Colorectal Cancer
Conditions
Keywords
adenocarcinoma of the rectum, stage II rectal cancer, stage III rectal cancer
Brief summary
RATIONALE: Studying samples of tumor tissue and blood from patients with cancer in the laboratory may help doctors learn more about changes that occur in DNA and identify biomarkers related to cancer. It may also help doctors predict how patients respond to treatment. PURPOSE: This phase I trial is studying biomarkers in tumor tissue and blood samples from patients undergoing chemotherapy and radiation therapy for stage II or stage III rectal cancer that can be removed by surgery.
Detailed description
OBJECTIVES: Primary * To obtain the distribution of stem cell markers (CD166, CD44, and ESA) in tumor tissue samples before and after neoadjuvant chemoradiotherapy (NCRT) in patients with stage II or III rectal cancer. Secondary * To correlate disease-free survival after NCRT with baseline expression and change in expression of stem cell markers (CD166, CD44, and ESA) after NCRT. * To correlate baseline and post-NCRT expression of all three stem cell markers (CD166, CD44, and ESA) with circulating tumor cell (CTC) count and stem cell marker expression on CTC at baseline and after NCRT. OUTLINE: Patients receive chemotherapy according to the treating physician's choice and undergo concurrent radiotherapy over approximately 6 weeks. Between 6-8 weeks after completion of neoadjuvant chemoradiotherapy (NCRT), patients undergo low anterior or abdominoperineal surgical resection. Some patients may then receive additional chemotherapy. Tumor tissue samples are obtained via sigmoidoscopy-guided biopsies at baseline and at the time of surgery. Blood samples are also collected at baseline and after completion of NCRT. Samples are isolated for RNA analysis of CD44, CD166, and ESA expression by quantitative reverse transcriptase-PCR and IHC. After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Interventions
GENETICreverse transcriptase-polymerase chain reaction
OTHERimmunohistochemistry staining method
OTHERlaboratory biomarker analysis
PROCEDUREendoscopic biopsy
PROCEDUREneoadjuvant therapy
PROCEDUREsigmoidoscopy
RADIATIONradiation therapy
DRUGsystemic chemotherapy
GENETICRNA analysis
GENETICgene expression analysis
Sponsors
National Cancer Institute (NCI)
Barbara Ann Karmanos Cancer Institute
Study design
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed adenocarcinoma of the rectum * Inferior margin within 16 cm of the anal verge on endoscopic exams * Locally advanced or low lying disease meeting 1 of the following stage criteria: * Stage II (T2, N0, M0) disease * Distal tumor (\< 5 cm from anal verge) invades into muscularis propria but not beyond (T2) * Stage II (T3-4, N0, M0) disease * Tumor invades through muscularis propria into subserosa or into non-peritonealized pericolic or perirectal tissues (T3) OR tumor directly invades other organs or structures and/or perforates visceral peritoneum (T4) * Stage III (any T, N1-2, M0) disease * Tumor has invaded to any depth with involvement of regional lymph nodes (N1-2) * Resectable disease * No suspicious metastatic disease (M1) PATIENT CHARACTERISTICS: * ECOG performance status 0-1 * Adequate organ function * No significant co-morbidities that would preclude the use of neoadjuvant chemoradiotherapy, including any of the following: * Severe heart failure * Arrhythmia * Significant liver or kidney dysfunction * No psychiatric or addictive disorder that would preclude study compliance * No bleeding diathesis * No contraindication for sigmoidoscopy PRIOR CONCURRENT THERAPY: * No prior radiotherapy or chemotherapy for rectal cancer * No concurrent warfarin unless appropriate bridging therapy is arranged during biopsy procedures
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Estimation of stem cell markers with stated precision | — |
| Correlation of disease-free survival with post-treatment value and change in expression of colorectal cancer stem cell markers after neoadjuvant chemoradiotherapy | — |
Outcome results
None listed