Combination Chemotherapy Before or After Surgery in Treating Patients With Colorectal Cancer With Liver Metastases That Could Be Removed By Surgery

Phase 3

Terminated

Conditions: Colorectal Cancer
Metastatic Cancer

Registration Number: NCT01189227

Lead Sponsor: NSABP Foundation Inc

Brief Summary: RATIONALE: Drugs used in chemotherapy work in different ways to kill tumor cells or stop them from growing. Giving combination chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving combination chemotherapy after surgery may kill any remaining tumor cells. It is not yet known whether giving combination chemotherapy before and after surgery is more effective than giving combination chemotherapy after surgery.

PURPOSE: This randomized phase III trial is studying giving combination chemotherapy before and after surgery to see how well it works compared to giving combination chemotherapy after surgery in treating patients with colorectal cancer with liver metastases that could be removed by surgery.

Detailed Description: OBJECTIVES:

Primary

* To evaluate the difference in recurrence-free survival (RFS) of patients with potentially resectable hepatic colorectal metastases receiving perioperative (preoperative plus postoperative) adjuvant chemotherapy vs only postoperative adjuvant chemotherapy following liver resection for colorectal metastases.

Secondary

* To compare the proportion of patients between study arms who are R0 or R1 resected, alive, and free of recurrence at 6 months.

* To compare RFS between study arms in the cohort of patients event-free at 6 months.

* To compare overall survival between study arms.

* To evaluate the difference in R0 and combined R0 + R1 resection rates in patients receiving neoadjuvant therapy and those undergoing initial surgical resection.

* To compare the postoperative morbidity profile between study arms.

* To evaluate the safety and toxicity profile of postoperative and perioperative administration of chemotherapy and bevacizumab.

Tertiary

* To evaluate the relationship of baseline circulating tumor cells (CTC) to RFS.

* To evaluate the relationship of baseline CTC to R0 resection.

* To evaluate the relationship of pre-resection CTC in the preoperative therapy group only with RFS and R0 resection.

OUTLINE: This is a multicenter study. Patients are stratified by number of liver metastases (1-3 vs 4+), chemotherapy regimen\* (mFOLFOX6 vs FOLFIRI), and synchronous\*\* primary colorectal cancer (yes vs no). Patients are randomized to 1 of 2 treatment arms.

NOTE: \*Patients who have not received previous oxaliplatin receive mFOLFOX6 chemotherapy comprising oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV over 46 hours on day 1. Patients who have received previous oxaliplatin receive FOLFIRI chemotherapy comprising irinotecan hydrochloride IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV over 46 hours on day 1.

NOTE: \*\*Synchronous is defined as the detection (by imaging) of suspicious liver metastases within 90 days before or after the date of histologic diagnosis of the primary colon or rectal cancer.

* Arm 1 (postoperative): Patients undergo hepatic resection. Beginning 31-56 days after surgery, patients receive mFOLFOX6 or FOLFIRI chemotherapy IV on day 1 over 3 hours. Patients receive an additional dose of fluorouracil over 46 hours using a portable pump. Treatment repeats every 2 weeks for 12 courses.

* Arm 2 (perioperative): Patients receive mFOLFOX6 or FOLFIRI chemotherapy IV over 3 hours on day 1. Patients receive an additional dose of fluorouracil over 46 hours using a portable pump. Treatment repeats for every 2 weeks for 6 courses. Patients then undergo hepatic resection. Beginning 31-56 days after surgery, patients receive an additional 6 courses of mFOLFOX6 or FOLFIRI chemotherapy.

Blood and tumor tissue samples may be collected periodically for correlative studies.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 9

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Recurrence-free Survival (RFS)	From study entry until the date of recurrence or death or for a maximum of 5 years.	Time to recurrence or death

Secondary Outcome Measures

Name	Time	Method
RFS of Patients Event-free	From study entry until the date of recurrence or for a maximum of 6 months.
Overall Survival	From study entry until the time of death or for a maximum of 5 years.
The Difference in R0 and Combined R0 + R1 Resection Rates Between the Two Arms.	Assessed at the time of surgery
Frequencies of Selected Postoperative Surgical Complications and Other Adverse Events Within 30 Days of Surgery	Assessed within 30 days from the time of surgery
Frequencies of Adverse Events as Assessed by the NCI CTCAE v4.0	From study entry through 3 months after the last treatment dose.

Trial Locations

Locations (281): Kaiser Permanente - Deer Valley
🇺🇸
Antioch, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸
Duarte, California, United States
Kaiser Permanente - Fremont
🇺🇸
Fremont, California, United States
Kaiser Permanente Medical Center - Hayward
🇺🇸
Hayward, California, United States
Kaiser Permanente Medical Center - Oakland
🇺🇸
Oakland, California, United States
St. Joseph Hospital Regional Cancer Center - Orange
🇺🇸
Orange, California, United States
Kaiser Permanente Medical Center - Redwood City
🇺🇸
Redwood City, California, United States
Kaiser Permanente Medical Center - Richmond
🇺🇸
Richmond, California, United States
Kaiser Permanente Medical Center - Roseville
🇺🇸
Roseville, California, United States
South Sacramento Kaiser-Permanente Medical Center
🇺🇸
Sacramento, California, United States
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Kaiser Permanente - Deer Valley
🇺🇸Antioch, California, United States