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Translational Validation Study to Examine KFO179-1 Biomarker Scores for the Prediction and Prognosis of Advanced Primary Resectable Rectal Cancer Stages UICC-II-IV, With a 5-Fluorouracil-based Standard Radiochemotherapy Followed by Total Mesorectal Excision. (TransValid-A)

Primary Purpose

Locally Advanced Rectal Cancer

Status

Unknown status

Phase

Not Applicable

Locations

Germany

Study Type

Interventional

Intervention

Translational Research and multimodal treatment

About this trial

This is an interventional diagnostic trial for Locally Advanced Rectal Cancer focused on measuring locally advanced rectal cancer, translational research, Biomarker

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Aged 18 to 85 years, inclusive
Histologically confirmed advanced primary rectal cancer localized up to 12 cm above the anocutaneous line (determined with a rigid rectoscope), classified as T3/T4 or N+ carcinomas or with evidence for synchronous, but resectable distant metastases (liver or lung metastases)
No specific tumor treatment except colostomy due to tumor stenosis with ileus
World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) status ≤2
Adequate bone marrow function (WBC >3.0x10^9/L, neutrophils >1.5x10^9/L, thrombocytes >100x10^9/L, hemoglobin ≥10 g/dl)
Adequate liver function (bilirubin ≤2.0 mg/dl, SGOT, SGPT, AP, gamma-GT < three point five fold of upper level of normal range
serum creatinine < 1.5 mg/dl
Written and signed informed consent indicating the understanding of the investigational nature and the study protocol.

Exclusion Criteria:

Pregnant or lactating women
Men and women unwilling or unable to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment
Prolonged drug, medication or alcohol abuse
Previous chemotherapy (up to 2 years before diagnosis of rectal cancer)
Previous radiotherapy to the pelvic area
Simultaneous therapy with other anti-cancer drugs
Participation in a clinical trial in the period 30 days prior to inclusion
Patients (man and woman) who are not able or willing to accept treatment and follow-up care according to trial protocol
Patients (man and woman) with uncontrolled, serious physical or mental diseases, e.g.: instable cardiac disease in spite of medical treatment, myocardial infarction during the last 3 months prior to start of trial participation
- neurological or psychiatric dysfunction including dementia or seizure disorder
- Disseminated infection or sepsis
- Disseminated intravascular coagulopathy
- Symptomatic neuropathy (NCI CTC ≥2)
Patients with secondary malignancies except basal cell carcinoma of the skin or carcinoma in situ of the cervix, which have been successfully treated. (The inclusion of patients with other tumors that were successfully treated and no recurrence within the last 3-5 years should be discussed before registration in the trial)
Chronic diarrhea (>grade 1 according NCI CTCAE)
Allergic reaction to platin-derivates or study medication
Simultaneous treatment with sorivudine and analogous
Known Dihydropyrimidine dehydrogenase deficiency

Sites / Locations

University Medical Center Goettingen

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Blood and tissue samples during therapy

Arm Description

Collection of blood and tissue samples during preoperative multimodal treatment (Radiochemotherapy (RCTx) followed by total mesorectal excision (TME) and Chemotherapy (CT)) in rectal cancer.

Outcomes

Primary Outcome Measures

Number of patients with histopathologically confirmed complete remission (pCR) (ypT0N0 R0) after preoperative RCTx related to pretherapeutically determined gene expression signature predicting tumor response to RCTx.

The efficacy of the pretherapeutically determined response prediction using a reliable and robust panel of biomarkers (gene expression signature) is assessed by several clinicopathological parameters after preoperative RCTx and TME-surgery that indicate response and toxicity (ypN-status, pCR, tumor regression-grading, R-status, toxicity). Timepoint for measuring the gene expression signature is the time of diagnosis (pretreatment biopsy); several immunohistochemical biomarkers (Thymidylatesynthase, Survivin, HER-2) will be determined in the pretreatment biopsy as well as at the time of resection in the residual tumor tissue.

Secondary Outcome Measures

R0-rate of resection

The resection status will be classified by the pathologists according to the established UICC-TNM-Classification (R0 vs R1 vs R2 resection status)

post-operative 30-day mortality

post-operative morbidity (esp. rate of anastomotic insufficiencies)

post-operative late complications (defecation problems, anastomotic, stenoses, loss of sphincter function)

Quality of TME-surgery according to M.E.R.C.U.R.Y classification

The quality of total mesorectal excision (TME) will be classified by the surgeons (intraoperatively according to M.E.R.C.U.R.Y criteria: good vs moderat vs poor as published in national guidelines) and independently by the pathologists (on the resected specimen according to the well established M.E.R.C.U.R.Y criteria: good vs moderate vs poor).

acute and late toxicity of the chemotherapy according to the CommonToxicity Criteria of the National Cancer Institute (CTC) (vs 4.0)

Disease free survival (DSF) after 2 and 3 years (local and/or distant recurrences)

Cumulative incidence of local relapses and distant metastases

Overall cancer specific survival (CSS) after 3 and 5 years

Quality of life (QL) according to the EORTC-Questionnaire QLQ-30 (3.0)

The EORTC-Questionnaire QLQ-30 (3.0) have to be completed at the following timepoints: before first treatment (baseline), at the end of treatment (30 days after last intervention or application) and during follow-up (12, 36 and 60 months after surgical intervention). The outcome measures at the end of treatment, 12,36,60 months after surgery will be compared to baseline. EORTC-Life Quality (LQ)-Questionnaire and Wexner Score-Questionnaire will be analysed separately.

Wexner-Score-Questionnaire

The Wexner-Score-Questionnaire have to be completed at the following timepoints: before first treatment (baseline), at the end of treatment (30 days after last intervention or application) and during follow-up (12, 36 and 60 months after surgical intervention). The outcome measures at the end of treatment, 12,36,60 months after surgery will be compared to baseline. EORTC-LQ-Questionnaire and Wexner Score-Questionnaire will be analysed separately.

Full Information

NCT ID

NCT03034473

First Posted

January 13, 2017

Last Updated

October 15, 2018

Sponsor

University Medical Center Goettingen

Collaborators

German Research Foundation

1. Study Identification

Unique Protocol Identification Number

NCT03034473

Brief Title

Translational Validation Study to Examine KFO179-1 Biomarker Scores for the Prediction and Prognosis of Advanced Primary Resectable Rectal Cancer Stages UICC-II-IV, With a 5-Fluorouracil-based Standard Radiochemotherapy Followed by Total Mesorectal Excision.

Acronym

TransValid-A

Official Title

Translational Validation Study to Examine KFO179-1 Biomarker Scores for the Prediction and Prognosis of Advanced Primary Resectable Rectal Cancer Stages UICC II-IV, With a 5-FU-based Standard Radiochemotherapy Followed by Total Mesorectal Excision.

Study Type

Interventional

2. Study Status

Record Verification Date

October 2018

Overall Recruitment Status

Unknown status

Study Start Date

August 2011 (undefined)

Primary Completion Date

May 2020 (Anticipated)

Study Completion Date

October 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

University Medical Center Goettingen

Collaborators

German Research Foundation

4. Oversight

Data Monitoring Committee

5. Study Description

Brief Summary

The objective of the TransValid-KFO179/GRCSG-Trial-A is the validation of potential biomarkers. These are predictive (Prediction of probability of response to a certain therapy) / prognostic (predicting long-term outcome) microarray-based gene expression signatures and immunohistochemically evaluated biomarkers. The evaluation was done within the KFO179 (www.kfo179.de) - the validation is implemented in this trial. Therefore tumor material of patients undergoing standard radiochemotherapy will be analyzed from pretreatment biopsies an residual tissue from the resection specimen after surgery. This validation and the biomaterial asservation will be incorporated into clinical routine in all participating centers as a model for the treatment of solid tumors. The obtained biomarkers with a predictive and prognostic power will be used to develop an algorithm to predict patients at high risk of local and distant cancer recurrence.

Detailed Description

The objective of the TransValid-KFO179/GRCSG-Trial-A is to validate the predictive/prognostic microarray-based gene expression signatures and single gene biomarkers (including 5-Fluorouracil (FU) metabolism, apoptosis, Kirsten Rat Sarcoma (KRAS), CpGCpG island methylation phenotype (CIMP) and TGF-beta pathway), which have been established in patients treated with standard 5-FU based RCT in the GRCSG trials (e.g. the CAO/ARO/AIO-94-, CAO/ARO/AIO-04-phase III trials). This validation will be incorporated into clinical routine in all participating centers as a model for the treatment of solid tumors. If the KFO179 biomarkers are predictive at a satisfactory level in the validation set, we will propose a prediction algorithm to stratify the patient population into a "high"-risk and "low"-risk population to develop local and distant cancer recurrence.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Locally Advanced Rectal Cancer

Keywords

locally advanced rectal cancer, translational research, Biomarker

7. Study Design

Primary Purpose

Diagnostic

Study Phase

Not Applicable

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

N/A

Enrollment

200 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Blood and tissue samples during therapy

Arm Type

Other

Arm Description

Collection of blood and tissue samples during preoperative multimodal treatment (Radiochemotherapy (RCTx) followed by total mesorectal excision (TME) and Chemotherapy (CT)) in rectal cancer.

Intervention Type

Other

Intervention Name(s)

Translational Research and multimodal treatment

Intervention Description

Blood/biopsy samples (tumor & mucosa) are taken pretherapeutically. Blood samples (serum & plasma) are drawn at 11 time points during RCTx (e.g. for analysis of 5-FU metabolism, genomic DNA extraction). After pathohistological workup of the TME specimen, the formalin-fixed material will be transferred to the central biobank of KFO179. Blood samples (plasma & serum) will be drawn during 5y-follow-up. Treatment (based on CAO/ARO/AIO-94- and CAO/ARO/AIO-04-phase-III trials of the GRCSG): Preoperative RCT: 28x1.8 Gy (total: 50.4 Gy, 5 fractions per week on d1-d38) combined with 5-FU (1000 mg/m2/d) as 120 h civ during 1st and 5th week. TME-surgery is performed 6 weeks after RCTx. 4 to 8 weeks after surgery, patients receive either 4 cycles 5-FU (500 mg 5-FU/m2 iv, d1-5, repeat d 29-33) or 3 cycles (6 single appl.) of FOLFOX regimen [(400 mg FA/m2, 2-h civ, d 1; 100 mg oxaliplatin/m2, 2-h civ in 500 ml Glucose 5%, d 1; 2400 mg 5-FU/m2 as 46-h civ) on d1+d15, d30+d45 and d60+d75].

Primary Outcome Measure Information:

Title

Description

Time Frame

1 year after surgery

Secondary Outcome Measure Information:

Title

R0-rate of resection

Description

The resection status will be classified by the pathologists according to the established UICC-TNM-Classification (R0 vs R1 vs R2 resection status)

Time Frame

30 days after surgery based on histopathological findings and reports

Title

post-operative 30-day mortality

Time Frame

30 days after surgery

Title

post-operative morbidity (esp. rate of anastomotic insufficiencies)

Time Frame

30 days after surgery

Title

post-operative late complications (defecation problems, anastomotic, stenoses, loss of sphincter function)

Time Frame

up to 5 years after surgery

Title

Quality of TME-surgery according to M.E.R.C.U.R.Y classification

Description

Time Frame

30 days after surgery based on surgical and histopathological findings/reports

Title

acute and late toxicity of the chemotherapy according to the CommonToxicity Criteria of the National Cancer Institute (CTC) (vs 4.0)

Time Frame

up to 5 years after therapy

Title

Disease free survival (DSF) after 2 and 3 years (local and/or distant recurrences)

Time Frame

up to 3 years after surgery

Title

Cumulative incidence of local relapses and distant metastases

Time Frame

up to 5 years after surgery

Title

Overall cancer specific survival (CSS) after 3 and 5 years

Time Frame

up to 5 years after surgery

Title

Quality of life (QL) according to the EORTC-Questionnaire QLQ-30 (3.0)

