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Neoadjuvant Chemoradiotherapy and Adjuvant Chemotherapy in Treating Patients Who Are Undergoing Surgical Resection for Locally Advanced Rectal Cancer

Primary Purpose

Colorectal Cancer

Status

Completed

Phase

Phase 2

Locations

United States

Study Type

Interventional

Intervention

Radiation Therapy

Capecitabine 1650 mg/m^2/day

Capecitabine 1200 mg/m^2/day

Irinotecan

Oxaliplatin

Surgery

Folinic Acid

Fluorouracil

Oxaliplatin

About this trial

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

Eligibility Criteria

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

Inclusion Criteria: Adenocarcinoma of the rectum originating at or below 12 cm from the anal verge without evidence of distant metastases Patient must be 18 years of age or greater. Potentially resectable en bloc based upon surgeon evaluation Clinical stages T3 or T4, based upon endorectal ultrasound, or physical examination (only acceptable for T4 lesions). Absolute neutrophil count of > 1500 per microliter and platelet count > 100,000 per microliter; aspartate aminotransferase (AST) and alkaline phosphatase < 2.5 X upper limit of normal (ULN), bilirubin < = 1.5 ULN, calculated creatinine clearance > 50 ml/min using Cockcroft-Gault formula: CrCl male = (140 - age) x (wt. in kg) / (Serum Cr) x 72 CrCl female = 0.85 x (CrCl male) Zubrod performance status 0-2 No history of other malignancies within 5 years, except non-melanoma skin cancer, in situ carcinoma of the cervix, or ductal carcinoma in situ of the breast. Previous invasive cancer permitted if disease free at least 5 years. Signed study-specific informed consent prior to randomization Exclusion Criteria: Any evidence of distant metastasis Synchronous primary colon carcinomas, except T1 lesions (full colonoscopy not required for enrollment) Extension of malignant disease to the anal canal Prior radiation therapy to the pelvis Prior chemotherapy for malignancies Pregnancy or lactation, (exclusion due to potential adverse effects of therapy). Women of childbearing potential with either a positive or no pregnancy test (serum or urine) at baseline. Women/men of childbearing potential not using a reliable and appropriate contraceptive method. (Postmenopausal women must have been amenorrheic for at least 12 months to be considered to be of non-childbearing potential.) Patients will agree to continue contraception for 30 days from the date of the last study drug administration. Serious, uncontrolled, concurrent infection(s). Participation in any investigational drug study within 4 weeks preceding the start of study treatment. Clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac arrhythmias not well controlled with medication) or myocardial infarction within the last 12 months. Evidence of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant, precluding informed consent, or interfering with compliance of oral drug intake. Other serious uncontrolled medical conditions that the investigator feels might compromise study participation. Major surgery within 4 weeks of the study treatment. Lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome. Known, existing uncontrolled coagulopathy. No concurrent cimetidine allowed.

Sites / Locations

University of California Davis Cancer Center
Baptist-South Miami Regional Cancer Program
Ingalls Cancer Care Center at Ingalls Memorial Hospital
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton
Northeast Radiation Oncology Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Arm Label

Neoadjuvant chemoradiation with irinotecan

Neoadjuvant chemoradiation with oxaliplatin

Arm Description

Patients receive neoadjuvant therapy comprising 45 Gy (1.8 Gy/fx) + 5.4 Gy boost (1.8 Gy/fx) radiation therapy (RT), oral capecitabine 1200mg/m^2/day 5 days/week during RT, and irinotecan 50 mg/m^2 IV for 1 hour days 1, 8, 22, 29. Surgery 4-8 weeks after RT. Postoperative chemotherapy beginning Day 1 postoperatively for nine 14-day cycles(folinic acid 400 mg/m^2 over 2 hours Day 1; 5-fluorouracil bolus 400 mg/m^2 IV push Day 1 plus 2400 mg/m^2 IV continuous infusion over 46 hours, beginning Day 1; and oxaliplatin 85 mg/m^2 IV over 2 hours Day 1) .

Patients receive neoadjuvant therapy comprising 45 Gy (1.8 Gy/fx) + 5.4 Gy boost (1.8 Gy/fx) radiation therapy (RT), oral capecitabine 1650mg/m^2/day 5 days/week during RT, and oxaliplatin 50 mg/m^2 IV for 2 hours days 1, 8, 15, 22, 29. Surgery 4-8 weeks after RT. Postoperative chemotherapy beginning Day 1 postoperatively for nine 14-day cycles(folinic acid 400 mg/m^2 over 2 hours Day 1; 5-fluorouracil bolus 400 mg/m^2 IV push Day 1 plus 2400 mg/m^2 IV continuous infusion over 46 hours, beginning Day 1; and oxaliplatin 85 mg/m^2 IV over 2 hours Day 1) .

