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Non-Operative Management and Early Response Assessment in Rectal Cancer (NOM-ERA)

Primary Purpose

Adenocarcinoma of the Lower Rectum

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Radiation therapy
FOLFOX regimen
Functional Assessment of Cancer Therapy-Colorectal cancer (FACT-C) questionnaire
Rectal biopsy samples
Blood for ctDNA
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma of the Lower Rectum

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of biopsy proven stage I-IIIB (cT1-3, N0-2a, M0) adenocarcinoma of the rectum; staging must also be based on multidisciplinary evaluation including MRI
  • Tumor ≤ 12 cm from anal verge as determined by MRI or endoscopy
  • Clinically detectable (MR, endoscopy, or DRE) tumor present
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • At least 18 years of age
  • Adequate bone marrow function defined as:

    • Absolute neutrophil count (ANC) > 1,500 cells/mm3
    • Hemoglobin> 8 g/dl
    • Platelets >100,000 cells/mm3
  • Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
  • Able to understand and willing to sign an Institutional Review Board (IRB)-approved written informed consent document.

Exclusion Criteria

  • Prior radiation therapy, chemotherapy or extirpative surgery for rectal cancer.
  • Prior oxaliplatin or capecitabine use for any malignancy
  • No prior radiation therapy to the pelvis.
  • A history of other malignancy (except non-melanomatous skin cancers) with the exception of malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease.
  • Currently receiving any investigational agents.
  • A history of allergic reaction attributed to compounds of similar chemical or biologic composition to capecitabine, 5FU, oxaliplatin, or leucovorin.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
  • Pregnant and/or breastfeeding. Women of childbearing potential must have a negative serum pregnancy test within 14 days of study entry.
  • Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of AIDS-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective antiretroviral therapy (ART) according to Department of Health and Human Services (DHHS) treatment guidelines is recommended. HIV testing for patients without a history of HIV is not a protocol requirement.

Sites / Locations

  • University of ColoradoRecruiting
  • Mayo ClinicRecruiting
  • Washington University School of MedicineRecruiting
  • University of Vermont Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Radiation + FOLFOX

Arm Description

Pelvic radiotherapy 5GY x 5 fractions once daily Radiation to extra-mesorectal node 7 Gy x 5 fractions once daily FOLFOX should begin 2-4 weeks after completion of radiotherapy and will consist of FOLFOX x 8 cycles (16 weeks). Oxaliplatin day 1 every 14 days Leucovorin day 1 every 14 days. Levoleucovorin may be substituted if leucovorin is not available. 5-FU bolus day 1 every 14 days 5-FU infusion day 1 every 14 days over 46 hours Alternatively CAPOX (capecitabine and oxaliplatin) may be given for 5 cycles over 15 weeks. An optional simultaneous integrated boost of 30 Gy in 5 fractions to the primary tumor is permitted

Outcomes

Primary Outcome Measures

Clinical complete response rate
-Criteria for clinical complete response: No residual gross tumor at procto/sigmoidoscopy;, or only erythematous scar or ulcer No palpable tumor on DRE No radiographic evidence of tumor on MRI No suspicious mesorectal lymph nodes on MRI Negative biopsy from scar, ulcer, or former tumor site (if necessary according to surgeon's judgment)

Secondary Outcome Measures

Progression-free survival (PFS)
Criteria for progressive disease *Increase in the size of primary tumor by RECIST criteria New metastatic disease
Incidence of grade 3 or higher toxicity during treatment
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
Incidence of post chemoradiotherapy grade 3 or higher toxicity
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
Quality of anorectal function as measured by the FACT-C questionnaire
Questionnaire with 5 sections (physical well-being, social/family well being, emotional well-being, functional well-being, and additional concerns) Answers to the questions range from 0=not at all to 4=very much. The higher the total score the lower quality of life the person has
Organ preservation rate
Organ preservation rate

