Rectal Cancer And Pre-operative Induction Therapy Followed by Dedicated Operation. The RAPIDO Trial

Phase 3

Active, not recruiting

• Conditions: Rectal Cancer
• Interventions: Other: standard long course chemoradiotherapy; Other: M1 scheme

• Registration Number: NCT01558921
• Lead Sponsor: University Medical Center Groningen

Brief Summary

Currently the 3-year disease free survival of patients with locally advanced rectal cancer is about 50%. Current standard treatment for patients at high risk of failing locally and/or systemically includes pre-operative long course radiotherapy (5 weeks) in combination with chemotherapy (so called neoadjuvant chemoradiotherapy). The neoadjuvant chemoradiotherapy has been demonstrated to improve local control, but had no effect on the overall survival. Different studies in patients with rectal cancer studying the effect of adjuvant post operative chemotherapy did not result in an improved survival. This may be due the fact that rectal cancer surgery (TME) is associated with a high complication rate so substantial proportion of patients cannot receive chemotherapy postoperatively. An alternative approach is to administer the systemic therapy preoperative. To guarantee control of the rectum tumor short-course radiotherapy (5 days) is given, as different studies showed local control of the tumor for a long time. During this waiting period the patient is in a good condition to receive an optimal dose of chemotherapy. The investigators hypothesize that with this proposed protocol both the local tumour and possible micrometastases are effectively treated and that this will result in an increased survival. The investigators will compare this with the standard treatment of neoadjuvant chemoradiation followed by TME surgery and optional adjuvant chemotherapy.

Detailed Description

Patients will be randomized between an experimental group (arm B) in which short course 5 x 5 Gy radiation scheme is followed by six cycles of combination chemotherapy (capecitabine/5FU and oxaliplatin) and surgery and a control group (arm A) with long course chemoradiotherapy followed by surgery. In arm A adjuvant chemotherapy is allowed according to the local protocol of the institution. In both groups the rectal tumour will be removed by TME surgery or more extensive surgery if required because of tumour extent.

Study Timeline

• Study Start: 2011-06-21
• Study First Submitted: 2012-03-18
• Study First Submitted QC: 2012-03-19
• Study First Posted: 2012-03-20
• Primary Completion: 2020-03-08
• Status Verified: 2023-01
• Last Update Submitted: 2023-01-11
• Last Update Posted: 2023-01-13
• Study Completion: 2026-12-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 920

Inclusion Criteria

Primary tumour characteristics:

1. Histological proof of newly diagnosed primary adenocarcinoma of the rectum
2. Locally advanced tumour fulfilling at least one of the following criteria on pelvic MRI indicating high risk of failing locally and/or systemically (T4a, i.e. overgrowth to an adjacent organ or structure like the prostate, urinary bladder, uterus, sacrum, pelvic floor or side wall (according to TNM version 5), cT4b, i.e. peritoneal involvement, extramural vascular invasion (EMVI+). N2, i.e. four or more lymph nodes in the mesorectum showing morphological signs on MRI indicating metastatic disease. Positive MRF, i.e. tumor or lymph node < 1 mm from the mesorectal fascia. Enlarged lateral nodes, > 1 cm (lat LN+)

Exclusion Criteria

1. Extensive growth into cranial part of the sacrum (above S3) or the lumbosacral nerve roots indicating that surgery will never be possible even if substantial tumour down-sizing is seen
2. Presence of metastatic disease or recurrent rectal tumour
3. Familial Adenomatosis Polyposis coli (FAP), Hereditary Non-Polyposis Colorectal Cancer (HNPCC), active Crohn¡¦s disease or active ulcerative Colitis
4. Concomitant malignancies, except for adequately treated basocellular carcinoma of the skin or in situ carcinoma of the cervix uteri. Subjects with prior malignancies must be disease-free for at least 5 years
5. Known DPD deficiency
6. Any contraindications to MRI (e.g. patients with pacemakers)
7. Medical or psychiatric conditions that compromise the patient's ability to give informed consent
8. Concurrent uncontrolled medical conditions
9. Any investigational treatment for rectal cancer within the past month
10. Pregnancy or breast feeding
11. Patients with known malabsorption syndromes or a lack of physical integrity of the upper gastrointestinal tract
12. Clinically significant (i.e. active) cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac dysrhythmia, e.g. atrial fibrillation, even if controlled with medication) or myocardial infarction within the past 12 months
13. Patients with symptoms or history of peripheral neuropathy

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
A: 5 weeks chemoradiation -> surgery	standard long course chemoradiotherapy	control group (arm A) standard long course chemoradiotherapy
B: 5x5Gy -> CAPOX -> surgery	M1 scheme	experimental group (arm B) M1 scheme

Primary Outcome Measures

Name	Time	Method
Disease related Treatment Failure (DrTF)	3 year follow-up after surgery	DrTF = Either local or distant relapse or death caused by the rectal carcinoma whichever comes first. In case of nonrectal cancer related death patients will be censored at date of death. In case of a second primary tumour patients will be censored at the date of diagnosis of the second primary tumour. In case of local regrowth after wait \& watch strategy, followed by no resection or R2 resection, diagnosis local regrowth is taken. Patients lost to follow-up will be censored the last date of patient visit. Survival curves for Disease related Treatment Failure after 3 years of follow-up will be constructed using the method of Kaplan and Meier.

