Organ Preservation Program Using Short-Course Radiation & FOLFOXIRI in Rectal Cancer
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|ClinicalTrials.gov Identifier: NCT04380337|
Recruitment Status : Recruiting
First Posted : May 8, 2020
Last Update Posted : January 26, 2023
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|Condition or disease||Intervention/treatment||Phase|
|Rectal Cancer||Drug: FOLFOXIRI Drug: FOLFOX regimen Drug: XELOX Radiation: IMRT||Phase 2|
Primary Objective: To assess clinical complete response of an organ preservation approach using short course radiation followed by intensified chemotherapy.
Secondary Objective: To assess safety in all enrolled patients, local regrowth rate and other cancer specific outcomes (metastasis-free survival, colostomy-free survival and overall survival), longitudinal health-related quality of life of this organ preservation approach
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||37 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Phase II Trial of Organ Preservation Program Using Short-Course Radiation and FOLFOXIRI for Rectal Cancer (SHORT-FOX)|
|Actual Study Start Date :||May 21, 2020|
|Estimated Primary Completion Date :||May 2025|
|Estimated Study Completion Date :||May 2027|
Treatment will comprise 6 daily fractions of radiotherapy at 5 Gy per fraction followed by 4 months of FOLFOXIRI. Patients who have performance status or conditions that may preclude use of FOLFOXIRI may be treated with FOLFOX or XELOX. Those who achieve a clinical complete response will be considered for organ preservation approach. All other patients will receive standard of care total mesorectal excision (TME).
Chemotherapy regimen of Oxaliplatin 85mg/m2 , Leucovorin 400 mg/m2 , Irinotecan 165mg/m2 , 5-Fluorouracil
Drug: FOLFOX regimen
Chemotherapy regimen of Oxaliplatin 85mg/m2, Leucovorin 400 mg/m2, 5-Fluorouracil 2400mg/m2
Chemotherapy regimen of Oxaliplatin 130 mg/m2, Capecitabine 1000mg/m2
Radiotherapy (5 Gy x 5 fractions) with an additional boost fraction (5 Gy x 1 fraction) delivered sequentially
Other Name: Intensity-modulated radiotherapy (IMRT)
- Clinical complete response (cCR) [ Time Frame: 8 (+/-4 ) weeks ]Proportion of patients who achieve a clinical complete response following therapy, expressed as a number and proportion without dispersion.
- Measure Toxicity [ Time Frame: 3 months ]Toxicity defined as non-hematologic grade 4 adverse events using CTCAE v5 or higher toxicity at least possibly related to treatment, and assessed up to 3 months after completion of radiotherapy (RT) and chemotherapy, expressed as a number and proportion without dispersion"
- Local regrowth rate [ Time Frame: 2 year ]Local regrowth is defined as the presence of adenocarcinoma within the rectal wall or within the mesorectum confirmed by pathology, expressed as a percentage with its 95% confidence interval.
- Disease free survival (DFS) [ Time Frame: 2 years ]DFS defined as the time from the start date of RT to the date of the first documented progression or death due to any cause assessed up to 2 years after completion of chemotherapy. Patients will be censored at the last date of follow-up if lost to follow-up prior to two years, expressed as a median with interquartile range.
- Colostomy-free survival [ Time Frame: 2 years ]Colostomy-free survival defined as the time from the start date of RT to the date of colostomy or death due to any cause assessed up to 2 years after completion of chemotherapy, expressed as a median with interquartile range. Patients will be censored at the last date of follow-up if lost to follow-up prior to two years.
- Overall Survival (OS) [ Time Frame: 84 months ]OS defined as death from any cause from start date of RT until death, study completion, or loss to follow-up, whichever occurs first. This will be reported as median survival time with interquartile range.
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, Learn About Clinical Studies.
|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- 1. Pathologically (histologically or cytologically) proven diagnosis of adenocarcinoma of rectum requiring total mesorectal excision as deemed by multidisciplinary evaluation
- 2.At least 18 years of age
- 3.For women of childbearing potential or who are not postmenopausal (see Appendix B for Definition of Menopausal Status), a negative urine or serum pregnancy test must be done. Also, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation and for up to 4 weeks following the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
- 4.ECOG 0, 1, or 2
- 5.Ability to understand and the willingness to personally sign the written IRB approved informed consent document.
6.Patients must have acceptable organ and marrow function as defined below:
- Absolute neutrophil count (ANC) >1,500/uL
- Hg > 8.0 g/dL; if blood transfusion is performed for achieving adequate hemoglobin level, the level should stay above goal for at least 1 week after transfusion
- Platelets >100,000/uL
- Total bilirubin <1.5X normal institutional limits
- aspartate aminotransferase (AST) (SGOT) / alanine aminotransferase (ALT)(SGPT) < 3X upper limit of normal
- Creatinine <1.5X upper limit of normal or creatinine clearance (CrCL)>50 by Cockcroft-Gault
7 Clinical stage >T2N0 or low T2N0 rectal cancer (AJCC, 8th ed.) including no metastases based on the following diagnostic workup:
- General history and physical examination with DRE (if deemed appropriate by treating physician) within 45 days prior to enrollment
- Sigmoidoscopy within 90 days prior to enrollment
The following imaging studies are required within 45 days prior to enrollment:
- CT chest/abdomen/pelvis
- MRI Pelvis
- 1.Prior pelvic RT or chemotherapy for rectal cancer.
- 2.Upper T2N0 rectal cancers eligible for sphincter-preservation surgery
- 3.Use of other investigational agents.
- 4.Ongoing or active infections requiring systemic antibiotic treatment or uncontrolled intercurrent illness including but not limited to symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- 5.Any concurrent malignancy other than non-melanoma skin cancer or carcinoma in situ of the cervix. Patients with any previous malignancy without evidence of disease for >3 years will be allowed to enter the trial.
- 6.Known hypersensitivity to 5-FU compounds.
- 7.Pregnant and breastfeeding women are excluded. Women of child-bearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period and for up to 4 weeks after the study are excluded. (This applies to women who have experienced menarche and have not undergone successful surgical sterilization or are not postmenopausal).
Because patients with immune deficiency are at increased risk of lethal infections when treated with marrow-suppressive therapy, known HIV-positive patients with detectable viral loads and/or receiving combination anti-retroviral therapy are excluded from the study.
- 8.Primary unresectable rectal cancer (tumor invading adjacent organs and en bloc resection will not achieve negative margins).
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): NCT04380337
|Contact: Eleanor Brownfirstname.lastname@example.org|
|United States, California|
|Stanford, California, United States, 94304|
|Contact: Eleanor Brown 650-724-4606 email@example.com|
|Principal Investigator: Erqi L Pollum|
|Principal Investigator:||Erqi L Pollom||Stanford Universiy|
|Responsible Party:||Stanford University|
|Other Study ID Numbers:||
IRB-56027 ( Other Identifier: Stanford IRB )
COR0019 ( Other Identifier: OnCore )
|First Posted:||May 8, 2020 Key Record Dates|
|Last Update Posted:||January 26, 2023|
|Last Verified:||January 2023|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||No|
|Studies a U.S. FDA-regulated Drug Product:||Yes|
|Studies a U.S. FDA-regulated Device Product:||No|
|Product Manufactured in and Exported from the U.S.:||No|
Digestive System Neoplasms
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Digestive System Diseases