Study of SIB-IMRT in Combination With 5-FU and Mitomycin-C Among Patients With Locally Advanced Anal Canal Cancer: Efficacy, Safety and Quality of Life (CANAL-IMRT-01)

• ClinicalTrials.gov Identifier: NCT02701088
• Recruitment Status: Recruiting
• First Posted: March 8, 2016
• Last Update Posted: October 20, 2021
• Sponsor: Centre Francois Baclesse
• Collaborator: Accuray Incorporated
• Information provided by (Responsible Party): Centre Francois Baclesse

Study Description

Brief Summary:

Anal canal carcinoma (ACC) represents 1.2% of digestive cancers. Its incidence is increasing. As epidermoid ACC (95% of ACC) are particularly sensitive to radio and chemotherapy, concomitant radio-chemotherapy is the standard treatment of locally advanced ACC, with proven efficacy on locoregional control, anal sphincter preservation, progression-free survival and complete response rate higher than 80%.

Nevertheless, conventional radiotherapy frequently induces significant non-haematological toxicities requiring treatment interruptions. Thus, treatment usually includes a chemotherapy (5-Fluorouracil and Mitomycine-C) and 25 fractions of 1.8 Gy followed by a planned 1-week (or more) interruption and a boost, for a total 54-60 Gy radiation dose over 9 weeks.

Considering the numerous anatomic pelvic structures, ACC has become a localisation of interest for Intensity-Modulated Radiation Therapy (IMRT) associated with less toxicity.

However, IMRT induces grade≥3 cutaneous toxicities requiring irradiation breaks. Dose escalade did not show its interest: 60 Grays remains the standard.

Assuming the deleterious effect of increased overall treatment time on local control and survival in head-and-neck and cervical cancers and the epidermoid histology of ACC, the benefit of no irradiation break on ACC tumour control is of interest.

IMRT offers the possibility to deliver different doses to different target volumes simultaneously by altered fractionation schedule like SIB-IMRT (simultaneously integrated boost-IMRT). Several SIB-IMRT schedules have been retrospectively evaluated. Similar results were observed with moderate doses and schedules delivering higher doses with short interruptions. Nevertheless, standard SIB-IMRT schedule in ACC still not exist.

Condition or disease	Intervention/treatment	Phase
Locally Advanced Anal Canal Cancer	Drug: 5Fluorouracile and Mitomycin-C; Radiation: Simultaneously integrated boost of intensity modulated radiation therapy (SIB-IMRT) by tomotherapy	Phase 2

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 71 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase II Study of SIB-IMRT in Combination With 5-FU and Mitomycin-C Among Patients With Locally Advanced Anal Canal Cancer: Efficacy, Safety and Quality of Life
• Actual Study Start Date: December 2015
• Estimated Primary Completion Date: March 2022
• Estimated Study Completion Date: December 2022

Arms and Interventions

Arm

Intervention/treatment

Experimental: Concomitant chemotherapy and radiotherapy; Chemoradiotherapy with two cycles of 5FU and Mitomycin-C plus radiotherapy by SIB-IMRT (for simultaneous integrated boost intensity modulated radiation therapy) day 1 to day 50 in 36 fractions

Drug: 5Fluorouracile and Mitomycin-C; All the patients will receive radiochemotherapy with two cycles of 5FU (1,000 mg/m²/d with 96-h infusion, days 1-5 and 29-33 of SIB-IMRT) and Mitomycin-C (10 mg/m², days 1 and 29).; Radiation: Simultaneously integrated boost of intensity modulated radiation therapy (SIB-IMRT) by tomotherapy; SIB-IMRT schedule of 61.2 Gy/1.7 Gy to the primary tumor, 57.60 Gy / 1.6 Gy to involved nodes, and 54 / 1.5 Gy to elective pelvic lymph nodes.

Outcome Measures

Primary Outcome Measures :

1. Efficacy: The 3-month locoregional control rate [ Time Frame: 3 months after the end of radiotherapy ]
   The 3-month locoregional control rate after the end of IMRT by helical tomotherapy defined by the proportion of patients alive with no local disease progression 3 months after the end of radiotherapy
2. Tolerance profile: Proportion of patients with no significant toxicities responsible for irradiation breaks [ Time Frame: Until 11 weeks after treatment start ]
   Tolerance profile: Proportion of patients with no significant (grade ≥3 according to NCI CTCAE v4.03) toxicities responsible for irradiation breaks

Secondary Outcome Measures :

1. Quality of life measured by the EORTC QLQ-C30 (version 3.0) [ Time Frame: From treatment start to 5 years after the end of radiotherapy ]
2. The acute and late toxicities assessed according to NCI CTCAE v4.03 [ Time Frame: From treatment start to 5 years after the end of radiotherapy ]
3. The 6- and 12-month locoregional control rates defined by the proportion of patients with no local disease progression at 6 and 12 months after the end of radiotherapy [ Time Frame: at 6 and 12 months after the end of radiotherapy ]
4. Duration of response defined by the time elapsed from first objective response to progression or death from any cause [ Time Frame: From months 3 to progression ]
5. Quality of life measured by the additional colorectal module QLQ-CR 29 [ Time Frame: From treatment start to 5 years after the end of radiotherapy ]
6. Quality of life measured by the Vaizey incontinence scale [ Time Frame: From treatment start to 5 years after the end of radiotherapy ]
7. The acute and late toxicities assessed according the SOMA/LENT scale [ Time Frame: From treatment start to 5 years after the end of radiotherapy ]