Full Information

First Posted
April 3, 2019
Last Updated
August 13, 2023
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03904043
Brief Title
Non-Operative Management and Early Response Assessment in Rectal Cancer
Acronym
NOM-ERA
Official Title
Non-Operative Management and Early Response Assessment in Rectal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 1, 2020 (Actual)
Primary Completion Date
December 31, 2024 (Anticipated)
Study Completion Date
June 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The investigators' data from a phase I study of short course radiation therapy followed by chemotherapy showed 74% complete clinical response (cCR). Given the promising response rate, the investigators are evaluating short course radiation therapy (SCRT) followed by chemotherapy in a multi-institution phase II trial to validate the cCR rate of this treatment paradigm. SCRT has not been prospectively evaluated in non-operative management for patients with non-metastatic rectal adenocarcinoma.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
68 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Radiation + FOLFOX
Arm Type
Experimental
Arm Description
Pelvic radiotherapy 5GY x 5 fractions once daily Radiation to extra-mesorectal node 7 Gy x 5 fractions once daily FOLFOX should begin 2-4 weeks after completion of radiotherapy and will consist of FOLFOX x 8 cycles (16 weeks). Oxaliplatin day 1 every 14 days Leucovorin day 1 every 14 days. Levoleucovorin may be substituted if leucovorin is not available. 5-FU bolus day 1 every 14 days 5-FU infusion day 1 every 14 days over 46 hours Alternatively CAPOX (capecitabine and oxaliplatin) may be given for 5 cycles over 15 weeks. An optional simultaneous integrated boost of 30 Gy in 5 fractions to the primary tumor is permitted
Intervention Type
Radiation
Intervention Name(s)
Radiation therapy
Intervention Description
-Monday-Friday treatment is strongly recommended
Intervention Type
Drug
Intervention Name(s)
FOLFOX regimen
Intervention Description
-CAPOX can be given as alternative
Intervention Type
Other
Intervention Name(s)
Functional Assessment of Cancer Therapy-Colorectal cancer (FACT-C) questionnaire
Intervention Description
-Baseline, completion of chemotherapy (3-8 weeks after the end of chemotherapy), and 10 to 14 months after radiotherapy
Intervention Type
Procedure
Intervention Name(s)
Rectal biopsy samples
Intervention Description
-Multiple biopsy samples of the rectal tumor will be taken from the patient tumor prior to treatment initiation for genomic extraction. For patients at affiliate sites who do not have enough tissue from the diagnostic biopsy, a repeat pre-treatment biopsy is optional.
Intervention Type
Procedure
Intervention Name(s)
Blood for ctDNA
Intervention Description
-Prior to the start of treatment, Post radiation therapy labs (with standard of care (SOC) CBC/CMP prior to start of cycle 1 of chemotherapy), Day 1 of cycle 2 of chemotherapy (with SOC CBC/CMP), Completion of chemotherapy (3-8 weeks after the end of chemotherapy), months 3, 6, 9, 12, 16, 20, 24 until salvage surgery or 2 years from completion of chemotherapy (whichever is first)
Primary Outcome Measure Information:
Title
Clinical complete response rate
Description
-Criteria for clinical complete response: No residual gross tumor at procto/sigmoidoscopy;, or only erythematous scar or ulcer No palpable tumor on DRE No radiographic evidence of tumor on MRI No suspicious mesorectal lymph nodes on MRI Negative biopsy from scar, ulcer, or former tumor site (if necessary according to surgeon's judgment)
Time Frame
Completion of treatment (estimated to be 22 weeks)
Secondary Outcome Measure Information:
Title
Progression-free survival (PFS)
Description
Criteria for progressive disease *Increase in the size of primary tumor by RECIST criteria New metastatic disease
Time Frame
2 years
Title
Incidence of grade 3 or higher toxicity during treatment
Description
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
Time Frame
Completion of treatment (estimated to be 22 weeks)
Title
Incidence of post chemoradiotherapy grade 3 or higher toxicity
Description
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
Time Frame
1 year
Title
Quality of anorectal function as measured by the FACT-C questionnaire
Description
Questionnaire with 5 sections (physical well-being, social/family well being, emotional well-being, functional well-being, and additional concerns) Answers to the questions range from 0=not at all to 4=very much. The higher the total score the lower quality of life the person has
Time Frame
1 year (between 10-14 months post treatment start date)
Title
Organ preservation rate
Time Frame
1 year
Title
Organ preservation rate
