A Randomized Phase II Trial of Preoperative Chemoradiation (Preop CRT) Followed by CapOx (Capecitabine Plus Oxaliplatin) Versus Preop CRT Alone for Locally Advanced Rectal Cancer (LARC)
Overview
- Phase
- Phase 2
- Intervention
- Capecitabine Oxaliplatin
- Conditions
- Rectal Neoplasms
- Sponsor
- National Cancer Center, Korea
- Enrollment
- 110
- Locations
- 7
- Primary Endpoint
- downstaging rate
- Last Updated
- 8 years ago
Overview
Brief Summary
The current standard treatment of locally advanced rectal cancer (clinical stage II or III) is preoperative radiation with chemotherapy (CRT) followed by surgery. But this approach can be suboptimal for patients with high risk features (more deeply-seated tumor or many regional lymph nodes involved)that are associated with recurrence. This study test a hypothesis that CRT followed by chemotherapy before surgery can improve efficacy of preoperative treatment.
Detailed Description
Downstaging rate with CRT using fluoropyrimidine monotherapy is usually 30-40%.In MRI-defined high-risk patients, downstaging rate with conventional fluoropyrimidine-based monotherapy with radiation has not been shown. We assume that the downstaging rate of chemoradiation arm (control arm) would be 30%, and that addition of CapOx after CRT (experimental arm) may increase downstaging rate 30% to 50%. A sample size of 52 patients per group is needed have 85% power to detect downstaging rate = 50% as compared to 30% with type I error rate of 15%. We will perform one interim futility analysis when half of the patients are recruited and evaluated for the primary endpoint. O'Brien-Fleming boundary will be considered. Therefore, when 26 patients per arm are evaluated, the interim futility analysis will be performed, and when the Z score at the interim is less than -0.09192 (one-sided p-value greater than 0.5366192), the study will be stopped for futility. Considering 5% follow-up loss, a sample size of 55 per arm (a total of 110 patients) will be studied.
Investigators
Sun Young Kim
MD
National Cancer Center, Korea
Eligibility Criteria
Inclusion Criteria
- •histologically confirmed adenocarcinoma of the rectum
- •distal margin of tumor located from 0 to 12 cm from anal verge measured by digital rectal examination
- •high risk clinical stage II or III in MRI (satisfying at least one of the followings)
- •circumferential resection margin \< 1 mm involved
- •low-lying tumor below anal verge 3 cm
- •T3 \> 5 mm extramural spread
- •T4 (involving surrounding structures or peritoneum)
- •cN2 (4 or more mixed signal intensity or irregularly bordered node or tumor deposit)
- •age 20 years or more
- •ECOG (Eastern Cooperative Oncology Group) performance status 0-2
Exclusion Criteria
- •malignant disease of the rectum other than adenocarcinoma or arisen from chronic inflammatory bowel disease
- •any unresected synchronous colon cancer
- •any distant metastases
- •intestinal obstruction or impending obstruction, but decompressing colostomy is permitted
- •any previous or concurrent malignancy withih 5 years other than non-melanoma skin cancer / in situ cancer of uterine cervix / early gastric cancer / thyroid cancer of low risk
- •any other morbidity or situation with relative contraindication for chemoradiotherapy
- •patients with history of significant gastric or small bowel resection, or malabsorption syndrome, or other lack of integrity of the upper gastrointestinal tract that may compromise the absorption of capecitabine
- •pregnant or lactating women or patients of childbearing potential not predicting adequate contraception
Arms & Interventions
chemoradiation followed by CapOx
preoperative chemoradiation 50.4Gy with capecitabine or 5-fluorouracil/leucovorin (pelvic radiation capecitabine 5-fluorouracil) followed by 2 cycles of chemotherapy (Capecitabine Oxaliplatin - CapOx) and surgery (total mesorectal excision)
Intervention: Capecitabine Oxaliplatin
chemoradiation followed by CapOx
preoperative chemoradiation 50.4Gy with capecitabine or 5-fluorouracil/leucovorin (pelvic radiation capecitabine 5-fluorouracil) followed by 2 cycles of chemotherapy (Capecitabine Oxaliplatin - CapOx) and surgery (total mesorectal excision)
Intervention: pelvic radiation capecitabine 5-fluorouracil
chemoradiation
preoperative chemoradiation 50.4Gy with capecitabine or 5-fluorouracil/leucovorin (pelvic radiation capecitabine 5-fluorouracil) followed by rest for 8 weeks and surgery (total mesorectal excision)
Intervention: pelvic radiation capecitabine 5-fluorouracil
Outcomes
Primary Outcomes
downstaging rate
Time Frame: expected average of 15 weeks after start of study treatment
downstaging rate is defined as the proportion of patients with ypStage (pathologic stage after preoperative treatment) 0 or I (from pathologic findings after preoperative treatment and surgery) out of all patients who were assigned to each arm.
Secondary Outcomes
- pathologic response(expected average of 15 weeks after start of study treatment)
- radiologic response rate(expected average of 14 weeks after start of study treatment)
- toxicity profile(expected average of 35 weeks after start of study treatment)
- relapse-free survival(3 years after surgery)
- Disease-free survival(3 years after surgery)
- pattern of failure(3 years after surgery)
- local control rate(3 years after surgery)
- overall survival(3 years after surgery)
- quality of life(before study treatment, 7 weeks after completion of chemoradiation, and at 4 weeks after surgery)