Secondary Outcome Measures

Name	Time	Method
Quality of life LARS	3 year after surgery	LARS
Surgical complications	3 year follow-up	Wound rupture, bleeding, infection, rectal anastomotic leak
Quality of life QLQ-CIPN20	3 year after surgery	Quality of life QLQ-CIPN20
CRM negative rate	within 30 days	Circumferential resection margin \> 1 mm
Quality of life QLQ-CR-29+	3 year after surgery	Quality of life QLQ-CR-29+
pCR rate	within 30 days	Pathological complete response after neo-adjuvant treatment
Overall survival	10 year	Overall survival will be computed as the time between randomization and colorectal cancer or treatment related death. Patients lost to follow-up will be censored the last date of patient visit.; In case of a second primary tumour patients will be censored at the date of diagnosis of the second primary tumour.
Short and long-term toxicity	3 year follow-up	Treatment associated toxicity
Quality of life QLQ-C30	3 year after surgery	Quality of life QLQ-C30

Trial Locations

Locations (56)

Reinier de Graaf Groep; 🇳🇱 Delft, Netherlands

Deventer Hospital; 🇳🇱 Deventer, Netherlands

Aalborg Universitetshospital; 🇩🇰 Aalborg, Denmark

Odense Universitetshospital; 🇩🇰 Odense, Denmark

Siteman Cancer Center, Washington University Medical School; 🇺🇸 Saint Louis, Missouri, United States

Amsterdam UMC, location AMC; 🇳🇱 Amsterdam, Netherlands

University Medical Center Groningen; 🇳🇱 Groningen, Po Box 30001, Netherlands

Noordwest Ziekenhuisgroep; 🇳🇱 Alkmaar, Netherlands

Amsterdam UMC, location VUMC; 🇳🇱 Amsterdam, Netherlands

Onze Lieve Vrouwe Gasthuis; 🇳🇱 Amsterdam, Netherlands

Nki / Avl; 🇳🇱 Amsterdam, Netherlands

Wilhelmina Ziekenhuis; 🇳🇱 Assen, Netherlands

Amphia Ziekenhuis; 🇳🇱 Breda, Netherlands

Bronovo Ziekenhuis; 🇳🇱 Den Haag, Netherlands

HaGaZiekenhuis; 🇳🇱 Den Haag, Netherlands

Medisch Centrum Haaglanden; 🇳🇱 Den Haag, Netherlands

Catharina ZIekenhuis; 🇳🇱 Eindhoven, Netherlands

Het Groene Hart Ziekenhuis; 🇳🇱 Gouda, Netherlands

Martini Ziekenhuis; 🇳🇱 Groningen, Netherlands

Universitair Medisch Centrum Groningen; 🇳🇱 Groningen, Netherlands

de Tjongerschans; 🇳🇱 Heerenveen, Netherlands

UMC Nijmegen St Radboud; 🇳🇱 Nijmegen, Netherlands

Ziekenhuisgroep Twente; 🇳🇱 Hengelo, Netherlands

Medisch Centrum Leeuwarden; 🇳🇱 Leeuwarden, Netherlands

Spaarne Ziekenhuis; 🇳🇱 Hoofddorp, Netherlands

Alrijne Ziekenhuis; 🇳🇱 Leiderdorp, Netherlands

Radiotherapeutisch Instituut Friesland; 🇳🇱 Leeuwarden, Netherlands

Leiden University Medical Center; 🇳🇱 Leiden, Netherlands

Antonius Ziekenhuis; 🇳🇱 Sneek, Netherlands

Isala Klinieken; 🇳🇱 Zwolle, Netherlands

Sørlandet Sykehus Kristiansand; 🇳🇴 Kristiansand, Norway

Diakonessenhuis; 🇳🇱 Utrecht, Netherlands

Oslo Universitetssykehus; 🇳🇴 Oslo, Norway

Institute of Oncology; 🇸🇮 Ljubljana, Slovenia

Hospital Clínico Universitario de Valencia; 🇪🇸 Valencia, Spain

Hospital Vall d'Hebron; 🇪🇸 Barcelona, Spain

ICO Hospital Duran I Reynals; 🇪🇸 L'HOSPITALET de LLOBREGAT, Spain

Consorcio Hospital General Universitario Valencia; 🇪🇸 Valencia, Spain

Södra Älvsborgs Sjukhus; 🇸🇪 Borås, Sweden

Mälarsjukhuset; 🇸🇪 Eskilstuna, Sweden

Falu Lasarett; 🇸🇪 Falun, Sweden

Hospital Universitari i Politècnic la Fe; 🇪🇸 Valencia, Spain

Kalmar Hospital; 🇸🇪 Kalmar, Sweden

Centralsjukhuset i Karlstad; 🇸🇪 Karlstad, Sweden

Gävle sjukhus; 🇸🇪 Gävle, Sweden

Sahlgrenska Universitetssjukhuset; 🇸🇪 Göteborg, Sweden

Linköpings Universitet; 🇸🇪 Linköping, Sweden

Universitetssjukhuset i Lund; 🇸🇪 Lund, Sweden

Skaraborgs Sjukhus; 🇸🇪 Skövde, Sweden

Norrlands Universitetssjukhus; 🇸🇪 Umeå, Sweden

Karolinska Universitetssjukhuset; 🇸🇪 Stockholm, Sweden

Sundsvalls Sjukhus; 🇸🇪 Sundsvall, Sweden

Akademiska Sjukhuset; 🇸🇪 Uppsala, Sweden

Centrallasarett; 🇸🇪 Västerås, Sweden

Centrallasarettet Växjö; 🇸🇪 Växjö, Sweden

Universitetssjukhuset ÖREBRO; 🇸🇪 Örebro, Sweden