Bortezomib, Fluorouracil, and External-Beam Radiation Therapy in Treating Patients With Stage II, Stage III, or Stage IV Rectal Cancer
RATIONALE: Bortezomib 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. Drugs used in chemotherapy, such as fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving bortezomib and fluorouracil together with radiation therapy may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of bortezomib when given together with fluorouracil and external-beam radiation therapy in treating patients with stage II, stage III, or stage IV rectal cancer.
Radiation: radiation therapy
|Study Design:||Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Phase I Study of PS-341 in Combination With 5-Fluorouracil and External Beam Radiotherapy For The Treatment Of Locally Advanced And Metastatic Rectal Cancer|
- Maximum tolerated dose [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
- Dose-limiting toxicity [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]
- Dose-effect relationship of bortezomib on NF-kappa B activation induced by chemoradiotherapy [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- Downstream events induced by NF-kappa B activation [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
- Downstream events related to activation of p53 in response to treatment with chemoradiotherapy and bortezomib [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
- Rate of complete pathologic remission [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Gene expression pattern of tumors as assessed by cDNA microarray analysis pre- and post-treatment [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
|Study Start Date:||April 2003|
|Study Completion Date:||September 2010|
|Primary Completion Date:||November 2008 (Final data collection date for primary outcome measure)|
- Determine the maximum tolerated dose of bortezomib when administered in combination with fluorouracil and external beam radiotherapy as preoperative or palliative treatment in patients with stage II-IV rectal adenocarcinoma.
- Determine the dose-limiting toxicities of this regimen in these patients.
- Determine the dose-effect relationship of bortezomib on NF-kappa B activation induced by chemoradiotherapy.
- Determine downstream events induced by NF-kappa B activation.
- Determine downstream events related to activation of p53 in response to treatment with chemoradiotherapy and bortezomib.
- Determine the rate of complete pathologic remission in patients who undergo surgical resection of their primary tumor.
- Determine the gene expression pattern of tumors by cDNA microarray analysis before and during treatment with this regimen.
OUTLINE: This is a multicenter, dose-escalation study of bortezomib.
Patients receive bortezomib IV on days 1, 4, 8, 11, 22, 25, 29, and 32 and fluorouracil IV continuously on days 2-38. Patients also undergo external beam radiotherapy 5 days a week for 5½ weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Patients undergo tissue biopsy at baseline and on days 1 and 2. Samples are collected and evaluated by tissue microarray analysis for NF-kappa B pathway activation; cDNA analysis, RNase protection assay, and immunohistochemistry for analysis of downstream events induced by NF-kappa B activation; and modified TdT-mediated dUTP nick-end label for analysis of apoptosis by DNA fragmentation. NF-kappa B subunits are quantified by enzyme-linked immunosorbent assay. Serum samples are collected at baseline and stored for future studies.
After completion of study treatment, patients are followed every 3 months for up to 2 years.
|United States, North Carolina|
|Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill|
|Chapel Hill, North Carolina, United States, 27599-7295|
|United States, Tennessee|
|Vanderbilt-Ingram Cancer Center|
|Nashville, Tennessee, United States, 37232-6838|
|Principal Investigator:||Bert H. O'Neil, MD||UNC Lineberger Comprehensive Cancer Center|