FOLFOX-4 3months Versus 6 Months and Bevacizumab as Adjuvant Therapy for Patients With Stage II/III Colon Cancer (TOSCA)

This study has been completed.

Sponsor:

ClinicalTrials.gov Identifier:

NCT00646607

First Posted: March 28, 2008

Last Update Posted: November 26, 2014

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Collaborator:

Mario Negri Institute for Pharmacological Research

Information provided by (Responsible Party):

Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente

Purpose

This project consists of two independent, following specific eligibility criteria and different randomisation schemes studies, later on called DURATION study and BEV study. Once randomised in the duration study, patients fulfilling eligibility criteria for BEV study may also be randomized to receive BEV or no BEV, in addition to FOLFOX-4 chemotherapy.

As both are open label studies, there will be no blinding of treatment assignment.

Condition	Intervention	Phase
Colon Cancer	Drug: FOLFOX (Oxaliplatin, 5Fluorouracil, Lederfolin)	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment
Official Title:	A Randomized Trial Investigating the Role of FOLFOX-4 Regimen Duration (3 Versus 6 Months) and Bevacizumab as Adjuvant Therapy for Patients With Stage II/III Colon Cancer

Resource links provided by NLM:

Drug Information available for: Fluorouracil Oxaliplatin

U.S. FDA Resources

Further study details as provided by Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente:

Primary Outcome Measures:

disease free survival (DFS) [ Time Frame: time from randomization date to date of local or regional relapse ]

Secondary Outcome Measures:

overall Survival (OS), Toxicity and incidence of adverse events [ Time Frame: from the day of randomisation to the date of death from any cause. ]


Enrollment:	3756
Study Start Date:	June 2007
Study Completion Date:	November 2014
Primary Completion Date:	April 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: A FOLFOX-4 (infusional 5-Fluouracil, leucovorin and oxaliplatin) for 3 months or XELOX (capecitabine and oxaliplatin) for 12 weeks.	Drug: FOLFOX (Oxaliplatin, 5Fluorouracil, Lederfolin) To assess whether a 3-month FOLFOX-4 treatment is at least equivalent to a 6-month FOLFOX-4 treatment Other Name: FOLFOX 3 vs 6
Active Comparator: B FOLFOX-4 (infusional 5-Fluouracil, leucovorin and oxaliplatin) for 6 months or XELOX (capecitabine and oxaliplatin) for 24 weeks.	Drug: FOLFOX (Oxaliplatin, 5Fluorouracil, Lederfolin) standard treatment Other Name: FOLFOX 3 vs 6

Detailed Description:

At the present time the standard treatment for resected colon cancer with high possibility of relapse ("high risk" stage II and all stage III) is represented by the regimen FOLFOX (leucovorin, bolus and infusional 5fluorouracil and oxaliplatin), which is able to increase significantly the disease-free survival (DFS) at 3 and 4 years, whereas the advantage for 5-year overall survival (OS) (which is predicted by the previous parameter) could be observed only with a further increase of follow-up. The conventional duration of chemotherapy is today of 6 months (12 courses every 2 weeks), but this long drug exposure increases the risk of long-term neurotoxicity. A reduction of adjuvant chemotherapy under 6 months was proven effective in other cancers (breast, testis…) and is better tolerated by patients in clinical practice. On the other hand, bevacizumab significantly increases OS and all other parameters when combined with standard chemotherapy in advanced disease.

Eligibility

Information from the National Library of Medicine

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

Criteria

Inclusion Criteria:

Histologically confirmed AJCC/UICC high-risk stage II or stage III colon cancer . High-risk stage III patients (T4, N+, M0, or any T, N2, M0) may also be further randomized in the BEV study (plus or minus BEV)
Stage II patients have to be considered at high-risk if they fulfill >1 of the following criteria:
- T4 tumours,
- grade >3,
- clinical presentation with bowel obstruction or perforation,
- histological signs of vascular or lymphatic or perineural invasion,
- <12 nodes examined
Age 18 to 75 years
Curative surgery no less than 3 ( 4 in the BEV study) and no more than 8 weeks prior to randomization
ECOG performance Status (ECOG-PS) <1
Signed written informed consent obtained prior to any study specific procedures

Exclusion Criteria:

Macroscopic or microscopic evidence of residual tumor (R1 or R2 resections).
Previous anti-angiogenic treatment for any malignancy; cytotoxic chemotherapy, radiotherapy or immunotherapy for colon cancer
Other malignancies within the last 5 years (other than curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix)
Lactating women
Fertile women (<2 years after last menstruation) and men of childbearing potential not willing to use effective means of contraception
History of clinically relevant psychiatric disability , precluding informed consent
Clinically relevant cardiovascular disease
History or presence of other diseases
Evidence of bleeding diathesis or coagulopathy
Current or recent (within 10 days prior to study treatment start) use of full-dose oral or parenteral anticoagulants or thrombolytic agent for therapeutic purposes
Chronic, daily treatment with high-dose aspirin (>325 mg/day) or clopidogrel (>75 mg/day)
Current or recent (within the 28 days prior to randomization) treatment with another investigational drug or participation in another investigational study

Contacts and Locations

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): NCT00646607

Show 111 Study Locations

Sponsors and Collaborators

Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente

Mario Negri Institute for Pharmacological Research

Investigators


Principal Investigator:	Roberto Labianca, MD	Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente
Study Chair:	Alberto Sobrero, MD	Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Lonardi S, Sobrero A, Rosati G, Di Bartolomeo M, Ronzoni M, Aprile G, Scartozzi M, Banzi M, Zampino MG, Pasini F, Marchetti P, Cantore M, Zaniboni A, Rimassa L, Ciuffreda L, Ferrari D, Barni S, Zagonel V, Maiello E, Rulli E, Labianca R; TOSCA (Three or Six Colon Adjuvant) Investigators. Phase III trial comparing 3-6 months of adjuvant FOLFOX4/XELOX in stage II-III colon cancer: safety and compliance in the TOSCA trial. Ann Oncol. 2016 Nov;27(11):2074-2081. Epub 2016 Aug 29.


Responsible Party:	Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente
ClinicalTrials.gov Identifier:	NCT00646607 History of Changes
Other Study ID Numbers:	2007-000354-31
First Submitted:	March 17, 2008
First Posted:	March 28, 2008
Last Update Posted:	November 26, 2014
Last Verified:	December 2009

Keywords provided by Gruppo Italiano per lo studio dei Carcinomi dell'Apparato Digerente:


colorectal neoplasm high risk stage II/III

Additional relevant MeSH terms:


Colonic Neoplasms Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms Digestive System Diseases Gastrointestinal Diseases Colonic Diseases Intestinal Diseases Bevacizumab Oxaliplatin Fluorouracil Leucovorin	Levoleucovorin Angiogenesis Inhibitors Angiogenesis Modulating Agents Growth Substances Physiological Effects of Drugs Growth Inhibitors Antineoplastic Agents Antimetabolites Molecular Mechanisms of Pharmacological Action Antimetabolites, Antineoplastic Immunosuppressive Agents Immunologic Factors Antidotes Protective Agents Vitamin B Complex

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