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of biopsy proven stage I-IIIB (cT1-3, N0-2a, M0) adenocarcinoma of the rectum; staging must also be based on multidisciplinary evaluation including MRI Tumor ≤ 12 cm from anal verge as determined by MRI or endoscopy Clinically detectable (MR, endoscopy, or DRE) tumor present Eastern Cooperative Oncology Group (ECOG) performance status 0-2 At least 18 years of age Adequate bone marrow function defined as: Absolute neutrophil count (ANC) > 1,500 cells/mm3 Hemoglobin> 8 g/dl Platelets >100,000 cells/mm3 Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Able to understand and willing to sign an Institutional Review Board (IRB)-approved written informed consent document. Exclusion Criteria Prior radiation therapy, chemotherapy or extirpative surgery for rectal cancer. Prior oxaliplatin or capecitabine use for any malignancy No prior radiation therapy to the pelvis. A history of other malignancy (except non-melanomatous skin cancers) with the exception of malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease. Currently receiving any investigational agents. A history of allergic reaction attributed to compounds of similar chemical or biologic composition to capecitabine, 5FU, oxaliplatin, or leucovorin. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia. Pregnant and/or breastfeeding. Women of childbearing potential must have a negative serum pregnancy test within 14 days of study entry. Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of AIDS-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective antiretroviral therapy (ART) according to Department of Health and Human Services (DHHS) treatment guidelines is recommended. HIV testing for patients without a history of HIV is not a protocol requirement.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hyun Kim, M.D.
Phone
314-362-8502
Email
kim.hyun@wustl.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jeffrey Olsen, M.D.
Phone
719-365-6800
First Name & Middle Initial & Last Name & Degree
Jeffrey Olsen, M.D.
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christopher Hallemeier, M.D.
Email
hallemeier.christopher@mayo.edu
First Name & Middle Initial & Last Name & Degree
Christopher Hallemeier, M.D.
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
Phone
314-362-8502
Email
kim.hyun@wustl.edu
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
First Name & Middle Initial & Last Name & Degree
Sean Glasgow, M.D.
First Name & Middle Initial & Last Name & Degree
Kian-Huat Lim, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Matthew Mutch, M.D.
First Name & Middle Initial & Last Name & Degree
Matthew Silviera, M.D.
First Name & Middle Initial & Last Name & Degree
Rama Suresh, M.D.
First Name & Middle Initial & Last Name & Degree
Benjamin R Tan, M.D.
First Name & Middle Initial & Last Name & Degree
Nikolaos Trikalinos, M.D.
First Name & Middle Initial & Last Name & Degree
Paul Wise, M.D.
First Name & Middle Initial & Last Name & Degree
Esther Lu, Ph.D.
First Name & Middle Initial & Last Name & Degree
David DeNardo, Ph.D.
First Name & Middle Initial & Last Name & Degree
Radhika Smith, M.D.
First Name & Middle Initial & Last Name & Degree
Lauren Henke, M.D.
First Name & Middle Initial & Last Name & Degree
Shahed Badiyan, M.D.
First Name & Middle Initial & Last Name & Degree
Pamela Samson, M.D.
First Name & Middle Initial & Last Name & Degree
Carl DeSelm, M.D.
First Name & Middle Initial & Last Name & Degree
Olivia Aranha, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Patrick Grierson, M.D., Ph.D.
Facility Name
University of Vermont Medical Center
City
Burlington
State/Province
Vermont
ZIP/Postal Code
05401
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chris Anker, M.D.
Phone
802-847-3506
Email
chris.anker@uvmhealth.org
First Name & Middle Initial & Last Name & Degree
Chris Anker, M.D.
First Name & Middle Initial & Last Name & Degree
Steven Ades, M.D.
First Name & Middle Initial & Last Name & Degree
Maura Berry, M.D.
First Name & Middle Initial & Last Name & Degree
Marc Greenblatt, M.D.
First Name & Middle Initial & Last Name & Degree
Nataniel Lester-Coll, M.D.
First Name & Middle Initial & Last Name & Degree
Peter Cataldo, M.D.
First Name & Middle Initial & Last Name & Degree
Jesse Moore, M.D.
First Name & Middle Initial & Last Name & Degree
Krista Evans, M.D.

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Deidentified data will be shared with investigators who submit a sound proposal. Participants who opted out of data sharing in the informed consent will not be included.
IPD Sharing Time Frame
Up to 5 years after completion of the study
IPD Sharing Access Criteria
Proposals should be directed to kim.hyun@wustl.edu. To gain access, data requestors will need to sign a data access agreement and provide proof of appropriate regulatory approvals as necessary.
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Non-Operative Management and Early Response Assessment in Rectal Cancer

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