Testing the Addition of an Anti-Cancer Drug, Irinotecan, to the Standard Chemotherapy Treatment (FOLFOX) After Long-Course Radiation Therapy for Advanced-Stage Rectal Cancers to Improve the Rate of Complete Response and Long-Term Rates of Organ Preservation (JANUS)
Locally Advanced Rectal Carcinoma, Stage II Rectal Cancer AJCC v8, Stage III Rectal Cancer AJCC v8
About this trial
This is an interventional treatment trial for Locally Advanced Rectal Carcinoma
Eligibility Criteria
Inclusion Criteria: Stage: Clinical stage II or III rectal adenocarcinoma defined as T4N0 or any T with node positive disease (any T, N+); also T3N0 requiring abdominal perineal resection (APR) or coloanal anastomosis Tumor site: Rectum; =< 12cm from the anal verge No prior systemic chemotherapy, targeted therapy, or immunotherapy; or radiation therapy administered as treatment for colorectal cancer within the past 5 years is allowed Not pregnant and not nursing, because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects * Therefore, for women of childbearing potential only, a negative pregnancy test (urine or serum according to institutional guidelines) done =< 14 days prior to registration is required. Female subjects agree to use highly effective contraception combined with an additional barrier method (e.g, diaphragm, with a spermicide) while on study and for >= 9 months after last dose of study drug, and the same criteria are applicable to male subjects if they have a partner of childbirth potential. Male subject agrees to use a condom and not donate sperm while in this study and for >= 6 months after the last treatment Age >= 18 years Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (or Karnofsky >= 60%) Absolute neutrophil count (ANC) >= 1,500/mm^3 Platelet count >= 100,000/mm Creatinine =< 1.5 x upper limit of normal (ULN) OR calculated (calc.) creatinine clearance >= 50 mL/min ^3 Total bilirubin =< 1.5 x upper limit of normal (ULN) Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 3 x upper limit of normal (ULN) No upper rectal tumors (distal margin of tumor > 12 cm from the anal verge) No recurrent rectal cancer; prior transanal excision, prior distal sigmoid cancer with a low anastomosis No known mismatch repair deficient rectal adenocarcinoma Human immunodeficiency virus HIV-infected patients on effective anti-retro viral therapy with undetectable viral load within 6 months are eligible for this trial Patients with known history or current symptoms of cardiac disease, or history of treatment with cardio toxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification1. To be eligible for this trial, patients should be class 2B or better Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug for 14 days prior to registration on the study * Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of study treatment
Sites / Locations
- Mission Hope Medical Oncology - Arroyo Grande
- City of Hope Comprehensive Cancer Center
- Washington Hospital
- City of Hope at Irvine Lennar
- Los Angeles County-USC Medical Center
- USC / Norris Comprehensive Cancer Center
- Saint Joseph Hospital - Orange
- UC Irvine Health/Chao Family Comprehensive Cancer Center
- University of California Davis Comprehensive Cancer Center
- Salinas Valley Memorial
- Mission Hope Medical Oncology - Santa Maria
- City of Hope South Pasadena
- City of Hope South Bay
- City of Hope Upland
- Penrose-Saint Francis Healthcare
- Saint Francis Cancer Center
- Hartford Hospital
- Midstate Medical Center
- The Hospital of Central Connecticut
- Beebe South Coastal Health Campus
- Beebe Medical Center
- Delaware Clinical and Laboratory Physicians PA
- Helen F Graham Cancer Center
- Medical Oncology Hematology Consultants PA
- Christiana Care Health System-Christiana Hospital
- Beebe Health Campus
- MedStar Washington Hospital Center
- Morton Plant Hospital
- University of Florida Health Science Center - Gainesville
- Saint Joseph's Hospital-North
- AdventHealth Orlando
- Saint Anthony's Hospital Cancer Care Center
- Saint Joseph's Hospital/Children's Hospital-Tampa
- Saint Luke's Cancer Institute - Boise
- Saint Luke's Cancer Institute - Fruitland
- Saint Luke's Cancer Institute - Meridian
- Saint Luke's Cancer Institute - Nampa
- Saint Luke's Cancer Institute - Twin Falls
- Advocate Good Shepherd Hospital
- Centralia Oncology Clinic
- Northwestern University
- John H Stroger Jr Hospital of Cook County
- University of Chicago Comprehensive Cancer Center
- Advocate Illinois Masonic Medical Center
- AMG Crystal Lake - Oncology
- Carle at The Riverfront
- Cancer Care Specialists of Illinois - Decatur
- Decatur Memorial Hospital
- Northwestern Medicine Cancer Center Kishwaukee
- Advocate Good Samaritan Hospital
- Carle Physician Group-Effingham
- Crossroads Cancer Center
- Elmhurst Memorial Hospital
- Northwestern Medicine Cancer Center Delnor
- Advocate South Suburban Hospital
- Northwestern Medicine Lake Forest Hospital
- AMG Libertyville - Oncology
- Condell Memorial Hospital
- Carle Physician Group-Mattoon/Charleston
- Edward Hospital/Cancer Center
- UC Comprehensive Cancer Center at Silver Cross
- Cancer Care Center of O'Fallon
- Advocate Christ Medical Center
- University of Chicago Medicine-Orland Park
- Advocate Lutheran General Hospital
- Southern Illinois University School of Medicine
- Springfield Clinic
- Memorial Medical Center
- Carle Cancer Center
- Northwestern Medicine Cancer Center Warrenville
- Parkview Regional Medical Center
- Mercy Hospital
- Oncology Associates at Mercy Medical Center
- Medical Oncology and Hematology Associates-West Des Moines
- Mercy Cancer Center-West Lakes
- Greater Regional Medical Center
- Mercy Medical Center - Des Moines
- Mission Cancer and Blood - Laurel
- Mercy Medical Center-West Lakes
- Ochsner Medical Center Jefferson
- Lafayette Family Cancer Center-EMMC
- Sinai Hospital of Baltimore
- Boston Medical Center
- Saint Joseph Mercy Hospital
- Saint Joseph Mercy Brighton
- Trinity Health IHA Medical Group Hematology Oncology - Brighton
- Saint Joseph Mercy Canton
- Trinity Health IHA Medical Group Hematology Oncology - Canton
- Caro Cancer Center
- Saint Joseph Mercy Chelsea
- Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
- Beaumont Hospital - Dearborn
- Beaumont Hospital - Farmington Hills
- Genesys Hurley Cancer Institute
- Hurley Medical Center
- Sparrow Hospital
- Trinity Health Saint Mary Mercy Livonia Hospital
- Saint Mary's Oncology/Hematology Associates of Marlette
- 21st Century Oncology-Pontiac
- Saint Joseph Mercy Oakland
- William Beaumont Hospital-Royal Oak
- Ascension Saint Mary's Hospital
- Oncology Hematology Associates of Saginaw Valley PC
- Ascension Saint Joseph Hospital
- William Beaumont Hospital - Troy
- Saint Mary's Oncology/Hematology Associates of West Branch
- Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
- Sanford Joe Lueken Cancer Center
- Minnesota Oncology - Burnsville
- Minnesota Oncology Hematology PA-Maplewood
- Abbott-Northwestern Hospital
- United Hospital
- Minnesota Oncology Hematology PA-Woodbury
- Baptist Memorial Hospital and Cancer Center-Golden Triangle
- Baptist Cancer Center-Grenada
- Baptist Memorial Hospital and Cancer Center-Union County
- Baptist Memorial Hospital and Cancer Center-Oxford
- Baptist Memorial Hospital and Cancer Center-Desoto
