Colorectal Cancer, Peritoneal Metastases
Conditions
Keywords
ctDNA
Brief summary
This is a prospective, open-label, randomized controlled clinical trial, by monitoring the serum ctDNA mutational profile using NGS, aiming to elucidate the correlation between the postoperative ctDNA status and the assisted diagnosis, early intervention and prognosis for colorectal cancer peritoneal metastases.
Interventions
DIAGNOSTIC_TESTctDNA monitoring
Patients who undergoing radical surgery for colorectal cancer for 6\ 12 months and with 2 consecutive positive ctDNA testing results within 1 month will be enrolled, and diagnostic laparoscopy will be performed immediately after enrollment. Patients with positive peritoneal metastasis (PCI score \<20) will be treated with CRS+HIPEC. Tumor markers, endoscopic and imaging examinations, and ctDNA monitoring will be performed every 3 months in patients with negative peritoneal metastasis. Laparoscopy will be performed when imaging suggested peritoneal metastasis (oligometastases). Re-diagnostic laparoscopy will be performed 24 months after radical surgery when there is no radiographic evidence of recurrence or metastasis. Follow-up time will up to 36 months after colorectal cancer surgery.
DIAGNOSTIC_TESTImageology
Patients who undergoing radical surgery for colorectal cancer for 6\ 12 months and with 2 consecutive positive ctDNA testing results within 1 month will be enrolled. and there will be no need to conduct endoscopic exploration immediately after enrollment. Tumor markers, endoscopic and imaging examinations, and ctDNA monitoring will be performed every 3 months until imaging suggested peritoneal metastasis (oligometastases). Patients with positive peritoneal metastasis (PCI score \<20) will be treated with CRS+HIPEC. Re-diagnostic laparoscopy will be performed 24 months after radical surgery when there is no radiographic evidence of recurrence or metastasis. Follow-up time will up to 36 months after colorectal cancer surgery.
Sponsors
Sixth Affiliated Hospital, Sun Yat-sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients must be a man or woman of at 18-75; * Patients must have an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-21； * Patients with primary colorectal cancer proven by pathology； * Patients with high risk factors for peritoneal metastasis (simultaneous peritoneal metastasis, ovarian metastasis, PT4, CT4, tumor perforation, tumor-complete intestinal obstruction, mucinous adenocarcinoma/signet ring cell carcinoma of PT3, positive surgical margin, and tumor rupture and hemorrhage); * 6-12 months after colorectal cancer radical surgery, patients who have two consecutive positive ctDNA tests within one month; * Patients who have finished standard adjuvant therapy after surgery; (Choose 5-FU or 5-FU analog-based chemotherapy regimen, and the perioperative chemotherapy should not exceed 6 months)； * Patients who are negative of recurrence or metastasis in conventional oncology examination (serology, endoscopy, imaging) ; * Written informed consent must be obtained from patients and ability for patients to comply with the requirements of the study.
Exclusion criteria
* Patients who were diagnosed with other malignant tumors within 2 years before diagnosis of colorectal cancer; * ASA class Ⅳ to Ⅴ; * Patients who have other existence of distant metastasis outside the abdomen; * Patients with serious mental illness; * Patients with severe cardiovascular disease, uncontrollable infections, or other uncontrollable co-diseases; * Patients who cannot be followed up as scheduled; * Patients who participated in other clinical studies within 3 months prior to the trial; * Pregnant or nursing women, men or women of childbearing potential who are unwilling to employ adequate contraception.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Peritoneal Metastasis Free Survival (PMFS) | Through study completion, up to 3 years | The survival rate without peritoneal metastasis (oligometastatic) at 24 months after radical resection of colorectal cancer. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Positive Percent Agreement (PPA) | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | PPA of ctDNA monitoring for predicting peritoneal metastasis with abdominal exploration as the reference. PPA of imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. PPA of combination of ctDNA monitoring and imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. Will be compared in both arms. |
| Negative Percent Agreement (NPA) | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | NPA of ctDNA monitoring for predicting peritoneal metastasis with abdominal exploration as the reference. NPA of imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. NPA of combination of ctDNA monitoring and imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. Will be compared in both arms. |
| The time of peritoneal metastasis diagnosed after radical surgery | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | Will be compared in both arms. |
| Peritoneal Cancer Index (PCI) Score | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | This scale measures the extent of peritoneal cancer throughout the peritoneal cavity. The range of this scale is from 0 to 39. 0 = no disease within the peritoneal cavity 0-9 = minimal disease 10-29 = moderate disease 30-39 = extensive disease Lower values are considered a better outcome for the patient. Will be compared in both arms. |
| Detection Rate (DR) | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | DR of ctDNA monitoring for predicting peritoneal metastasis with abdominal exploration as the reference. DR of imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. DR of combination of ctDNA monitoring and imageological examination for predicting peritoneal metastasis with abdominal exploration as the reference. Will be compared in both arms. |
| The ctDNA clearance rate before and after CRS+HIPEC treatment | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | Will be compared in both arms. |
| The rate of Disease Free Survival (DFS) at 3 years after radical resection of colorectal cancer | Through study completion, up to 3 years | Whether the patient is still alive and free of disease or not. Will be compared in both arms. |
| The Overall Survival (OS) at 3 years after radical resection of colorectal cancer | Through study completion, up to 3 years | Whether the patient is still alive or not. Will be compared in both arms. |
| Completeness of Cytoreduction (CC) Score | Interim analyses: After 69 patients have been enrolled, up to 1.5 years | The degree to which the disease was able to be excised during the procedure. This scale ranges from CC0-CC3. CC0 = all disease has been cleared, with no visible peritoneal carcinomatosis after CRS CC1 = microscopic disease remains (Nodules persisting \< 2.5 mm after CRS) CC2 = macroscopic disease remains (Nodules persisting between 2.5 mm and 2.5 cm) CC3 = Substantial Macroscopic disease remains (Nodules persisting \> 2.5 cm) Lower values are considered a better outcome, with CC0/1 classed as favourable and CC2/3 indicating an incomplete clearance of disease. Will be compared in both arms. |
Countries
China
Contacts
Primary ContactHui Wang, MD, PhD
Backup ContactTenghui Ma, MD, PhD
Outcome results
None listed