The Influence of Micrometastases on Prognosis and Survival in Stage I-II Colon Cancer Patients: The EnRoute+ Study

Brief Summary

Detailed Description

OBJECTIVES: * To determine the subset of patients with stage I or II localized, resectable colon cancer (pN0) at risk for developing systemic metastases. * To determine the clinical and prognostic relevance of occult nodal isolated tumor cells and micrometastases in these patients. * To determine the benefits of adjuvant chemotherapy in patients with pN0micro+ colon cancer. OUTLINE: This is a phase II feasibility study (stage 1) followed by a phase III multicenter, open-label, randomized, and controlled study (stage 2). * Stage 1 (phase II feasibility study) After undergoing planned curative resection followed by ex vivo sentinel lymph node mapping (SLNM). Resected samples are examined. The sentinel lymph nodes of those deemed pN0 disease (no macroscopic metastases or angioinvasion) are further evaluated for micrometastases by serial sectioning and immunohistochemistry using pan-cytokeratin. pN0micro+ disease are defined as isolated tumor cells (ITC) \< 0.2 mm or micrometastasis 0.2 - 2 mm. Patients with pN0 disease are followed-up once every 6 months for 3 years and then annually for 2 years. * stage 2 (phase III randomized study): Patients undergo planned surgery and ex vivo SLNM as in stage 1. Patients with pN0micro- disease are assigned to arm C; patients with pN0micro+ disease are randomized to 1 of 2 intervention arms (arms A and B). . * Arm A (pN0micro+): Patients receive oral capecitabine twice daily on days 1-14 and oxaliplatin IV over 2 hours on day 1 OR oral capecitabine twice daily on days 1-14 alone according to standard protocol. Treatment repeats every 4 weeks for up to 8 courses. Patients are followed-up once every 6 months for 3 years and then annually for 2 years. * Arm B (pN0micro+): Patients are followed-up once every 6 months for 3 years and then annually for 2 years. * Arm C (pN0micro-): Patients are followed-up once every 6 months for 3 years and then annually for 2 years. * .

Primary Outcomes

Secondary Outcomes

• Overall survival (OS) at 3 years (stage 2)
• Stratified analysis of DFS and OS according to total harvested lymph nodes per resected specimen and chemotherapy regimen (capecitabine and oxaliplatin versus capecitabine alone) (stage 2)