- Saint Francis Medical Center
- Delbert Day Cancer Institute at PCRMC
- Mercy Clinic-Rolla-Cancer and Hematology
- Mercy Hospital Saint Louis
- CoxHealth South Hospital
- OptumCare Cancer Care at Seven Hills
- OptumCare Cancer Care at Charleston
- Radiation Oncology Centers of Nevada Central
- Radiation Oncology Centers of Nevada Southeast
- OptumCare Cancer Care at MountainView
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
- Comprehensive Cancer Centers of Nevada
- OptumCare Cancer Care at Fort Apache
- Renown Regional Medical Center
- New Hampshire Oncology Hematology PA-Concord
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
- The Dana-Farber Cancer Institute at Londonderry
- Solinsky Center for Cancer Care
- Memorial Sloan Kettering Basking Ridge
- Memorial Sloan Kettering Monmouth
- Memorial Sloan Kettering Bergen
- Holy Name Hospital
- Montefiore Medical Center-Einstein Campus
- Montefiore Medical Center-Weiler Hospital
- Montefiore Medical Center - Moses Campus
- Roswell Park Cancer Institute
- Memorial Sloan Kettering Commack
- Northwell Health Cancer Institute at Huntington
- Memorial Sloan Kettering Westchester
- Northwell Health/Center for Advanced Medicine
- NYU Winthrop Hospital
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
- Mount Sinai West
- Lenox Hill Hospital
- Mount Sinai Hospital
- Memorial Sloan Kettering Cancer Center
- University of Rochester
- Memorial Sloan Kettering Nassau
- Wilmot Cancer Institute at Webster
- Duke Cancer Institute Cary
- UNC Lineberger Comprehensive Cancer Center
- Wake Forest University at Clemmons
- Duke University Medical Center
- East Carolina University
- Duke Raleigh Hospital
- Wake Forest Baptist Health - Wilkes Medical Center
- Wake Forest University Health Sciences
- Sanford Bismarck Medical Center
- Sanford Broadway Medical Center
- Sanford Roger Maris Cancer Center
- MetroHealth Medical Center
- Ohio State University Comprehensive Cancer Center
- University of Oklahoma Health Sciences Center
- Mercy Hospital Oklahoma City
- Clackamas Radiation Oncology Center
- Providence Cancer Institute Clackamas Clinic
- Providence Newberg Medical Center
- Providence Willamette Falls Medical Center
- Providence Portland Medical Center
- Providence Saint Vincent Medical Center
- Lehigh Valley Hospital-Cedar Crest
- UPMC Altoona
- UPMC Camp Hill
- Carlisle Regional Cancer Center
- Christiana Care Health System-Concord Health Center
- UPMC Hillman Cancer Center Erie
- Saint Vincent Hospital
- UPMC Cancer Center at UPMC Horizon
- UPMC Cancer Centers - Arnold Palmer Pavilion
- UPMC Pinnacle Cancer Center/Community Osteopathic Campus
- Penn State Milton S Hershey Medical Center
- IRMC Cancer Center
- Jefferson Hospital
- UPMC-Johnstown/John P. Murtha Regional Cancer Center
- UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
- Forbes Hospital
- UPMC Hillman Cancer Center - Part of Frick Hospital
- Arnold Palmer Cancer Center Medical Oncology Norwin
- UPMC Hillman Cancer Center - New Castle
- Thomas Jefferson University Hospital
- Allegheny General Hospital
- UPMC-Saint Margaret
- University of Pittsburgh Cancer Institute (UPCI)
- UPMC-Shadyside Hospital
- UPMC-Passavant Hospital
- UPMC-Saint Clair Hospital Cancer Center
- UPMC Cancer Center at UPMC Northwest
- UPMC Cancer Center-Washington
- UPMC Washington Hospital Radiation Oncology
- Chester County Hospital
- Wexford Health and Wellness Pavilion
- Divine Providence Hospital
- Asplundh Cancer Pavilion
- UPMC Memorial
- Medical University of South Carolina
- Gibbs Cancer Center-Gaffney
- Tidelands Georgetown Memorial Hospital
- Prisma Health Cancer Institute - Faris
- Prisma Health Cancer Institute - Eastside
- Prisma Health Cancer Institute - Greer
- Gibbs Cancer Center-Pelham
- MUSC Health Tidelands Health Radiation Therapy Center
- Prisma Health Cancer Institute - Seneca
- Spartanburg Medical Center
- MGC Hematology Oncology-Union
- Lexington Medical Center
- Sanford Cancer Center Oncology Clinic
- Avera Cancer Institute
- Sanford USD Medical Center - Sioux Falls
- Avera Cancer Institute at Yankton
- Baptist Memorial Hospital and Cancer Center-Collierville
- The West Clinic - Wolf River
- Baptist Memorial Hospital and Cancer Center-Memphis
- Vanderbilt Breast Center at One Hundred Oaks
- Vanderbilt University/Ingram Cancer Center
- The Don and Sybil Harrington Cancer Center
- Lyndon Baines Johnson General Hospital
- M D Anderson Cancer Center
- University of Texas Health Science Center at San Antonio
- Farmington Health Center
- University of Utah Sugarhouse Health Center
- Huntsman Cancer Institute/University of Utah
- Inova Schar Cancer InstituteRecruiting
- Inova Fair Oaks HospitalRecruiting
- Inova Fairfax HospitalRecruiting
- Inova Loudoun HospitalRecruiting
- Virginia Cancer Institute
- VCU Massey Cancer Center at Stony Point
- Virginia Commonwealth University/Massey Cancer Center
- Valley Medical Center
- Virginia Mason Medical CenterRecruiting
- FHCC South Lake Union
- Fred Hutchinson Cancer Research Center
- University of Washington Medical Center - Montlake
- Langlade Hospital and Cancer Center
- Aurora Cancer Care-Southern Lakes VLCC
- Marshfield Medical Center-EC Cancer Center
- Aurora Health Care Germantown Health Center
- Aurora Cancer Care-Grafton
- Saint Vincent Hospital Cancer Center Green Bay
- Saint Vincent Hospital Cancer Center at Saint Mary's
- Aurora BayCare Medical Center
- Aurora Cancer Care-Kenosha South
- Aurora Bay Area Medical Group-Marinette
- Marshfield Medical Center-Marshfield
- Froedtert Menomonee Falls Hospital
- Aurora Cancer Care-Milwaukee
- Aurora Saint Luke's Medical Center
- Medical College of Wisconsin
- Aurora Sinai Medical Center
- Marshfield Clinic-Minocqua Center
- Drexel Town Square Health Center
- Vince Lombardi Cancer Clinic - Oshkosh
- Aurora Cancer Care-Racine
- Marshfield Medical Center-Rice Lake
- Saint Vincent Hospital Cancer Center at Sheboygan
- Vince Lombardi Cancer Clinic-Sheboygan
- Ascension Saint Michael's Hospital
- Marshfield Medical Center-River Region at Stevens Point
- Saint Vincent Hospital Cancer Center at Sturgeon Bay
- Aurora Medical Center in Summit
- Vince Lombardi Cancer Clinic-Two Rivers
- Aspirus Regional Cancer Center
- Aurora Cancer Care-Milwaukee West
- Aurora West Allis Medical Center
- Froedtert West Bend Hospital/Kraemer Cancer Center
- Marshfield Medical Center - Weston
- Aspirus Cancer Care - Wisconsin Rapids
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Group I (LCRT, FOLFOX or CAPOX)
Group II (LCRT, FOLFIRINOX)
Patients receive long-course chemoradiation therapy on study and then receive either: FOLFOX regimen consisting of leucovorin IV, fluorouracil IV, and oxaliplatin IV or CAPOX consisting of capecitabine PO, and oxaliplatin IV on study. Patients undergo CT scan, MRI, and biospecimen collection throughout the trial. Patients also undergo sigmoidoscopy throughout the trial and biopsy during screening.
Patients receive long-course chemoradiation therapy on study and then receive FOLFIRINOX regimen consisting of leucovorin IV, fluorouracil IV, irinotecan IV, and oxaliplatin IV on study. Patients undergo CT scan, MRI scan, and blood specimen collection throughout the trial. Patients undergo sigmoidoscopy throughout the trial and biopsy during screening.