Outcomes

Primary Outcome Measures

Pathologic Complete Response Rate

A pathologic complete response (pCR) was defined as no evidence of residual cancer histologically; disease progression or death before surgery was considered less than pCR (even without surgical specimen). All cases were reviewed by the study's surgical oncology co-chair for the determination of pCR. Each arm was first analyzed alone. If the arm had 9 or more pCRs in 48 evaluable pts, then the null hypothesis (H0) of 10% pCR rate would be rejected in favor of the alternative hypothesis of 25%, providing 90% power with a two-sided 10% type I error rate. If both arms reject H0, then statistical selection theory would be used to choose the arm for further study in a phase III trial. If only one arm has acceptable pCR rate, then that arm would be pursued in a phase III trial.

Secondary Outcome Measures

Survival Rate at 4 Years

Survival time is defined as time from registration/randomization to the date of death from any cause or last known follow-up (censored). Survival rates are estimated by the Kaplan-Meier method.

Local-regional Failure Rate at 4 Years

Local-regional failure is defined as any of the following: no clinical complete response (cCR) in the primary site and/or nodes at any time after treatment completion (persistence), recurrence and/or progression in the primary site and/or nodes after cCR, and nonprotocol surgery to the primary site after cCR. Time to local-regional failure is defined as time from randomization to date of failure, last known follow-up (censored), or death without local-regional failure (competing risk). Local-regional failure rates are estimated by the cumulative incidence method.

Distant Failure Rate at 4 Years

Time to distant failure is defined as time from randomization to date of the appearance of distant metastases, last known follow-up (censored), or death without distant failure (competing risk). Distant failure rates are estimated by the cumulative incidence method.

Second Primary Rate at 4 Years

Time to second primary is defined as time from randomization to date of the appearance of a second primary cancer, last known follow-up (censored), or death without second primary (competing risk). Second primary rates are estimated by the cumulative incidence method.

Disease-free Survival Rate at 4 Years

Disease-free survival time is defined as time from randomization to date of local-regional failure, the appearance of distant metastases, the appearance of a second primary failure, or date of death from any cause/ Disease-free survival rates are estimated by the Kaplan-Meier method. Patients last known to be alive without failure are censored at the date of last contact.

Number of Participants With Grade 3+ Treatment-related Adverse Events

Highest grade adverse event per subject were counted. Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE.

Number of Participants With Grade 3+ Treatment-related Adverse Events Preoperatively

Number of Participants With Grade 3+ Treatment-related Adverse Events Postoperatively

Tumor Marker Evaluation Using Preoperative Tissue Biopsy Specimens and Surgically Resected Tissue Specimens

Change From Baseline in QLQ-C30 Global Health Status Score at Completion of Chemoradiation

Global Health Status is calculated from two questions on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ]-C30. The question responses range from 1 "very poor" to 7 "excellent" such that a higher response indicates better quality of life (QOL). The mean of these responses is linearly transformed to a range of 0 (worst) to 100 (best). Change from baseline is calculated as the time point value - baseline value and a decrease from baseline indicates decline in quality of life. A positive number indicates improvement in QOL.

Change From Baseline in QLQ-C30 Global Health Status Score at Completion of Post-operative Chemotherapy

Change From Baseline in QLQ-C30 Global Health Status Score at Two Years

Change From Baseline in EORTC QLQ-CR38 Gastro-intestinal Symptom Score at Completion of Chemoradiation

The gastro-intestinal (GI) symptom score is calculated from five symptom questions on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ]-CR38. The question responses range from 1 (not at all) to 4 (very much) such that a higher response indicates worse symptoms. The mean of these responses is linearly transformed to a range of 0 (best) to 100 (worst). Change from baseline is calculated as the time point value - baseline value and a decrease from baseline indicates improvement in symptoms. A negative number indicates improvement in symptoms.

Change From Baseline in EORTC QLQ-CR38 Gastro-intestinal Symptom Score at Completion of Post-operative Chemotherapy

Change From Baseline in EORTC QLQ-CR38 Gastro-intestinal Symptom Score at Two Years

Change From Baseline in EORTC QLQ-CR38 Defecation Symptom Score at Completion of Chemoradiation

The defecation symptom score is calculated from seven symptom questions on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ]-CR38. The question responses range from 1 "not at all" to 4 "very much" such that a higher response indicates worse symptoms. The mean of these responses is linearly transformed to a range of 0 (best) to 100 (worst). Change from baseline is calculated as the time point value - baseline value and a decrease from baseline indicates improvement in symptoms. A negative number indicates improvement in symptoms.

