Oxaliplatin, Capecitabine, and Radiation Therapy With or Without Cetuximab in Treating Patients Undergoing Surgery for High-Risk Rectal Cancer (EXPERT-C)
Recruitment status was: Active, not recruiting
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. Radiation therapy uses high-energy x-rays to kill tumor cells. 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. Giving chemotherapy and radiation therapy with or without cetuximab before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. It is not yet known whether giving oxaliplatin, capecitabine, and radiation therapy is more effective with or without cetuximab when given before surgery in treating rectal cancer.
PURPOSE: This randomized phase II trial is studying oxaliplatin, capecitabine, and radiation therapy to compare how well they work with or without cetuximab in treating patients undergoing surgery for high-risk rectal cancer.
Procedure: adjuvant therapy
Procedure: conventional surgery
Procedure: neoadjuvant therapy
Radiation: radiation therapy
|Study Design:||Allocation: Randomized
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Multicentre Randomised Phase II Clinical Trial Comparing Oxaliplatin (Eloxatin), Capecitabine (Xeloda) and Pre-Operative Radiotherapy With or Without Cetuximab Followed by Total Mesorectal Excision for the Treatment of Patients With Magnetic Resonance Imaging (MRI) Defined High Risk Rectal Cancer|
- Pathological complete response rate at time of total mesorectal excision (TME)
- Radiological response rates after completion of neoadjuvant therapy
- Complete resection rate (R0 resection) with microscopic clear resection margin (tumor observed > 1 mm from the resection margin), especially circumferential resection margin
- Perioperative measures, including operation time, duration of in-patient stay, perioperative transfusion requirement, and mortality, within 30 days of TME
- Postoperative complications, including wound infection, wound dehiscence, and fistula formation
- Quality of TME as assessed by audit of photographed surgical specimens
- Rate of abdominoperitoneal excision
- Rate of permanent defunctioning colostomies
- Clinical and radiological anastomotic leak rate
- Progression-free survival and patterns of failure
- Overall survival
- Quality of life, including long-term bowel function
|Study Start Date:||September 2005|
- Compare the pathological complete response rate at total mesorectal excision in patients with high-risk rectal cancer treated with neoadjuvant therapy comprising oxaliplatin, capecitabine, and radiotherapy with or without cetuximab.
OUTLINE: This is a multicenter, open-label, randomized, controlled study. Patients are stratified according to participating center and presence of T4 disease (yes vs no). Patients are randomized to 1 of 2 treatment arms.
- Neoadjuvant chemotherapy: Patients receive oxaliplatin IV over 2 hours on days 1, 22, 43, and 64 and oral capecitabine twice daily on days 1-14, 22-35, 43-56, and 64-77.
- Neoadjuvant chemoradiotherapy: Patients undergo radiotherapy once daily on days 85-89, 92-96, 99-103, 106-110, 113-117, and 120-124 and receive oral capecitabine twice daily on days 85-126.
- Surgery: Four to six weeks after completion of chemoradiotherapy, patients undergo total mesorectal excision (TME).
- Adjuvant therapy: Beginning 6-8 weeks after surgery, patients receive oxaliplatin IV over 2 hours on days 1, 22, 43, and 64 and oral capecitabine twice daily on days 1-14, 22-35, 43-56, and 64-77.
- Neoadjuvant therapy: Patients receive oxaliplatin and capecitabine as in arm I neoadjuvant chemotherapy and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
- Neoadjuvant chemoradiotherapy: Patients undergo radiotherapy and receive capecitabine as in arm I neoadjuvant chemoradiotherapy and cetuximab IV over 1 hour on days 85, 92, 99, 106, 113, and 120.
- Surgery: Four to six weeks after completion of chemoradiotherapy patients undergo TME as in arm I.
- Adjuvant therapy: Beginning 6-8 weeks after surgery, patients receive oxaliplatin and capecitabine as in arm I adjuvant chemotherapy and cetuximab IV over 1 hour on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed periodically.
After completion of study treatment, patients are followed every 3 months for 1 year, every 6 months for 2 years, and then annually for 2 years.
PROJECTED ACCRUAL: A total of 164 patients will be accrued for this study.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00383695
|Vall d'Hebron University Hospital|
|Barcelona, Spain, 08035|
|Hospital Universitario La Paz|
|Madrid, Spain, 28046|
|Hospital Clinico Universitario de Valencia|
|Valencia, Spain, 46010|
|Karolinska University Hospital - Solna|
|Stockholm, Sweden, S-171 76|
|Uppsala University Hospital|
|Uppsala, Sweden, S-75185|
|Royal Bournemouth Hospital NHS Trust|
|Bournemouth, England, United Kingdom, BH7 7DW|
|Sussex Cancer Centre at Royal Sussex County Hospital|
|Brighton, England, United Kingdom, BN2 5BE|
|Eastbourne District General Hospital|
|Eastbourne, England, United Kingdom, BN21 2UD|
|Cancer Research UK Clinical Groups at Guy's King's & St. Thomas' Hospitals|
|London, England, United Kingdom, SE5 9NU|
|Mid Kent Oncology Centre at Maidstone Hospital|
|Maidstone, England, United Kingdom, ME16 9QQ|
|Dorset Cancer Centre|
|Poole Dorset, England, United Kingdom, BH15 2JB|
|Southampton General Hospital|
|Southampton, England, United Kingdom, SO16 6YD|
|Royal Marsden - Surrey|
|Sutton, England, United Kingdom, SM2 5PT|
|Study Chair:||David Cunningham, MD||Royal Marsden NHS Foundation Trust|