Chemotherapy and Internal Radiation in Treating Patients With Colorectal Cancer That Has Spread to the Liver

NCT ID: NCT00408551

Last Updated: 2013-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-11-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Internal radiation uses radioactive material placed directly into or near a tumor to kill tumor cells. Giving chemotherapy together with internal radiation may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving chemotherapy together with internal radiation works in treating patients with colorectal cancer that has spread to the liver.

Detailed Description

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OBJECTIVES:

Primary

* Evaluate the tumor response, as measured by total tumor mass, carcinoembryonic antigen (CEA) level, measurable tumor volume by CT scan, and metabolic response by positron emission tomography (PET) scan, in patients with colorectal cancer metastatic to the liver undergoing chemotherapy and selective internal radiation therapy (SIRT) comprising yttrium Y 90 resin microspheres.
* Evaluate the hepatic toxicity of this regimen, as measured by ALT, alkaline phosphatase, and bilirubin levels, in these patients.

Secondary

* Evaluate the therapeutic efficacy of this regimen, using time to in-liver disease progression as an end point, in these patients.
* Evaluate the therapeutic efficacy of this regimen, using down-staging to resectability as an end point, in these patients.

OUTLINE: This is a multicenter study.

Patients receive 1 of the following chemotherapy regimens:

* FOLFOX6: Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1. Patients also receive fluorouracil IV continously over 46 hours beginning on day 1.
* FOLFIRI: Patients receive irinotecan hydrochloride IV over 1 hour and leucovorin calcium IV over 2 hours on day 1. Patients also receive fluorouracil IV continuously over 46 hours beginning on day 1.
* FUDR: Patients receive floxuridine IV continuously on days 1-14. In all chemotherapy regimens, treatment repeats every 2 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Patients also undergo selective internal radiation therapy (SIRT) comprising yttrium Y 90 resin microspheres on day 2 of chemotherapy course 1 (for patients receiving FOLFOX6 or FOLFIRI chemotherapy regimens) or on day 1, 2, 3, 4, or 5 of course 1 (for patients receiving FUDR chemotherapy regimen). SIRT may repeat in week 10 or 12.

In week 18, patients may undergo surgery if down-staging has occurred or they may receive more chemotherapy.

After completion of study therapy, patients are followed every 3 months for up to 2 years.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Conditions

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Colorectal Cancer Metastatic Cancer

Keywords

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stage IV colon cancer stage IV rectal cancer liver metastases recurrent colon cancer recurrent rectal cancer

Study Design

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Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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FOLFOX6

Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1. Patients also receive fluorouracil IV continously over 46 hours beginning on day 1.

Group Type EXPERIMENTAL

fluorouracil

Intervention Type DRUG

Given IV

leucovorin calcium

Intervention Type DRUG

Given IV

oxaliplatin

Intervention Type DRUG

Given IV

FOLFIRI

Patients receive irinotecan hydrochloride IV over 1 hour and leucovorin calcium IV over 2 hours on day 1. Patients also receive fluorouracil IV continuously over 46 hours beginning on day 1.

Group Type EXPERIMENTAL

fluorouracil

Intervention Type DRUG

Given IV

irinotecan hydrochloride

Intervention Type DRUG

Given IV

leucovorin calcium

Intervention Type DRUG

Given IV

FUDR

Patients receive floxuridine IV continuously on days 1-14.

Group Type EXPERIMENTAL

floxuridine

Intervention Type DRUG

Given IV

Interventions

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floxuridine

Given IV

Intervention Type DRUG

fluorouracil

Given IV

Intervention Type DRUG

irinotecan hydrochloride

Given IV

Intervention Type DRUG

leucovorin calcium

Given IV

Intervention Type DRUG

oxaliplatin

Given IV

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Histologically or cytologically confirmed colorectal cancer\* meeting 1 of the following criteria:

* Metachronous metastasis after resection of Dukes A-C (i.e., stage I-III) primary colon cancer with or without adjuvant chemotherapy
* Metachronous metastasis after resection of primary rectal cancer with neoadjuvant or adjuvant chemotherapy
* Synchronous metastatic liver disease with symptomatic or asymptomatic primary colorectal cancer NOTE: \*If the patient has a second malignancy with liver metastasis potential, histologic or cytologic confirmation of the liver lesions may be performed as clinically indicated
* Liver-only or liver-predominant disease with any of the following:

* Unresected primary disease
* Limited bone or lung disease
* Potentially resectable nodal disease
* Anastomotic disease
* No active CNS metastasis or diffuse peritoneal metastasis
* No hepatic metastases from a second malignancy
* No predominant extrahepatic disease

PATIENT CHARACTERISTICS:

* ECOG performance status 0-2
* Life expectancy \> 3 months
* Platelet count ≥ 100,000/mm\^3
* Hemoglobin ≥ 9 g/dL
* WBC ≥ 1,500/mm\^3
* Creatinine ≤ 2 mg/dL
* Bilirubin ≤ 2 mg/dL (without extrahepatic biliary obstruction)
* Albumin \> 2 g/dL
* INR \< 1.5 (without anticoagulation)
* Not pregnant or nursing
* Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
* No prior external-beam radiotherapy to the liver
* Concurrent targeted therapy agents (e.g., bevacizumab or cetuximab) allowed
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Goshen Health System

OTHER

Sponsor Role lead

Responsible Party

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Center for Cancer Care at Goshen General Hospital

Principal Investigators

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Kenneth L. Pennington, MD

Role: STUDY_CHAIR

Goshen Health System

Locations

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Center for Cancer Care at Goshen General Hospital

Goshen, Indiana, United States

Site Status RECRUITING

Countries

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United States

Facility Contacts

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Clinical Trials Office - Center for Cancer Care at Goshen Gene

Role: primary

Other Identifiers

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CCCGHS-CHEMO-SIRT

Identifier Type: -

Identifier Source: secondary_id

CDR0000515900

Identifier Type: -

Identifier Source: org_study_id