Randomised Study Evaluating Adjuvant Chemotherapy After Resection of Stage III Colonic Adenocarcinoma in Patients of 70 and Over (ADAGE)
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ClinicalTrials.gov Identifier: NCT02355379 |
Recruitment Status :
Recruiting
First Posted : February 4, 2015
Last Update Posted : March 24, 2022
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Colorectal cancer occurs mainly in elderly patients. Recent estimation showed that in France more than 50% of the patients diagnosed with a colorectal cancer are 70 years old or more. Adjuvant chemotherapy has demonstrated a benefit on disease-free survival and overall survival after a stage III colon cancer resection. Nevertheless adjuvant chemotherapy is poorly used in elderly patients. Prognostic improvement with chemotherapy based on 5FU is suggested by a post-hoc analysis of randomized prospective clinical trial. But elderly patients in this study were highly selected and patients older than 80 represented only 0.7% of the total population. Thus, there is still a concern about the benefit of adjuvant 5FU-based chemotherapy in very elderly unselected patients.
The recommended treatment for stage III adjuvant chemotherapy is a combination of fuoropyrimidine and oxaliplatin. Nevertheless oxaliplatin did not demonstrated survival advantage in elderly patients.
Altogether there are still two matters of debate:
- First, is there a benefit of fluoropyrimidine-based adjuvant chemotherapy for unfit elderly patients?
- Second, is there a benefit of oxaliplatin-based adjuvant chemotherapy for fit elderly patients? The aim of this randomized phase III study is to evaluate the benefit for disease-free survival of adjuvant chemotherapy in elderly patient and which chemotherapy.
The elderly patient population will be dichotomized into two groups according to physician's choice after a multidisciplinary evaluation involving a geriatrician, with two different randomization assignments. The patients with an expected life-expectancy below 4 years according Lee score are excluded of this study.
Some biological tumour abnormalities are more frequently observed in elderly (i.e. mismatch repair deficiency), therefore an evaluation of specific biological prognostic factors is needed in elderly population.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Colonic Adenocarcinoma | Drug: LV5FU2 or capectitabine Drug: FOLFOX4 or XELOX Other: Observation Drug: LV5FU2 or capecitabine | Phase 3 |
Colorectal cancer occurs mainly in elderly patients. Recent estimation showed that in France more than 50% of the patients diagnosed with a colorectal cancer are 70 years old or more. Adjuvant chemotherapy has demonstrated a benefit on disease-free survival and overall survival after a stage III colon cancer resection. Nevertheless adjuvant chemotherapy is poorly used in elderly patients. Prognostic improvement with chemotherapy based on 5FU is suggested by a post-hoc analysis of randomized prospective clinical trial. But elderly patients in this study were highly selected and patients older than 80 represented only 0.7% of the total population. Thus, there is still a concern about the benefit of adjuvant 5FU-based chemotherapy in very elderly unselected patients.
The recommended treatment for stage III adjuvant chemotherapy is a combination of fuoropyrimidine and oxaliplatin. Nevertheless oxaliplatin did not demonstrated survival advantage in elderly patients.
Altogether there are still two matters of debate:
- First, is there a benefit of fluoropyrimidine-based adjuvant chemotherapy for unfit elderly patients?
- Second, is there a benefit of oxaliplatin-based adjuvant chemotherapy for fit elderly patients? The aim of this randomized phase III study is to evaluate the benefit for disease-free survival of adjuvant chemotherapy in elderly patient and which chemotherapy.
The elderly patient population will be dichotomized into two groups according to physician's choice after a multidisciplinary evaluation involving a geriatrician, with two different randomization assignments. The patients with an expected life-expectancy below 4 years according Lee score are excluded of this study.
Some biological tumour abnormalities are more frequently observed in elderly (i.e. mismatch repair deficiency), therefore an evaluation of specific biological prognostic factors is needed in elderly population.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 774 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Randomised Phase III Study Evaluating Adjuvant Chemotherapy After Resection of Stage III Colonic Adenocarcinoma in Patients of 70 and Over Intergroup Trial: Ffcd, Gercor, Gerico, Unicancer-gi |
Study Start Date : | January 2015 |
Estimated Primary Completion Date : | August 2023 |
Estimated Study Completion Date : | August 2025 |
Arm | Intervention/treatment |
---|---|
Experimental: GROUP1 -ARM A
LV5FU2 or capecitabine
|
Drug: LV5FU2 or capectitabine |
Experimental: GROUP1-ARMB
FOLFOX4 or XELOX
|
Drug: FOLFOX4 or XELOX |
Experimental: GROUP2- ARM C
Observation
|
Other: Observation |
Experimental: GROUP2-ARM D
LV5FU2 or capecitabine
|
Drug: LV5FU2 or capecitabine |
- The 3-year disease-free survival [ Time Frame: 3 years after last patient in ]
- Overal survival [ Time Frame: 5 years after last patient in ]
- Observed toxicities, graded according to NCI-CTC v4 [ Time Frame: 3 years after last patient in ]

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Ages Eligible for Study: | 75 Years and older (Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age ≥ 70 years
- Patient considered able to receive chemotherapy
- Lee score detailed faxed to CRGA
- Stage III colon adenocarcinoma
- R0 resection of the primary tumor
- Start of the potential adjuvant chemotherapy within 12 weeks after surgery
- No prior chemotherapy for colon cancer
- Geriatric Self-administered questionnaire completed faxed to CRGA
- Geriatric Questionnaire completed by the team faxed to CRGA
- Effective contraception for men patients throughout treatment and for at least 6 months after discontinuation of oxaliplatin
- Consent signed
Exclusion Criteria:
- Other progressive disease (cancer uncontrolled for less than 2 years)
- Rectal Cancer (located less than 15 cm from the anal verge endoscopy or sub-peritoneal)
- ANC <2000 / mm3 for group 1 and ANC <1500 / mm3 for group 2 and platelets <100,000 / mm3 or hemoglobin <9 g / dL
- Neuropathy for patients in group 1
- Known deficit of dihydropyrimidine dehydrogenase (DPD)
- Patients with severe hepatic insufficiency
- Any contrindication to the drugs used in the study
- Inability to submit to medical follow-up for geographical, social or psychological reasons.

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): NCT02355379
Contact: Martina Schneider | +33 3 80 39 34 83 | martina.schneider@u-bourgogne.fr | |
Contact: Jaique Cario | +33 3 80 39 34 86 | jaique.cario_isat@u-bourgogne.fr |

Principal Investigator: | Thomas Aparicio, Pr | FFCD member |
Responsible Party: | Federation Francophone de Cancerologie Digestive |
ClinicalTrials.gov Identifier: | NCT02355379 |
Other Study ID Numbers: |
PRODIGE34-ADAGE |
First Posted: | February 4, 2015 Key Record Dates |
Last Update Posted: | March 24, 2022 |
Last Verified: | March 2022 |
Adjuvant chemotherapy in colonic adenocarcinoma in elderly |
Adenocarcinoma Carcinoma Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Capecitabine Fluorouracil |
Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs |