Rectal Cancer
Conditions
Brief summary
In this phase 2 study, the efficacy of total neoadjuvant therapy in Taiwanese patients with rectal cancer will be investigated. Patients with stage II or III middle/low rectal cancer will be prospective enrolled. The total neoadjuvant therapy with the short-course radiotherapy (5×5 Gy over a maximum of 8 days) followed by chemotherapy with mFOLFOX6 for 9 cycles will be administered. The primary endpoint is the complete response (CR) rate which will take into account the patients with clinical and pathological complete response.
Detailed description
This is a single center, single-arm, open-label, phase II study to investigate the efficacy and toxicities of total neoadjuvant therapy in patients with middle or lower rectal cancer. This study is planned to start after the approval by IRB, enroll patients for 2 years, and follow the clinical outcome for another 5 years. It will be conducted at National Cheng Kung University Hospital. Forty-two subjects will be enrolled. Patients who have newly diagnosed stage II or III, middle or low rectal adenocarcinoma will be recruited to receive the TNT treatment. The TNT includes the short-course radiotherapy (5×5 Gy over a maximum of 8 days)) followed by chemotherapy with the regimen of mFOLFOX6 for total 9 cycles
Interventions
RADIATIONShort-course radiotherapy
Short-course radiotherapy, 5×5 Gy.
DRUGmFOLFOX6
Oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, infusinal 5-fluorouracil 2400 mg/m2 every 2 weeks, for 9 cycles
Sponsors
National Cheng-Kung University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed diagnosis of adenocarcinoma of the rectum; * Tumors located at mid or low rectum (distal extension less than 10 cm from the anal verge); * Clinical stage II or III (T3/4 and/or N+; no distant metastasis); * No prior chemotherapy, radiotherapy or surgery for rectal cancer; * Age ≥20; * ECOG 0-1; * Adequate organ function, including followings: ANC ≥1,500/μL; Hb ≥8.0 gm/dL; Platelet 100,000/mm3; Total bilirubin ≤1.5x upper normal limit; AST ≤3x upper normal limit; ALT ≤3x upper normal limit; Creatinine ≤1.5x upper normal limit; * Ability to understand and the willingness to sing a written informed consent.
Exclusion criteria
* Recurrent rectal cancer; * Patients who have concomitant malignancies, except for adequately treated basal cell carcinoma of the skin or in situ carcinoma of the cervix. Subjects who have prior malignancies and have been disease-free for more than 5 years can be enrolled; * Patients who have received prior pelvic radiotherapy; * Patients with active infection requiring intravenous antibiotic treatment; * Patients with a history of any arterial thrombotic event within the past 6 months, including unstable angina, myocardial infarction (MI) or cerebrovascular accident (CVA), New York Hear Association (NYHA) grade II or greater congestive heart failure, or uncontrolled cardiac arrhythmia; * Patients with any other concurrent medical or psychiatric condition or disease which, in the investigator's judgement, would make them inappropriate candidates for entry into this study; * Women who are pregnant or breastfeeding. Women of childbearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period; * Patients receiving other anticancer or experimental therapy; * Known DPD deficiency or hypersensitivity to oxaliplatin; * Any contraindications to MRI.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Complete response (CR) rate | The response will be assessed at the period of 2 to 4 weeks after the completion of total neoadjuvant chemotherapy | The percentage of patients who achieve a complete response |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| R0 resection rate | The R0 resection rate will be assessed at the period of 2 to 4 weeks after completion of the total neoadjuvant chemotherapy | The percentage of patients who receive the surgery of total neoadjuvant therapy and achieve R0 resection |
| Response rate | The response will be assessed at the period of 2 to 4 weeks after the completion of total neoadjuvant chemotherapy | The percentage of patients who achieve a complete response or partial response |
| Loco-regional failure rate | The loco-regional failure will be assessed from the date of surgical resection until the first documented local recurrence, up to 84 months | The percentage of patients who develop local recurrence after surgery |
| Rate of distant metastasis | The distant metastasis will be assessed from the date of beginning short-course RT until the first documented distant metastasis, up to 84 months | The percentage of patients who develop distant metastasis |
| Safety profiles | The safety profile will be assessed from the beginning of the short-course RT to the end of last cycle of FOLFOX chemotherapy, up to 24 weeks | The occurrence and severity of adverse events which develop during the treatment of total neoadjuvant therapy |
Countries
Taiwan
Contacts
CONTACTYu-Min Yeh, MD
PRINCIPAL_INVESTIGATORYu-Min Yeh, MD
National Cheng-Kung University Hospital
Outcome results
None listed