S0713: Oxaliplatin, Capecitabine, Cetuximab, and RT Followed By Surgery in Pts W/Stage II or III Rectal Cancer
RATIONALE: Drugs used in chemotherapy, such as oxaliplatin and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving chemotherapy and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.
PURPOSE: This phase II trial is studying the side effects and how well giving oxaliplatin, capecitabine, and cetuximab together with radiation therapy followed by surgery works in treating patients with stage II or stage III rectal cancer.
Procedure: therapeutic surgical procedure
Radiation: radiation therapy
|Study Design:||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase II Study of Oxaliplatin, Capecitabine, Cetuximab and Radiation in Pre-Operative Therapy of Rectal Cancer|
- Pathologic complete response rate [ Time Frame: 15-20 weeks from registration ] [ Designated as safety issue: No ]
- Disease-free survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Frequency and severity of toxicities [ Time Frame: Weekly through Week 12 ] [ Designated as safety issue: Yes ]
- Association between expression levels of genes involved in the DNA repair, EGFR, angiogenesis, and 5-FU pathway with pathologic complete response [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Intratumoral gene expression levels after completion of study treatment [ Time Frame: 3 years ] [ Designated as safety issue: No ]
- Data on genomic polymorphisms of these genes for correlation with clinical outcome and toxicity [ Time Frame: 3 years ] [ Designated as safety issue: No ]
|Study Start Date:||February 2009|
|Estimated Study Completion Date:||July 2017|
|Estimated Primary Completion Date:||July 2014 (Final data collection date for primary outcome measure)|
Experimental: Chemo + Chemo and radiation + Surgery
Chemotherapy Cycle 1 (1 cycle is 35 days):
Chemotherapy+ Radiation Cycle 2:
Therapeutic Surgical procedure: Resection
Chemotherapy cycle 1: Cetuximab, 400 mg/m^2, IV, Day 1; Cetuximab, 250 mg/m^2, IV, Days 8,15,22,29
Chemotherapy+ Radiation Cycle 2: Cetuximab, 250 mg/m^2, IV, Days 50,57,64,71,78
Other Names:Drug: capecitabine
Chemotherapy Cycle 1: Capecitabine, 1650 mg/m^2/day, PO, Monday-Friday (Day 1-35)
Chemotherapy+ Radiation Cycle 2: Capecitabine, 1650 mg/m^1, PO, Monday-Friday (Day 50-84)
Other Names:Drug: oxaliplatin
Chemotherapy Cycle 1: Oxaliplatin, 50 mg/m^2, IV, Days 1,8,15,22,29
Chemotherapy+ Radiation Cycle 2: Oxaliplatin, 50 mg/m^2, IV, Days 50,57,71,78
Other Names:Procedure: therapeutic surgical procedure
Other Name: ResectionRadiation: radiation therapy
IMRT (intensity-modulated radiation therapy)
Other Name: RT
- To assess the pathologic complete response rate for the combination of oxaliplatin, capecitabine, and cetuximab alone and concurrently with external beam radiotherapy for patients with adenocarcinoma of the rectum, stages II and III with wild-type K-ras.
- To estimate the 3-year disease-free survival probability in this patient population when treated with this regimen.
- To assess the frequency and severity of toxicities associated with this regimen in these patients.
- To explore, preliminarily, the association between expression levels of genes involved in the DNA repair, EGFR (epidermal growth factor receptor), angiogenesis, and 5-FU pathway (i.e., k-ras, TS [Thymidylate Synthase], ERCC-1 [excision repair cross complementing-1), TP [Thymidine phosphorylase], DPD [Dihydropyrimidine dehydrogenase], EGFR, VEGF [vascular endothelial growth factor], and IL-8 [interleukin-8]) and pathologic complete response.
- To explore, preliminarily, the intratumoral gene expression levels of these genes after completion of study treatment.
- To obtain, preliminarily, data on genomic polymorphisms of these genes for correlation with clinical outcome and toxicity.
OUTLINE: This is a multicenter study.
- Neoadjuvant therapy (course 1): Patients receive oxaliplatin IV over 2 hours once a week for 5 weeks, oral capecitabine twice daily 5 days a week for 5 weeks, and cetuximab IV over 1-2 hours once a week for 5 weeks.
- Neoadjuvant therapy with concurrent radiotherapy (course 2): Beginning two weeks later, patients receive oxaliplatin IV over 2 hours once a week in weeks 1, 2, 4, and 5. Patients also receive capecitabine and cetuximab as in course 1. Patients also undergo external beam radiotherapy 5 days a week for 5 weeks beginning in week 1.
Treatment continues in the absence of disease progression or unacceptable toxicity. Patients undergo surgery 3-8 weeks after completion of chemoradiotherapy.
Blood samples are collected for germline polymorphism testing and tissue samples are collected and assessed for gene expression analysis.
After completion of study treatment, patients are followed every 6 months for 4 years.