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A Study Comparing Adjuvant Chemotherapy Versus Observation for Patients With Rectal Adenocarcinoma After Neoadjuvant Chemo-Radiotherapy Treatment.

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ClinicalTrials.gov Identifier: NCT01941979
Recruitment Status : Unknown
Verified October 2014 by Instituto do Cancer do Estado de São Paulo.
Recruitment status was:  Recruiting
First Posted : September 13, 2013
Last Update Posted : October 30, 2014
Sponsor:
Information provided by (Responsible Party):
Instituto do Cancer do Estado de São Paulo

Brief Summary:

Surgery is the most indicated curative treatment for rectal cancer when disease is diagnosed early, however local recurrence risk increases when the disease is diagnosed at advanced stage.T1-2 tumors have a recurrence rate lower than 10%, while T3N0 tumors have 15% - 35% and positive lymph nodes T3-4 45% to 67% of recurrence rate within 5 years. These data indicate that patient who have a high risk of tumor recurrence should receive an adjuvant therapy treatment.

It is possible that adjuvant chemotherapy has a positive impact on survival of patients already treated with neoadjuvant combination therapy. However it is necessary to identify those patients that might have this benefit.

An exploratory analysis of the European Organization for Research and Treatment of Cancer (EORTC) 22921 study showed that the addition of adjuvant chemotherapy has benefited only the group of patients who had a reduction of tumor stage to ypT0-2. In the group who had no reduction (ypT3-4), there was no benefit. Retrospective analyzes suggest that the response to neoadjuvant chemoradiotherapy is a predictor of prognosis and even benefit to adjuvant chemotherapy. However the benefit of adjuvant chemotherapy for patients with rectal cancer remains controversial. Therefore, a randomized trial is needed to answer this question.

Based on these data the investigators proposed a phase III study, randomized, unblinded, adjuvant chemotherapy based on Fluorouracil(5-FU) and Oxaliplatin versus observation in patients with rectal adenocarcinoma T3-4, N0-1, M0 previously treated with neoadjuvant chemoradiotherapy and who did not presented complete response. The investigator believes that this subgroup of patients, who have not achieved complete response, will be benefit from adjuvant therapy.

Study objective:

The main objective of this study is verify if adjuvant chemotherapy with 5-FU and oxaliplatin, for 4 months, increases recurrence-free survival versus the observation. Secondary objectives include the evaluation of toxicity, overall survival and assessment of biomarkers (study protocol separately).

The study's primary endpoint is disease-free survival (DFS) to be defined as time from randomization to radiological detection of distant disease and / or locoregional recurrence. Isolate carcinoembryonic antigen (CEA) increase will not be consider as recurrence until a new measurable lesion be found.

NOTE: The TNM system is based on the size and/or extent (reach) of the primary tumor (T), the amount of spread to nearby lymph nodes (N), and the presence of metastasis (M) or secondary tumors formed by the spread of cancer cells to other parts of the body.


Condition or disease Intervention/treatment Phase
Rectal Cancer Drug: 5-FU, Capecitabine, Oxaliplatin, Leucovorin. Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 309 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III, Randomized Study of Adjuvant Chemotherapy for Patients With Rectal Adenocarcinoma Who Achieved Suboptimal Response After Neoadjuvant Chemo-radiotherapy.
Study Start Date : September 2011
Estimated Primary Completion Date : September 2015
Estimated Study Completion Date : September 2016

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Adjuvant therapy

5-FU, Leucovorin and Oxaliplatine (FLOX) OR Capecitabine and Oxaliplatin (CAPOX)

NOTE: If the patient was randomized for the arm experimental, the investigator can choose between intravenous (IV) treatment or oral treatment (PO). Both are considered equal by the principal investigator.

Drug: 5-FU, Capecitabine, Oxaliplatin, Leucovorin.
No Intervention: Observation



Primary Outcome Measures :
  1. Disease free survival [ Time Frame: Thorax, abdome, and pelvis tomography Every 6 month up to 3 years and anualy up to 5 years. ]

Secondary Outcome Measures :
  1. Overall survival [ Time Frame: 36 month ]

Other Outcome Measures:
  1. Incidence of Adverse Event [ Time Frame: 36 month ]
    To evaluate the toxicity of treatment.



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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of adenocarcinoma rectal stages T3 - 4, N0-1 and M0 - according to TNM staging system (primary tumor, regional nodes, metastasis), previously treated with neoadjuvant chemo-radiotherapy according to institutional routine.
  • Tumor with clinical end radiological incomplete response after neoadjuvant therapy, according to institutional routine, and completely resection by mesorectal excision with clear margins technique.
  • No more than 8 weeks after the surgery.
  • Normal result of CEA in compared to the pre randomization results (28 days of window)
  • Age ≥ 18 years and ≤ 75 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
  • Adequate organ function during screening (28 days of window)

    , defined as:

    1. Serum aspartate aminotransferase (AST) and amino alanine transferase (ALT) ≤ 2.5 × Upper Limit of Normal(ULN)
    2. Serum total bilirubin ≤ 2.0 × ULN
    3. Absolute neutrophil count ≥ 1500 /mm3
    4. Platelet count ≥ 100000 /mm3
    5. Hemoglobin ≥ 8.0 g/dL
    6. Serum creatinine ≥ 1.5 × ULN
  • Signed written informed consent

Exclusion Criteria:

  • Patients who presented unacceptable toxicity or intolerance to neoadjuvant combination therapy.
  • Patients with surgical complications that prevent them from receiving adjuvant therapy for up to 8 weeks after surgery;
  • Compromised surgical margins.
  • Confirmation or strong suspicion of Lynch syndrome.
  • History of serious illness or psychiatric clinic.
  • Patients who participate in other protocols with experimental drugs.
  • For female patients, current pregnancy and/or lactation.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01941979


Contacts
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Contact: Rachel S.P. Riechelmann, MD 55 11 38932000 pesquisa.clinica@icesp.org.br

Locations
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Brazil
ICESP Recruiting
Sao Paulo, SP, Brazil, 01246000
Contact: Rachel SP Riechelmann, MD    55 11 38932000    pesquisa.clinica@icesp.org.br   
Principal Investigator: Rachel SP Riechemann, MD         
Sponsors and Collaborators
Instituto do Cancer do Estado de São Paulo

Additional Information:
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Responsible Party: Instituto do Cancer do Estado de São Paulo
ClinicalTrials.gov Identifier: NCT01941979     History of Changes
Other Study ID Numbers: NP-113/2011
First Posted: September 13, 2013    Key Record Dates
Last Update Posted: October 30, 2014
Last Verified: October 2014
Additional relevant MeSH terms:
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Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Capecitabine
Oxaliplatin
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents