Oxaliplatin, Capecitabine, and Radiation Therapy With or Without Cetuximab in Treating Patients Undergoing Surgery for High-Risk Rectal Cancer
- Conditions
- Colorectal Cancer
- Registration Number
- NCT00383695
- Lead Sponsor
- Royal Marsden NHS Foundation Trust
- Brief Summary
RATIONALE: Drugs used in chemotherapy, such as oxaliplatin and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving chemotherapy and radiation therapy with or without cetuximab before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. It is not yet known whether giving oxaliplatin, capecitabine, and radiation therapy is more effective with or without cetuximab when given before surgery in treating rectal cancer.
PURPOSE: This randomized phase II trial is studying oxaliplatin, capecitabine, and radiation therapy to compare how well they work with or without cetuximab in treating patients undergoing surgery for high-risk rectal cancer.
- Detailed Description
OBJECTIVES:
* Compare the pathological complete response rate at total mesorectal excision in patients with high-risk rectal cancer treated with neoadjuvant therapy comprising oxaliplatin, capecitabine, and radiotherapy with or without cetuximab.
OUTLINE: This is a multicenter, open-label, randomized, controlled study. Patients are stratified according to participating center and presence of T4 disease (yes vs no). Patients are randomized to 1 of 2 treatment arms.
* Arm I:
* Neoadjuvant chemotherapy: Patients receive oxaliplatin IV over 2 hours on days 1, 22, 43, and 64 and oral capecitabine twice daily on days 1-14, 22-35, 43-56, and 64-77.
* Neoadjuvant chemoradiotherapy: Patients undergo radiotherapy once daily on days 85-89, 92-96, 99-103, 106-110, 113-117, and 120-124 and receive oral capecitabine twice daily on days 85-126.
* Surgery: Four to six weeks after completion of chemoradiotherapy, patients undergo total mesorectal excision (TME).
* Adjuvant therapy: Beginning 6-8 weeks after surgery, patients receive oxaliplatin IV over 2 hours on days 1, 22, 43, and 64 and oral capecitabine twice daily on days 1-14, 22-35, 43-56, and 64-77.
* Arm II:
* Neoadjuvant therapy: Patients receive oxaliplatin and capecitabine as in arm I neoadjuvant chemotherapy and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
* Neoadjuvant chemoradiotherapy: Patients undergo radiotherapy and receive capecitabine as in arm I neoadjuvant chemoradiotherapy and cetuximab IV over 1 hour on days 85, 92, 99, 106, 113, and 120.
* Surgery: Four to six weeks after completion of chemoradiotherapy patients undergo TME as in arm I.
* Adjuvant therapy: Beginning 6-8 weeks after surgery, patients receive oxaliplatin and capecitabine as in arm I adjuvant chemotherapy and cetuximab IV over 1 hour on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed periodically.
After completion of study treatment, patients are followed every 3 months for 1 year, every 6 months for 2 years, and then annually for 2 years.
PROJECTED ACCRUAL: A total of 164 patients will be accrued for this study.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 164
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Pathological complete response rate at time of total mesorectal excision (TME)
- Secondary Outcome Measures
Name Time Method Radiological response rates after completion of neoadjuvant therapy Complete resection rate (R0 resection) with microscopic clear resection margin (tumor observed > 1 mm from the resection margin), especially circumferential resection margin Perioperative measures, including operation time, duration of in-patient stay, perioperative transfusion requirement, and mortality, within 30 days of TME Postoperative complications, including wound infection, wound dehiscence, and fistula formation Quality of TME as assessed by audit of photographed surgical specimens Rate of abdominoperitoneal excision Clinical and radiological anastomotic leak rate Progression-free survival and patterns of failure Overall survival Rate of permanent defunctioning colostomies Quality of life, including long-term bowel function Safety
Trial Locations
- Locations (13)
Dorset Cancer Centre
🇬🇧Poole Dorset, England, United Kingdom
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Karolinska University Hospital - Solna
🇸🇪Stockholm, Sweden
Uppsala University Hospital
🇸🇪Uppsala, Sweden
Royal Bournemouth Hospital NHS Trust
🇬🇧Bournemouth, England, United Kingdom
Mid Kent Oncology Centre at Maidstone Hospital
🇬🇧Maidstone, England, United Kingdom
Eastbourne District General Hospital
🇬🇧Eastbourne, England, United Kingdom
Sussex Cancer Centre at Royal Sussex County Hospital
🇬🇧Brighton, England, United Kingdom
Royal Marsden - Surrey
🇬🇧Sutton, England, United Kingdom
Cancer Research UK Clinical Groups at Guy's King's & St. Thomas' Hospitals
🇬🇧London, England, United Kingdom
Southampton General Hospital
🇬🇧Southampton, England, United Kingdom
Vall d'Hebron University Hospital
🇪🇸Barcelona, Spain
Hospital Clinico Universitario de Valencia
🇪🇸Valencia, Spain