Neoadjuvant Metformin in Association to Chemoradiotherapy for Locally Advanced Rectal Cancer

Phase 2

Terminated

• Conditions: Adenocarcinoma; Carcinoma; Rectal Neoplasms
• Interventions: Drug: Capecitabine; Drug: Metformin; Radiation: Radiotherapy; Drug: Placebo

• Registration Number: NCT02473094
• Lead Sponsor: University of Campinas, Brazil

Brief Summary

A phase II, randomized study of placebo versus metformin in association to chemotherapy with capecitabine and radiation in the neoadjuvant treatment of locally advanced (T3-4N0M0 or TxN1-2M0) rectal carcinomas.

Detailed Description

NEOMETRE is a randomized, double blind trial aiming to evaluate the efficacy and tolerability of metformin in association to chemoradiotherapy for the preoperative treatment of locally advanced (T3-4N0M0 or TxN1-2M0) rectal carcinomas.

Patients eligible for this study will be submitted to neoadjuvant 3D radiotherapy with 50,4 Gray (Gy) divided in 25 applications, in association to capecitabine, 825mg/m2 bid for five days every week. The participants will be randomized to daily metformin or placebo during the chemoradiotherapy period. The primary end-point is pathological complete response. The secondary end-points are recurrence-free survival (RFS), disease-free survival (DFS), overall survival (OS), local recurrence rate, overall response rate, sphincter preservation rate, quality of life (QoL) and toxicity.

Study Timeline

• Study First Submitted: 2015-06-13
• Study First Submitted QC: 2015-06-15
• Study First Posted: 2015-06-16
• Study Start: 2015-07
• Primary Completion: 2016-02
• Study Completion: 2016-02
• Status Verified: 2017-11
• Last Update Submitted: 2017-11-27
• Last Update Posted: 2017-11-28

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 3

Inclusion Criteria

• 18 years or older;
• biopsy proven poorly differentiated carcinoma or adenocarcinoma of the rectum;
• lesions located within 12 cm of the anal verge (from colonoscopy assessment);
• ability to tolerate oral treatment;
• locally advanced tumor, classified by the presence of positive regional lymph nodes or primary tumor invasion beyond the serosa (T3 or T4), assessed by MRI;
• eligibility for curative surgery (no distant metastasis or invasion of bony structures of the pelvis);
• Performance Status (PS) Eastern Cooperative Oncology Group (ECOG) 0-2;
• adequate hematologic functions (hemoglobin ≥ 10 g / dL [5.6 mmol / L]; neutrophil count ≥ 1,500 / mm3 and platelet count ≥ 100,000 / mm3), adequate renal function (serum creatinine less than 1.5 times the UNL) and adequate hepatic function (bilirubin less than 1.5 times the UNL; aspartate aminotransferase and alanine aminotransferase less than 2.5 times the UNL);

Read More

Exclusion Criteria

• known hypersensitivity to metformin or its excipients;
• squamous carcinomas of the rectum or anal canal;
• chronic treatment with corticosteroids or other immunosuppressive agents;
• treatment with oral antidiabetic products;
• distant metastasis at diagnosis or tumor invasion of pelvic bone structures that may proscribe curative intent surgery;
• chronic or acute infections;
• use of drugs under study up to four weeks prior to randomization;
• pregnant or nursing patients;
• prior radiotherapy to the pelvic region;
• myocardial infarction up to six months prior to randomization, or uncontrolled ischemic heart disease;
• congestive heart insufficiency New York Heart Association (NYHA) III-IV.

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Neoadjuvant capecitabine and metformin	Radiotherapy	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Metformin 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions
Neoadjuvant capecitabine and placebo	Radiotherapy	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Placebo 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions
Neoadjuvant capecitabine and placebo	Placebo	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Placebo 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions
Neoadjuvant capecitabine and metformin	Capecitabine	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Metformin 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions
Neoadjuvant capecitabine and metformin	Metformin	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Metformin 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions
Neoadjuvant capecitabine and placebo	Capecitabine	* Capecitabine 825 mg/m2 bid D1-5, q7d, for five weeks; * Placebo 2500mg/d for five weeks; * 3D radiotherapy 50,4Gy divided in 25 fractions

Primary Outcome Measures

Name	Time	Method
Pathological Complete Response	8 to 16 weeks after neoadjuvant treatment completion	Pathological evaluation of the surgical specimen. Complete response will be defined as absence of neoplastic tissue upon pathological exam.

Secondary Outcome Measures

Name	Time	Method
Sphincter Preservation Rate	8 to 16 weeks after neoadjuvant treatment completion	Rate of anal sphincter preservation during curative intent surgery.
Local Recurrence Free Survival	up to 5 years	The number of subjects without local relapse will be measured 6mo after the start of therapy, also after 1, 3 and 5 years from the start of therapy. Local recurrence free survival will be analysed with log-rank test, and reported as Hazard Ratio (HR) with respective 95% Confidence Interval (CI) and p value, and its median value will be estimated with kaplan-meyer method.
Local Recurrence Rate	up to 5 years	Rate of local or pelvic recurrence during follow up.
Overall Response Rate	4 to 6 weeks after neoadjuvant treatment completion	Magnetic Resonance Imaging (MRI) assessment to compare the response of chemoradiotherapy+metformin versus chemoradiotherapy+placebo.
Toxicity will be assessed using National Cancer Institute Common Toxicity Criteria for Adverse Effects (NCI CTCAE) v4.03	up to 4 weeks after neoadjuvant treatment completion	Safety and tolerability will be assessed using National Cancer Institute Common Toxicity Criteria for Adverse Effects (NCI CTCAE) v4.03. The number of patients in each arm experiencing grade 3-5 adverse events ou AE (for each AE) over the total number of subjects will be measured, and the proportion of patients experiencing AE in each arm will be compared using uncorrected chi-square test. AE will be recorded in baseline and in each visit, and the worst grade AE will be considered.
Disease Free Survival	up to 5 years	The number of subjects without relapse will be measured 6mo after the start of therapy, also after 1, 3 and 5 years from the start of therapy. Disease free survival will be analysed with log-rank test, and reported as HR with respective 95% CI and p value, and its median value will be estimated with kaplan-meyer method.
Overall Survival	up to 5 years	The number of subjects without death (any cause) will be measured 6mo after the start of therapy, and also after 1, 3 and 5 years from the start of therapy. Overall survival will also be analysed with log-rank test, and reported as HR with respective 95% CI and p value, and median OS will be estimated with kaplan-meyer method. All calculations will be performed 6 months after the last patient recruited. Also, the survival rate at year one, three and five will be calculated.
Quality of Life	up to 20 weeks after neoadjuvant treatment completion	European Organization for Research and Treatment of Cancer Quality of Life Questionaire (EORTC QLQ)-C30 and EORTC QLQ-CR29 will be assessed on screening, at the last day of neoadjuvant treatment, 4 weeks after neoadjuvant treatment completion and up to 4 weeks after surgery.

Trial Locations

Locations (1)

Clinical Oncology Department - General Hospital - State University of Campinas (UNICAMP); 🇧🇷 Campinas, São Paulo, Brazil