Change From Baseline in EORTC QLQ-CR38 Defecation Symptom Score at Post-operative Chemotherapy

Change From Baseline in EORTC QLQ-CR38 Defecation Symptom Score at Two Years

Full Information

NCT ID

NCT00081289

First Posted

April 7, 2004

Last Updated

February 4, 2020

Sponsor

Radiation Therapy Oncology Group

Collaborators

National Cancer Institute (NCI)

1. Study Identification

Unique Protocol Identification Number

NCT00081289

Brief Title

Neoadjuvant Chemoradiotherapy and Adjuvant Chemotherapy in Treating Patients Who Are Undergoing Surgical Resection for Locally Advanced Rectal Cancer

Official Title

Randomized Phase II Trial Of Neoadjuvant Combined Modality Therapy For Locally Advanced Rectal Cancer

Study Type

Interventional

2. Study Status

Record Verification Date

February 2020

Overall Recruitment Status

Completed

Study Start Date

March 2004 (undefined)

Primary Completion Date

May 2011 (Actual)

Study Completion Date

December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Radiation Therapy Oncology Group

Collaborators

National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Chemoradiotherapy (combining chemotherapy with radiation therapy) before surgery may shrink the tumor so that it can be removed. Giving chemotherapy after surgery may kill any remaining tumor cells. PURPOSE: This randomized phase II trial is studying two different regimens of neoadjuvant chemoradiotherapy and adjuvant chemotherapy and comparing how well they work in treating patients who are undergoing surgical resection for locally advanced rectal cancer.

Detailed Description

OBJECTIVES: Evaluate the pathologic complete response rate in patients with locally advanced rectal cancer undergoing surgical resection treated with 2 different regimens of neoadjuvant chemoradiotherapy and adjuvant chemotherapy. Evaluate the time to treatment failure and patterns of failure in patients treated with these regimens. Evaluate the incidence of hematologic and non-hematologic grade 3-4 toxicity (preoperatively, postoperatively, and overall) in patients treated with these regimens. Evaluate the quality of life of patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to clinical stage of tumor (T3 vs T4). Patients are randomized to 1 of 2 treatment arms. Quality of life is assessed at baseline, within 1 week after completion of radiotherapy, within 1 week after completion of adjuvant chemotherapy (12 months), and then at 24 months. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

6. Conditions and Keywords

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

Colorectal Cancer

Keywords

stage III rectal cancer, adenocarcinoma of the rectum, stage II rectal cancer

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

146 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Neoadjuvant chemoradiation with irinotecan

Arm Type

Experimental

Arm Description

Arm Title

Neoadjuvant chemoradiation with oxaliplatin

Arm Type

Experimental

Arm Description

Intervention Type

Radiation

Intervention Name(s)

Radiation Therapy

Intervention Description

Pelvic radiation therapy given once daily 5 days a week for 6 weeks, 45 Gy in 25 fractions + boost of 5.4 Gy in 3 fractions for a total dose of 50.4 Gy.

Intervention Type

Drug

Intervention Name(s)

Capecitabine 1650 mg/m^2/day

Intervention Description

825 mg/m^2 q12 hours (1650 mg/m^2/day) orally 5 days per week during radiotherapy.

Intervention Type

Drug

Intervention Name(s)

Capecitabine 1200 mg/m^2/day

Intervention Description

600 mg/m^2 q12 hours(1200 mg/m^2/day) orally 5 days per week during radiotherapy.

Intervention Type

Drug

Intervention Name(s)

Irinotecan

Other Intervention Name(s)

Irinotecan Hydrochloride

Intervention Description

50mg/m^2 IV over 1 hour on days 1, 8, 22, and 29

Intervention Type

Drug

Intervention Name(s)

Oxaliplatin

Intervention Description

50mg/m^2 IV over 2 hours on days 1, 8, 15, 22, and 29

Intervention Type

Procedure

Intervention Name(s)

Surgery

Intervention Description

All patients will undergo surgery four to eight weeks following the completion of radiation therapy. The choice of procedure abdominoperineal resection (APR), low anterior resection (LAR), or LAR/coloanal anastomosis is at the discretion of the surgeon.

Intervention Type

Drug

Intervention Name(s)

Folinic Acid

Other Intervention Name(s)

Leucovorin

Intervention Description

400 mg/m^2 IV over 2 hours Day 1 (postoperatively) ,every 14 days, for nine 14-day cycles.

Intervention Type

Drug

Intervention Name(s)

Fluorouracil

Other Intervention Name(s)

5-FU

Intervention Description

5-fluorouracil bolus 400 mg/m^2 IV push Day 1 (postoperatively), every 14 days, for nine 14-day cycles. 5-fluorouracil infusion 2400 mg/m^2 IV continuous infusion over 46 hours, beginning day 1, every 14 days, for nine 14-day cycles.

Intervention Type

Drug

Intervention Name(s)

Oxaliplatin

Intervention Description

85 mg/m^2 IV over 2 hours Day 1 (postoperatively), every 14 days, for nine 14-day cycles.

Primary Outcome Measure Information:

Title

Pathologic Complete Response Rate

Description

Time Frame

After protocol surgery, approximately 10-16 weeks from randomization based on surgery occurring 4-8 weeks after chemoradiation

Secondary Outcome Measure Information:

Title

Survival Rate at 4 Years

Description

Survival time is defined as time from registration/randomization to the date of death from any cause or last known follow-up (censored). Survival rates are estimated by the Kaplan-Meier method.

Time Frame