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• WHO performance status ≤ 2
• Age > 18 years
• Epidermoid anal canal carcinoma histologically proven, locally advanced with an indication of radiation of pelvic and inguinal nodes concomitantly to chemotherapy
• The T corresponds to the larger dimension of tumor at the rectal examination and the N is assessed by imaging pelvic MRI-imaging, CT-scan, optionally PET-CT). Eligible tumors are: T2 more than 4 cm N0-N3, T2-T4 N1-N3 or usN1, T3-T4 N0, M0 according to the 6th edition of the American Joint Committee on cancer staging manual.
• Laboratory data obtained ≤ 14 days prior to registration on study, with adequate bone marrow, hepatic and renal function defined as follows: hemoglobinemia, neutrophil, platelet counts, bilirubin and creatinin level
• Informed consent form

Exclusion Criteria:

• Previous invasive cancer within 5 years except basocellular cancer and in situ cervical cancer
• Tumors with predominant skin involvement
• Presence of metastases
• History of pelvic irradiation
• Contraindication to radiotherapy or chemotherapy
• Known HIV positive patients

Contacts and Locations

Contacts

Contact: Carmen FLORESCU, MD; c.florescu@baclesse.unicancer.fr

Contact: Aurélie PARZY, MD; a.parzy@baclesse.unicancer.fr

Locations

France

Institut de Cancérologie de l'Ouest - Centre Paul Papin; Recruiting

Angers, France

Contact: Emmanuel André RIO, MD

Principal Investigator: Emmanuel RIO, MD

Sub-Investigator: Amaury PAUMIER, MD

Sub-Investigator: Nathalie MESGOUEZ-NEBOUT, MD

Sub-Investigator: Hadji HAMIDOU, MD

Sub-Investigator: Julien BLANCHECOTTE, MD

Sub-Investigator: Pierre TREMOLIERES, MD

Sub-Investigator: Sandrine HIRET, MD

Sub-Investigator: Julie VANBOECKSTAEL, MD

Sub-Investigator: Victor SIMMET, MD

Centre François Baclesse; Recruiting

Caen, France, 14076

Contact: Camen FLORESCU, MD c.florescu@baclesse.unicancer.fr

Contact: Aurelie PARZY, MD a.parzy@baclesse.unicancer.fr

Principal Investigator: Carmen FLORESCU, MD

Sub-Investigator: Aurélie PARZY, MD

Sub-Investigator: Marie-Pierre GALAIS, MD

Sub-Investigator: Claude M'VONDO, MD

Sub-Investigator: Stephane CORBINAIS, MD

Sub-Investigator: Mélanie DOS SANTOS, MD

Sub-Investigator: Jean-Marc GUILLOIT, MD

Sub-Investigator: Paul LESUEUR, MD

Sub-Investigator: Pierre-Emmanuel BRACHET, MD

Sub-Investigator: Elodie COQUAN, MD

Centre Léon Berard; Recruiting

Lyon, France

Contact: Isabelle MARTEL-LAFAY, MD

Principal Investigator: Isabelle MARTEL-LAFAY, MD

Sub-Investigator: Severine RACADOT, MD

Centre Antoine Lacassagne; Recruiting

Nice, France

Contact: Lucile MONTAGNE, MD

Principal Investigator: Lucile MONTAGNE, MD

Sub-Investigator: Alexander FALK, MD

Sub-Investigator: Eric FRANCOIS, MD

Sub-Investigator: Ludovic EVESQUE, MD

Sub-Investigator: Gerard CAVAGLIONE, MD

Institut de cancérologie de l'Ouest; Recruiting

St HERBLAIN, France, 44805

Contact: Emmanuel RIO, MD

Principal Investigator: Emmanuel RIO, MD

Sub-Investigator: Charlotte DEMOOR, MD

Sub-Investigator: Valentine GUIMAS, MD

Sub-Investigator: Vincent LIBOIS, MD

Centre Paul Strauss; Not yet recruiting

Strasbourg, France

Contact: Georges NOEL, PhD

Principal Investigator: Georges NOEL, PhD

Sub-Investigator: Audrey KELLER, MD

Sub-Investigator: Catherine SCHUMACHER, MD

IUCT-Oncopole; Recruiting

Toulouse, France

Contact: Françoise IZAR, MD

Principal Investigator: Françoise IZAR, MD

Sub-Investigator: Anouchka MODESTO, MD

Sub-Investigator: Nathalie CAUNES-HILARY, MD

Sub-Investigator: Thibaud VALENTIN, MD

Institut de Cancérologie de Lorraine; Recruiting

Vandoeuvre-les-Nancy, France, 54519

Contact: Didier PEIFFERT, MD

Principal Investigator: Didier PEIFFERT, MD

Sub-Investigator: Maria JOLNEROVSKI, MD

Sub-Investigator: Anne-Sophie BAUMANN, MD

Sub-Investigator: Thierry CONROY, PHD

Sub-Investigator: Myriam KHADIGE, MD

Sub-Investigator: Sarah NADJAFIZADEH, MD

Sub-Investigator: Nicolas DEMOGEOT, MD

Sub-Investigator: Marie-Christine KAMINSKY, MD

Sponsors and Collaborators

Centre Francois Baclesse

Accuray Incorporated

Investigators

• Principal Investigator: Carmen FLORESCU, MD; Centre François Baclesse

More Information

• Responsible Party: Centre Francois Baclesse
• ClinicalTrials.gov Identifier: NCT02701088
• Other Study ID Numbers: CANAL-IMRT-01
• First Posted: March 8, 2016
• Last Update Posted: October 20, 2021
• Last Verified: September 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Additional relevant MeSH terms:

Anus Neoplasms; Rectal Neoplasms; Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Anus Diseases; Rectal Diseases; Mitomycins; Mitomycin; Antibiotics, Antineoplastic; Antineoplastic Agents; Alkylating Agents; Molecular Mechanisms of Pharmacological Action; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors