Potentialy or borderline resecable metastatic colorectal cancer(RAS and B-RAF W-T) at diagnosis and for whom a multidisciplinary meeting recommended chemotherapy first in a curative intent.
Conditions
Interventions
Sponsors
Eligibility
Inclusion criteria
Inclusion criteria: 1. Female or male patients with at least 18 years at the time the informed consent is signed 2. EGOG performance status 0 or 1 3. Histological or cytological confirmed diagnostic of adenocarcinoma of the colon or rectum, with or without primary tumour in situ. Wild-type RAS and B-RAF tumor status. 4. Patients must present a resectable metastatic disease at diagnosis with at least 3 metastases with one > 3cm. Resectability could be planed in one or multiple stage if indicated. As commonly admitted, resectability means the surgical clearance (+/- radiofrequency ablation) of all detectable (liver) lesions with tumor-free margins and compatible with an adequate hepatic reserve. 5. Partial and minor resection of metastatic disease is allowed within 3 months before inclusion if patient has never received chemotherapy for mCRC. 6. Extra hepatic metastatic location is limited to 1 site. Extra-hepatic location must be easily resectable in one stage surgery. 7. Patients may have received adjuvant chemotherapy or (neo-) adjuvant chemo-radiotherapy to the pelvis, provided the last dose of chemotherapy was administered at least 6 months prior to inclusion (12 months for oxaliplatin). Previous radiotherapy to the pelvis is not an exclusion criterion. 8.Adequate haematological, renal and hepatic function as follows: Haematological Neutrophils > 1.5 x 109/L Platelets > 100 x 109/L Renal Creatinine =65 years) no F.1.3.1 Number of subjects for this age range
Exclusion criteria
Exclusion criteria: 1. Non resectable mCRC at diagnosis. 2. Prior chemotherapy or systemic therapy for mCRC. Adjuvant chemotherapy for colorectal cancer is not an exclusion criterion provided that it was completed more than 6 months prior to inclusion. Oxaliplatin-based chemotherapy must be completed more than 1 year prior to inclusion. 3. Prior utilization of cetuximab, panitumumab (or other anti-EGFR therapy). 4. Previous radiotherapy delivered to the upper abdomen. 5. Evidence of ascites, cirrhosis, portal hypertension, main portal venous tumour involvement or thrombosis as determined by clinical or radiologic assessment. 6. Prior major liver resection: remnant liver < 50% of the initial liver volume. 7. Non-malignant disease that would render the patient unsuitable for treatment according to this protocol. 8. Concurrent central nervous systems metastases 9. Peripheric neuropathy = grade 2. 10. Interstitial lung disease 11. Pregnant or breast feeding. 12. The patient has previous or concomitant malignancies, except: Invasive malignancies in remission for more than 5 years and non melanoma skin cancer or carcinoma in situ of the cervix.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: To analyze the pathological tumor response on resected colorectal cancer metastases after preoperative treatment with cetuximab combined with FOLFOX or FOLFIRI regimen in a prospective cohort (RAS and B-RAF WT tumors) and to correlate this response with patient’s outcome.;Secondary Objective: •Major pathological response rate (MPRR), Progression Free Survival (PFS), Overall survival (OS), Clinical response rate at time of surgery, Metabolic response rate at time of sugery, pathological complete response (pCR), Curative response rate (R0 resection). •One month surgical complication rate, Clinical toxicity, Chemotherapy-associated hepatotoxicity.;Primary end point(s): Major pathological response rate (MPRR). MPRR is defined as the proportion of patients presenting a major pathological response. Pathologic response will be evaluated according the Rubbia-Brandt Tumor Regression Grade classification. For patients with multiple colorectal metastases the global pathological response will be categorized based on the mean TRG of all metastases: a major response is defined as a mean TRG <3, a partial response is defined by a mean TRG = 3 and < 4 and absence of response is characterized by a mean TRG = 4.;Timepoint(s) of evaluation of this end point: After 1,5 month of medical treatment (Chemotherapy), the surgery will be done to analyse the metastases. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): Progression Free Survival (PFS), Overall survival (OS), Pathological complete response (pCR), Clinical response rate at time of surgery, Metabolic response rate at time of surgery, Curative resection rate (R0 resection), Toxicity.;Timepoint(s) of evaluation of this end point: Depend of the patient survival. | — |
Countries
Belgium
Contacts
Cliniques universitaires Saint-Luc