Description

Time Frame

up to 5 years after surgery

Title

Wexner-Score-Questionnaire

Description

Time Frame

up to 5 years after surgery

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

85 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Aged 18 to 85 years, inclusive Histologically confirmed advanced primary rectal cancer localized up to 12 cm above the anocutaneous line (determined with a rigid rectoscope), classified as T3/T4 or N+ carcinomas or with evidence for synchronous, but resectable distant metastases (liver or lung metastases) No specific tumor treatment except colostomy due to tumor stenosis with ileus World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) status ≤2 Adequate bone marrow function (WBC >3.0x10^9/L, neutrophils >1.5x10^9/L, thrombocytes >100x10^9/L, hemoglobin ≥10 g/dl) Adequate liver function (bilirubin ≤2.0 mg/dl, SGOT, SGPT, AP, gamma-GT < three point five fold of upper level of normal range serum creatinine < 1.5 mg/dl Written and signed informed consent indicating the understanding of the investigational nature and the study protocol. Exclusion Criteria: Pregnant or lactating women Men and women unwilling or unable to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment Prolonged drug, medication or alcohol abuse Previous chemotherapy (up to 2 years before diagnosis of rectal cancer) Previous radiotherapy to the pelvic area Simultaneous therapy with other anti-cancer drugs Participation in a clinical trial in the period 30 days prior to inclusion Patients (man and woman) who are not able or willing to accept treatment and follow-up care according to trial protocol Patients (man and woman) with uncontrolled, serious physical or mental diseases, e.g.: instable cardiac disease in spite of medical treatment, myocardial infarction during the last 3 months prior to start of trial participation neurological or psychiatric dysfunction including dementia or seizure disorder Disseminated infection or sepsis Disseminated intravascular coagulopathy Symptomatic neuropathy (NCI CTC ≥2) Patients with secondary malignancies except basal cell carcinoma of the skin or carcinoma in situ of the cervix, which have been successfully treated. (The inclusion of patients with other tumors that were successfully treated and no recurrence within the last 3-5 years should be discussed before registration in the trial) Chronic diarrhea (>grade 1 according NCI CTCAE) Allergic reaction to platin-derivates or study medication Simultaneous treatment with sorivudine and analogous Known Dihydropyrimidine dehydrogenase deficiency

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Torsten Liersch, MD, Prof.

Organizational Affiliation

University Medical Center Goettingen

Official's Role

Principal Investigator

First Name & Middle Initial & Last Name & Degree

Michael Ghadimi, MD, Prof.

Organizational Affiliation

University Medical Center Goettingen

Official's Role

Study Director

Facility Information:

Facility Name

University Medical Center Goettingen

City

Gottingen

State/Province

Lower Saxony

ZIP/Postal Code

37075

Country

Germany

12. IPD Sharing Statement

Plan to Share IPD

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Sprenger T, Rodel F, Beissbarth T, Conradi LC, Rothe H, Homayounfar K, Wolff HA, Ghadimi BM, Yildirim M, Becker H, Rodel C, Liersch T. Failure of downregulation of survivin following neoadjuvant radiochemotherapy in rectal cancer is associated with distant metastases and shortened survival. Clin Cancer Res. 2011 Mar 15;17(6):1623-31. doi: 10.1158/1078-0432.CCR-10-2592. Epub 2010 Nov 30.

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Rodel C, Arnold D, Becker H, Fietkau R, Ghadimi M, Graeven U, Hess C, Hofheinz R, Hohenberger W, Post S, Raab R, Sauer R, Wenz F, Liersch T. Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer : is it time for a randomized phase III trial? Strahlenther Onkol. 2010 Dec;186(12):658-64. doi: 10.1007/s00066-010-2194-2. Epub 2010 Nov 30.

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Meller J, Liersch T, Oezerden MM, Sahlmann CO, Meller B. Targeting NCA-95 and other granulocyte antigens and receptors with radiolabeled monoclonal antibodies (Mabs). Q J Nucl Med Mol Imaging. 2010 Dec;54(6):582-98.

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Meller B, Rave-Franck M, Breunig C, Schirmer M, Baehre M, Nadrowitz R, Liersch T, Meller J. Novel Carcinoembryonic-Antigen-(CEA)-Specific Pretargeting System to Assess Tumor Cell Viability after Irradiation of Colorectal Cancer Cells. Strahlenther Onkol. 2011 Feb;187(2):120-6. doi: 10.1007/s00066-010-2191-5. Epub 2011 Jan 24.

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Danner BC, Gerdes JS, Jung K, Sander B, Enders C, Liersch T, Seipelt R, Gutenberg A, Gunawan B, Schondube FA, Fuzesi L. Comparison of chromosomal aberrations in primary colorectal carcinomas to their pulmonary metastases. Cancer Genet. 2011 Mar;204(3):122-8. doi: 10.1016/j.cancergen.2010.12.003.

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Wolff HA, Conradi LC, Schirmer M, Beissbarth T, Sprenger T, Rave-Frank M, Hennies S, Hess CF, Becker H, Christiansen H, Liersch T. Gender-specific acute organ toxicity during intensified preoperative radiochemotherapy for rectal cancer. Oncologist. 2011;16(5):621-31. doi: 10.1634/theoncologist.2010-0414. Epub 2011 May 9.

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Gaedcke J, Liersch T, Hess C, Becker H, Rodel C, Ghadimi BM. [Rectal cancer: current status of multimodal therapy--when and how?]. Zentralbl Chir. 2011 Aug;136(4):334-42. doi: 10.1055/s-0031-1271581. Epub 2011 Aug 23. German.

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Gehoff A, Basten O, Sprenger T, Conradi LC, Bismarck C, Bandorski D, Merkelbach-Bruse S, Schneider-Stock R, Stoehr R, Wirtz RM, Kitz J, Muller A, Hartmann A, Becker H, Ghadimi BM, Liersch T, Ruschoff J. Optimal lymph node harvest in rectal cancer (UICC stages II and III) after preoperative 5-FU-based radiochemotherapy. Acetone compression is a new and highly efficient method. Am J Surg Pathol. 2012 Feb;36(2):202-13. doi: 10.1097/PAS.0b013e31823fa35b.

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Rodel C, Hofheinz R, Liersch T. Rectal cancer: state of the art in 2012. Curr Opin Oncol. 2012 Jul;24(4):441-7. doi: 10.1097/CCO.0b013e328352ea02.

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Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rodel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012 Jun 1;30(16):1926-33. doi: 10.1200/JCO.2011.40.1836. Epub 2012 Apr 23.

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Rodel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sulberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Kohler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; German Rectal Cancer Study Group. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012 Jul;13(7):679-87. doi: 10.1016/S1470-2045(12)70187-0. Epub 2012 May 23.

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Rodel F, Sprenger T, Kaina B, Liersch T, Rodel C, Fulda S, Hehlgans S. Survivin as a prognostic/predictive marker and molecular target in cancer therapy. Curr Med Chem. 2012;19(22):3679-88. doi: 10.2174/092986712801661040.

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Sprenger T, Conradi LC, Beissbarth T, Ermert H, Homayounfar K, Middel P, Ruschoff J, Wolff HA, Schuler P, Ghadimi BM, Rodel C, Becker H, Rodel F, Liersch T. Enrichment of CD133-expressing cells in rectal cancers treated with preoperative radiochemotherapy is an independent marker for metastasis and survival. Cancer. 2013 Jan 1;119(1):26-35. doi: 10.1002/cncr.27703. Epub 2012 Jun 26.

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Conradi LC, Styczen H, Sprenger T, Wolff HA, Rodel C, Nietert M, Homayounfar K, Gaedcke J, Kitz J, Talaulicar R, Becker H, Ghadimi M, Middel P, Beissbarth T, Ruschoff J, Liersch T. Frequency of HER-2 positivity in rectal cancer and prognosis. Am J Surg Pathol. 2013 Apr;37(4):522-31. doi: 10.1097/PAS.0b013e318272ff4d.

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Wolff HA, Conradi LC, Beissbarth T, Leha A, Hohenberger W, Merkel S, Fietkau R, Raab HR, Tschmelitsch J, Hess CF, Becker H, Wittekind C, Sauer R, Rodel C, Liersch T; German Rectal Cancer Study Group. Gender affects acute organ toxicity during radiochemotherapy for rectal cancer: long-term results of the German CAO/ARO/AIO-94 phase III trial. Radiother Oncol. 2013 Jul;108(1):48-54. doi: 10.1016/j.radonc.2013.05.009. Epub 2013 Jun 11.

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Sprenger T, Rothe H, Becker H, Beissbarth T, Homayounfar K, Gauss K, Kitz J, Wolff H, Scheel AH, Ghadimi M, Rodel C, Conradi LC, Liersch T. Lymph node metastases in rectal cancer after preoperative radiochemotherapy: impact of intramesorectal distribution and residual micrometastatic involvement. Am J Surg Pathol. 2013 Aug;37(8):1283-9. doi: 10.1097/PAS.0b013e3182886ced.

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Fokas E, Conradi L, Weiss C, Sprenger T, Middel P, Rau T, Dellas K, Kitz J, Rodel F, Sauer R, Ruschoff J, Beissbarth T, Arnold D, Ghadimi BM, Rodel C, Liersch T. Preoperative chemoradiation therapy with capecitabine/oxaliplatin and cetuximab in rectal cancer: long-term results of a prospective phase 1/2 study. Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):992-9. doi: 10.1016/j.ijrobp.2013.09.011. Epub 2013 Oct 24.

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Quack H, Erpenbeck L, Wolff HA, Sprenger T, Seitz CS, Schon MP, Neumann S, Stanek K, Ghadimi BM, Michels B, Middel P, Schaefer IM, Liersch T, Conradi LC. Oxaliplatin-Induced Leukocytoclastic Vasculitis under Adjuvant Chemotherapy for Colorectal Cancer: Two Cases of a Rare Adverse Event. Case Rep Oncol. 2013 Dec 11;6(3):609-15. doi: 10.1159/000357166. eCollection 2013 Sep.

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Folprecht G, Gruenberger T, Bechstein W, Raab HR, Weitz J, Lordick F, Hartmann JT, Stoehlmacher-Williams J, Lang H, Trarbach T, Liersch T, Ockert D, Jaeger D, Steger U, Suedhoff T, Rentsch A, Kohne CH. Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept (CELIM study). Ann Oncol. 2014 May;25(5):1018-25. doi: 10.1093/annonc/mdu088. Epub 2014 Feb 27.

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Ilgen P, Stoldt S, Conradi LC, Wurm CA, Ruschoff J, Ghadimi BM, Liersch T, Jakobs S. STED super-resolution microscopy of clinical paraffin-embedded human rectal cancer tissue. PLoS One. 2014 Jul 15;9(7):e101563. doi: 10.1371/journal.pone.0101563. eCollection 2014.

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Fokas E, Liersch T, Fietkau R, Hohenberger W, Hess C, Becker H, Sauer R, Wittekind C, Rodel C. Downstage migration after neoadjuvant chemoradiotherapy for rectal cancer: the reverse of the Will Rogers phenomenon? Cancer. 2015 Jun 1;121(11):1724-7. doi: 10.1002/cncr.29260. Epub 2015 Jan 21.

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Scheel AH, Reineke RA, Sprenger T, Lokka S, Kitz J, Ghadimi BM, Ruschoff J, Liersch T, Middel P. Comprehensive lymph node morphometry in rectal cancer using acetone compression. J Clin Pathol. 2015 Jun;68(6):458-64. doi: 10.1136/jclinpath-2014-202555. Epub 2015 Mar 16.

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Poschau M, Dickreuter E, Singh-Muller J, Zscheppang K, Eke I, Liersch T, Cordes N. EGFR and beta1-integrin targeting differentially affect colorectal carcinoma cell radiosensitivity and invasion. Radiother Oncol. 2015 Sep;116(3):510-6. doi: 10.1016/j.radonc.2015.06.005. Epub 2015 Jun 18.

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Rodel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Strobel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. doi: 10.1016/S1470-2045(15)00159-X. Epub 2015 Jul 15.

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Bleckmann A, Conradi LC, Menck K, Schmick NA, Schubert A, Rietkotter E, Arackal J, Middel P, Schambony A, Liersch T, Homayounfar K, Beissbarth T, Klemm F, Binder C, Pukrop T. beta-catenin-independent WNT signaling and Ki67 in contrast to the estrogen receptor status are prognostic and associated with poor prognosis in breast cancer liver metastases. Clin Exp Metastasis. 2016 Apr;33(4):309-23. doi: 10.1007/s10585-016-9780-3. Epub 2016 Feb 9.

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Sprenger T, Rothe H, Conradi LC, Beissbarth T, Kauffels A, Kitz J, Homayounfar K, Wolff H, Strobel P, Ghadimi M, Wittekind C, Sauer R, Rodel C, Liersch T. Stage-Dependent Frequency of Lymph Node Metastases in Patients With Rectal Carcinoma After Preoperative Chemoradiation: Results from the CAO/ARO/AIO-94 Trial and From a Comparative Prospective Evaluation With Extensive Pathological Workup. Dis Colon Rectum. 2016 May;59(5):377-85. doi: 10.1097/DCR.0000000000000570.

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Jo P, Nietert M, Gusky L, Kitz J, Conradi LC, Muller-Dornieden A, Schuler P, Wolff HA, Ruschoff J, Strobel P, Grade M, Liersch T, Beissbarth T, Ghadimi MB, Sax U, Gaedcke J. Neoadjuvant Therapy in Rectal Cancer - Biobanking of Preoperative Tumor Biopsies. Sci Rep. 2016 Oct 18;6:35589. doi: 10.1038/srep35589.

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Sahlmann CO, Homayounfar K, Niessner M, Dyczkowski J, Conradi LC, Braulke F, Meller B, Beissbarth T, Ghadimi BM, Meller J, Goldenberg DM, Liersch T. Repeated adjuvant anti-CEA radioimmunotherapy after resection of colorectal liver metastases: Safety, feasibility, and long-term efficacy results of a prospective phase 2 study. Cancer. 2017 Feb 15;123(4):638-649. doi: 10.1002/cncr.30390. Epub 2016 Oct 20.

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