatment for rectal cancer No prior organ allografts More than 4 weeks since prior major surgery other than colostomy More than 30 days since prior treatment in a clinical trial No other concurrent experimental drugs or anticancer therapy No concurrent brivudine, lamivudine, ribavirin, or any other nucleoside analogue No concurrent drugs contraindicated for use with the study drugs No other concurrent radiotherapy No concurrent anticoagulation therapy other than low molecular weight heparin
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roger von Moos, MD
Organizational Affiliation
Kantonsspital Graubuenden
Official's Role
Study Chair
Facility Information:
Facility Name
Szent Laszlo Korhaz
City
Budapest
ZIP/Postal Code
1097
Country
Hungary
Facility Name
Saint Claraspital AG
City
Basel
ZIP/Postal Code
CH-4016
Country
Switzerland
Facility Name
Universitaetsspital-Basel
City
Basel
ZIP/Postal Code
CH-4031
Country
Switzerland
Facility Name
Istituto Oncologico della Svizzera Italiana - Ospedale Regionale Bellinzona e Valli
City
Bellinzona
ZIP/Postal Code
6500
Country
Switzerland
Facility Name
Inselspital, Bern
City
Bern
ZIP/Postal Code
CH-3010
Country
Switzerland
Facility Name
Spitalzentrum Biel
City
Biel
ZIP/Postal Code
CH-2501
Country
Switzerland
Facility Name
Kantonsspital Bruderholz
City
Bruderholz
ZIP/Postal Code
CH-4101
Country
Switzerland
Facility Name
Kantonsspital Graubuenden
City
Chur
ZIP/Postal Code
CH-7000
Country
Switzerland
Facility Name
Hopital Cantonal Universitaire de Geneva HUG
City
Geneva
ZIP/Postal Code
CH-1211
Country
Switzerland
Facility Name
Kantonsspital Luzern
City
Luzern
ZIP/Postal Code
6000
Country
Switzerland
Facility Name
OnkoZentrum Luzern at Klinik St. Anna
City
Luzern
ZIP/Postal Code
6006
Country
Switzerland
Facility Name
Kantonsspital - St. Gallen
City
St. Gallen
ZIP/Postal Code
CH-9007
Country
Switzerland
Facility Name
SpitalSTS AG Simmental-Thun-Saanenland
City
Thun
ZIP/Postal Code
3600
Country
Switzerland
Facility Name
Kantonsspital Winterthur
City
Winterthur
ZIP/Postal Code
CH-8400
Country
Switzerland
Facility Name
Onkozentrum - Klinik im Park
City
Zurich
ZIP/Postal Code
8002
Country
Switzerland
Facility Name
Onkozentrum Hirslanden
City
Zurich
ZIP/Postal Code
CH-8008
Country
Switzerland
Facility Name
UniversitaetsSpital Zuerich
City
Zurich
ZIP/Postal Code
CH-8091
Country
Switzerland
Facility Name
Stadtspital Triemli
City
Zürich
ZIP/Postal Code
8063
Country
Switzerland

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
29241084
Citation
von Moos R, Koeberle D, Schacher S, Hayoz S, Winterhalder RC, Roth A, Bodoky G, Samaras P, Berger MD, Rauch D, Saletti P, Plasswilm L, Zwahlen D, Meier UR, Yan P, Izzo P, Klingbiel D, Bartschi D, Zaugg K; Swiss Group for Clinical Cancer Research (SAKK). Neoadjuvant radiotherapy combined with capecitabine and sorafenib in patients with advanced KRAS-mutated rectal cancer: A phase I/II trial (SAKK 41/08). Eur J Cancer. 2018 Jan;89:82-89. doi: 10.1016/j.ejca.2017.11.005. Epub 2017 Dec 11.
Results Reference
result

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External-Beam Radiation Therapy, Capecitabine, and Sorafenib in Treating Patients With Locally Advanced Rectal Cancer

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