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Complete Neoadjuvant Treatment for REctal Cancer (CONTRE)

This study has been completed.
Sponsor:
Collaborators:
Memorial Hospital of Rhode Island
Rhode Island Hospital
The Miriam Hospital
Information provided by (Responsible Party):
William Sikov, Brown University
ClinicalTrials.gov Identifier:
NCT01363843
First received: May 26, 2011
Last updated: July 25, 2014
Last verified: July 2014

May 26, 2011
July 25, 2014
May 2010
January 2013   (final data collection date for primary outcome measure)
Incidence of Complete Resection [ Time Frame: approx 6 months ] [ Designated as safety issue: No ]
The primary objective of this study is to determine the incidence of pCRs and complete (R0) resections at surgery after induction chemotherapy with 8 cycles of modified FOLFOX6 followed by standard chemoradiation with IMRT with concurrent infusional 5-FU or capecitabine
Same as current
Complete list of historical versions of study NCT01363843 on ClinicalTrials.gov Archive Site
Evaluate the Toxicity of Study Therapy [ Time Frame: approx 1 year ] [ Designated as safety issue: Yes ]

Evaluate the toxicity of induction FOLFOX and subsequent infusional 5-FU or capecitabine/radiation.

•Secondary efficacy measures include the clinical response rate, as measured endorectal ultrasound or pelvic MRI, and incidence and severity of toxicities seen during the various phases of study treatment, including treatment delays, bleeding and post-op complications. Each visit will have a toxicity assessment completed

Same as current
Not Provided
Not Provided
 
Complete Neoadjuvant Treatment for REctal Cancer (CONTRE)
Complete Neoadjuvant Treatment for REctal Cancer (CONTRE)

The purpose of this study is to find out how well patients with cancer of the rectum do if they get all of their other treatment - chemotherapy by itself followed by chemotherapy and radiation together - before surgery. Patients have recently been diagnosed with rectal cancer, and the doctors have recommended neo-adjuvant chemo treatment to try to shrink the cancer before removing it.

The goals of treatment of locally advanced (T3-4 or N1-2) rectal cancer are to eliminate the primary tumor and any involved adjacent lymph nodes, minimize the risk of distant recurrence, and, when possible, preserve anal sphincter function. Standard treatment consists of surgery, concurrent chemotherapy and radiation (RT) and adjuvant chemotherapy. As the present time, the chemoradiation portion of the treatment is often administered before, as opposed to following, surgical resection. This approach has been associated with tumor down-staging, leading to higher rates of tumor resectability and an increase in the ability to perform sphincter-saving surgeries. (1). However, while advances in treatment of the primary tumor and regional nodes, specifically administration of preoperative chemoradiation and more aggressive surgical approaches, such as total mesorectal excision (TME), have been shown to improve locoregional disease control, toxicities and complications of these treatments may result in delay or omission of adjuvant chemotherapy, which could increase the risk of distant recurrence. In this pilot study, standard adjuvant chemotherapy (8 cycles of modified FOLFOX6) will be administered prior to chemoradiation and definitive surgery, eliminating the need for post-operative systemic therapy. The investigators will evaluate the ability of patients to tolerate this treatment and its impact on achievement of pathologic complete responses (pCRs), negative surgical margins and sphincter preservation.

Interventional
Phase 2
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Colon Cancer
  • Rectal Cancer
  • Drug: FOLFOX6
    FOLFOX6
    Other Names:
    • FOLFOX6
    • Oxaliplatin 85 mg/m2
    • Leucovorin 400 mg/m2 IV
    • 5-FU 400 mg/m2 IV followed 5-FU 2400 mg/m2 IV by continuous over 46 hours
  • Radiation: RT with concurrent chemotherapy
    IMRT 50.4Gy with chemotherapy
  • Procedure: Surgery
Experimental: treatment

Induction therapy - Modified FOLFOX6 - Oxaliplatin 85 mg/m2 + Leucovorin 400 mg/m2 IV, followed by 5-FU 400 mg/m2 IV, followed 5-FU 2400 mg/m2 IV by continuous infusion over 46 hours - Repeat q14 days x 8 cycles

Concurrent Chemoradiation

50.4 Gy Radiation in 28 fractions (45 Gy IMRT, 5.4 Gy 3D conformal boost)

Surgery

Interventions:
  • Drug: FOLFOX6
  • Radiation: RT with concurrent chemotherapy
  • Procedure: Surgery
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
39
January 2013
January 2013   (final data collection date for primary outcome measure)

Inclusion Criteria

  • Patients must have histologically proven adenocarcinoma of the rectum with no evidence of distant metastases.
  • The tumor must be clinically Stage II (T3-4 N0 with N0 being defined as all imaged lymph nodes are < 1.0cm) or III (T1-4 N1-2 with the definition of a clinically positive node being any node > 1.0cm). Stage of the tumor may be determined by CT scan, endorectal ultrasound or MRI.
  • Patients must have no evidence of distant metastases including liver metastases, peritoneal seeding, or inguinal lymphadenopathy.
  • Patients must not have received prior chemotherapy or pelvic radiation for rectal cancer, or prior pelvic radiation for any other malignancy that would prevent the patient from receiving the required radiation treatments for this study.
  • Patients must have a life expectancy of 5 years, excluding their diagnosis of cancer (as determined by the investigator).
  • Patients must not have an active concurrent invasive malignancy. Patients with prior malignancies, including invasive colon cancer, are eligible if they are deemed by their physician to be at low risk for recurrence. Patients with squamous or basal cell carcinoma of the skin, melanoma in situ, carcinoma of the cervix, or carcinoma in situ of the colon or rectum that have been effectively treated are eligible, even if these conditions were diagnosed within 5 years prior to randomization.
  • Patients must be > 18 years of age, ECOG performance status 0-1.
  • ANC > 1,500/µl, platelets > 100,000/µl, total bilirubin < 2.0 mg/dl or direct bilirubin < 1.0 mg/dl, alkaline phosphatase < 3xULN, ALT < 3xULN, creatinine < 1.5xULN.
  • The patient must have been evaluated by a surgeon, radiation oncologist and medical oncologist and all must concur that the patient is appropriate for this study.
  • Signed informed consent; able to comply with study and/or follow- up procedures
  • Peripheral neuropathy < grade 1

Exclusion Criteria:

  • Evidence of metastatic disease.
  • Rectal cancers other than adenocarcinoma, i.e., sarcoma, lymphoma, carcinoid, squamous cell carcinoma, cloacogenic carcinoma, etc.
  • Pregnancy or lactation at the time of proposed randomization. Eligible patients of reproductive potential (both sexes) must agree to use adequate contraception.
  • Any therapy for this cancer prior to randomization.
  • Synchronous invasive colon cancer.
  • Nonmalignant systemic disease (cardiovascular, renal, hepatic, etc.) that would preclude the patient from receiving any chemotherapy treatment option or would prevent required follow-up.
  • Patients with active inflammatory bowel disease, abdominal fistula, gastrointestinal perforation, or intraabdominal abscess within 6 months prior to Day 0 or other serious medical illness which might limit the ability of the patient to receive protocol therapy.
  • Prior pelvic irradiation for any indication.
  • Known hypersensitivity to 5-fluorouracil or oxaliplatin
  • Psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements.
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT01363843
BrUOG 224
Yes
William Sikov, Brown University
William Sikov
  • Memorial Hospital of Rhode Island
  • Rhode Island Hospital
  • The Miriam Hospital
Principal Investigator: William Sikov, md Brown University Oncology Research Group
Brown University
July 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP