Multicentric Phase II-III Study Evaluating the Tailored Management of Locally-advanced Rectal Carcinoma After a Favorable Response to Induction Chemotherapy

Status: Recruiting
Location: See all (29) locations...
Intervention Type: Other, Radiation, Procedure, Drug
Study Type: Interventional
Study Phase: Phase 2/Phase 3
SUMMARY

Locally advanced rectal carcinoma raise the issue of both the oncological control, local and general, and the therapeutic morbidity. Surgery alone can cure only one out of two patients, radiochemotherapy improves the local control but the metastatic risk remains about 30% with enhanced postoperative morbidity and poor functional results. The tumor response to preoperative treatment is the major prognostic factor which revealed the aggressiveness of the tumor. To this day, there are no biologic predictive markers for tumor response. The purpose of this trial is to tailor the management according to the early tumoral response after short and intensive induction chemotherapy. MRI volumetric tumor response will be used to distinguish between good responders and bad responders. Very good responders will be randomized to either immediate surgery or radiochemotherapy followed by surgery (Standard arm: Cap 50).

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Written consent,

• Patient who receive Folfirinox,

• Patient aged over 18 years old,

• World Health Organization (WHO) performance status ≥ 1,

• Histologically confirmed diagnosis of adenocarcinoma of the rectum,

• Distal part of the tumor from 1 to 12 cm from the upper part of the levator ani (dynamic rectal examination),

• No unequivocal evidence on CT-Scan of established metastatic disease,

• MRI evaluation of the locally advanced tumor before neoadjuvant chemotherapy:

∙ Predictive CRM \< 2 mm

‣ Or T3c-d (extending ≥ 5 mm beyond the muscularis propria) with extra mural venous invasion (EMVI)

‣ Or T4a-b (except bone and sphincteric invasion).

• NON INCLUSION CRITERIA FOR SCREENING

• Non measurable rectal tumor or not assessed by MRI before inclusion,

• Ultra-low rectal tumor at diagnosis which imposes radiotherapy administration (inferior tumor pole less than 1 cm from the upper part of the levator ani).

• Active cardiac disease including any of the following: a. Congestive heart failure ≥ New York Heart Association (NYHA) class 2 (appendix 4), b. Unstable angina (angina symptoms at rest), new-onset angina (begun within the last 3 months), c. Myocardial infarction less than 6 months before first dose of treatment, d. Cardiac arrhythmias requiring anti-arrhythmic therapy (beta blockers or digoxin are permitted),

• Previous or concurrent cancer that is distinct in primary site or histology from colorectal cancer within 5 years prior to study inclusion, except for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors \[Ta (non invasive tumor), Tis (carcinoma in situ) and T1 (lamina propria invasion)\],

• Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 months before start of treatment.

• WHO performance status 0-1,

• Patient with tumoral regression ≥ 60% and CRM ≥ 1mm,

• No unequivocal evidence on CT-Scan of established metastatic disease,

• General condition considered suitable for radical pelvic surgery and a systemic therapy with Capecitabine

• Adequate hematologic, hepatic, renal and ionogram function assessed within 7 days prior to study treatment a. Platelet count ≥ 100,000/mm3; Hemoglobin (Hb) ≥ 9 g/dL; Absolute neutrophil count (ANC) ≥ 1,500/ mm3 b. Total bilirubin ≤ 1.5 x Upper Limit Normal (ULN), Alkaline phosphatases ≤ 3 x ULN and ASpartate aminoTransferase (AST) and ALanine aminoTransferase (ALT) ≤ 3 x ULN, c. Serum creatinine ≤ 1.5 x ULN or calculated creatinine clearance ≥ 50 ml/min according to Modification of Diet in Renal Disease (MDRD),

• For women of reproductive potential, negative serum beta human chorionic gonadotropin (β-HCG) pregnancy test obtained within 7 days before the start of study treatment. Women not of reproductive potential are female patients who are postmenopausal or permanently sterilized (e.g., tubal occlusion, hysterectomy, bilateral salpingectomy),

• For women of childbearing potential and men, agreement to use an adequate contraception for the duration of study participation and up to 6 months following completion of therapy. Females of childbearing potential who are sexually active with a non-sterilized male partner must use 2 methods, of effective contraception. The investigator or a designated associate is requested to advise the patient on how to achieve an adequate birth control. Adequate contraception is defined in the study as any medically recommended method (or combination of methods) as per standard of care,

• No evidence of chronic or acute ischemic heart disease,

• Willing to participate to the study, and able to give informed consent and to comply with the treatment and follow-up schedules,

⁃ Affiliation to the French Social Security System.

Locations
Other Locations
France
CHU Amiens
RECRUITING
Amiens
Ch Annecy
NOT_YET_RECRUITING
Annecy
CHU Besançon
RECRUITING
Besançon
Bordeaux Colorectal Institute
RECRUITING
Bordeaux
CHU de Bordeaux
RECRUITING
Bordeaux
CHU Clermont-Ferrand
RECRUITING
Clermont-ferrand
Centre Georges-François Leclerc
NOT_YET_RECRUITING
Dijon
Chu Grenoble
RECRUITING
Grenoble
Hôpital Bicêtre
RECRUITING
Le Kremlin-bicêtre
Centre Oscart Lambret
RECRUITING
Lille
Chu Lille
RECRUITING
Lille
CAC Léon Bérard
RECRUITING
Lyon
CHU de Lyon
RECRUITING
Lyon
Hôpital Européen de MARSEILLE
RECRUITING
Marseille
Hôpital La Timone
RECRUITING
Marseille
Hôpital Nord de Marseille
NOT_YET_RECRUITING
Marseille
Insitut Régional du Cancer de Montpellier
RECRUITING
Montpellier
Centre Alexis Vautrin
RECRUITING
Nancy
Centre Antoine Lacassagne
RECRUITING
Nice
CHU de Nîmes
RECRUITING
Nîmes
Hôpital Diaconesses
RECRUITING
Paris
Hôpital Européen Georges-Pompidou
RECRUITING
Paris
Hôpital Saint-Antoine
RECRUITING
Paris
Hôpital Saint-Louis
RECRUITING
Paris
CH PAU
RECRUITING
Pau
CHU Rouen
RECRUITING
Rouen
Institut de Cancérologie de l'Ouest
RECRUITING
Saint-herblain
CHU de Toulouse
RECRUITING
Toulouse
CHU de Nancy
RECRUITING
Vandœuvre-lès-nancy
Contact Information
Primary
Philippe Rouanet, MD
Philippe.Rouanet@icm.unicancer.fr
4 67 61 30 71
Time Frame
Start Date: 2021-11-26
Estimated Completion Date: 2027-08
Participants
Target number of participants: 1075
Treatments
Experimental: Experimental: Arm A: immediate rectal surgery
Very good responder patients will be randomly assigned to proctectomy performed within 4 to 6 weeks from randomization.
Active_comparator: RCT Cap 50 and then rectal surgery
Very good responder patients will be randomly assigned to receive chemoradiotherapy combining the administration of oral capecitabine (1600 mg/m2/day, BID) and radiotherapy at a total dose of 50 grays (2Gy/day, 5 days a week, 5 weeks, boost 6 Gy) followed after 7 weeks by a proctectomy.
Related Therapeutic Areas
Sponsors
Leads: Institut du Cancer de Montpellier - Val d'Aurelle

This content was sourced from clinicaltrials.gov