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Circulating Tumour DNA (ctDNA) Rectal Cancer and the Relationship to Extramural Venous Invasion (ctDNA)

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified October 2015 by Royal Marsden NHS Foundation Trust
Information provided by (Responsible Party):
Royal Marsden NHS Foundation Trust Identifier:
First received: October 6, 2015
Last updated: October 16, 2015
Last verified: October 2015

In almost one third of patients with rectal cancer, cancer spreads through the bowel wall into nearby veins which can be seen on MRI scans and is known as mrEMVI. It has been observed that this is linked with worse survival due to the spread of cancer to the liver and other organs. The investigators think that this may occur by spread of cancer cells in the blood stream. Circulating cell-free tumour DNA (ctDNA) can be detected in the blood of patients with both metastatic and primary carcinoma (but not healthy individuals).

This trial does not interfere with the patient's routine treatment pathway. Participants will be grouped into whether or not they demonstrate mrEMVI on their post-radiotherapy MRI scan. 20 patients who are mrEMVI positive and 20 patients who are mrEMVI negative will have blood samples taken pre-surgery and then again during surgery and a comparison will be made between the two groups. If the investigators can find a link between the cancer cells seen in blood to mrEMVI they may be able to use this test to help guide treatment in the future. This study will serve as the feasibility of a larger, comparative study.

Condition Intervention
Rectal Cancer
Other: Blood sample

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Circulating Tumour DNA (ctDNA) Rectal Cancer and the Relationship to Extramural Venous Invasion (ctDNA Trial)

Resource links provided by NLM:

Further study details as provided by Royal Marsden NHS Foundation Trust:

Primary Outcome Measures:
  • To measure the presence or absence of ctDNA post CRT in EMVI-positive rectal cancer. [ Time Frame: 2 years ]

Secondary Outcome Measures:
  • To document the % mutation frequency [ Time Frame: 2 years ]
  • Comparison of levels of measured ctDNA intraoperatively between mrEMVI positive and mrEMVI negative tumours. [ Time Frame: 2 years ]
  • Comparison of % mutation frequency of ctDNA intraoperatively between mrEMVI negative and mrEMVI positive tumours. [ Time Frame: 2 years ]

Biospecimen Retention:   Samples Without DNA
Three blood samples will be analysed for ctDNA. One blood sample will be taken at the time of preoperative assessment, after chemoradiotherapy and two further samples will be taken intraoperatively, from the mesenteric vein after the resected specimen has been removed from the abdomen and from the peripheral vein of the patient's arm. For each of the blood samples the presence or absence of ctDNA mutations (kras and p53) will be identified.

Estimated Enrollment: 40
Study Start Date: November 2015
Estimated Study Completion Date: November 2017
Estimated Primary Completion Date: November 2017 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
ctDNA trial
20 patients will be registered whose rectal tumours are persistently mrEMVI positive (i.e. EMVI is present in baseline and post-chemoradiotherapy MRI scans) and 20 patients registered who are persistently mrEMVI negative (i.e. EMVI is NOT present in baseline and post-chemoradiotherapy MRI scans)
Other: Blood sample
Three blood samples are taken from each patient. Two from the arm (one pre-surgery and one during surgery) and one from the resected tumour specimen vein.

  Show Detailed Description


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
20 patients with persistently mrEMVI positive rectal tumours and 20 patients with persistently mrEMVI negative rectal tumours

Inclusion Criteria:

  • High-risk patients with biopsy proven rectal adenocarcinoma who will undergo long-course chemoradiotherapy (CRT) and who are potentially eligible for curative surgery
  • Patients who have persistently (i.e. in baseline and post-treatment MRI) mrEMVI positive (with superior rectal vein invasion) or mrEMVI negative tumours.
  • Patients aged over 18 years
  • Negative (on CT) for metastatic disease

Exclusion Criteria:

  • Under 18 years of age
  • Patients with any metastatic disease
  • Patients with a synchronous second malignancy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT02579278

Contact: Lisa Scerri +442089156067
Contact: Muhammed Siddiqui

United Kingdom
Royal Marsden Hospital NHS Foundation Trust
London/Surrey, Surrey, United Kingdom, SM2 5PT
Sponsors and Collaborators
Royal Marsden NHS Foundation Trust
Principal Investigator: Gina Brown Consultant Radiologist & Professor of Cancer Imaging, Royal Marsden Hospital
  More Information

Responsible Party: Royal Marsden NHS Foundation Trust Identifier: NCT02579278     History of Changes
Other Study ID Numbers: CCR 4121 
Study First Received: October 6, 2015
Last Updated: October 16, 2015

Keywords provided by Royal Marsden NHS Foundation Trust:
Extramural Venous Invasion
Rectal Cancer
Neoplasm DNA

Additional relevant MeSH terms:
Rectal Neoplasms
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Intestinal Diseases
Rectal Diseases processed this record on February 24, 2017