Study of Neoadjuvant CT With Selective Radiotherapy in Patients With Intermediate-Risk Cancer Rectum

NCT ID: NCT00909987

Last Updated: 2013-10-11

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

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

46 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-03-31

Study Completion Date

2013-06-30

Brief Summary

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Phase II, Multicenter, Open-label, Non-randomized Study of Neoadjuvant Chemotherapy (CAPECITABINE-OXALIPLATIN + BEVACIZUMAB) with Selective Radiotherapy and Chemotherapy with CAPECITABINE Use in Patients with Intermediate-Risk Cancer of the Rectum Defined by Magnetic Resonance Imaging.

Detailed Description

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XELOX / Bevacizumab will be administrated for 3 cycles over a 9 week period. XELOX without Bevacizumab will be administrated for an additional cycle over a 4 week period. Patients will undergo re-staging within 3 weeks of their 4th cycle of XELOX. This will include MRI of the pelvis. If the reassessment reveals that there has been no disease progression compared to the pre-treatment evaluation and the patient remains a candidate for an R0 resection, the patient will proceed to definitive rectal cancer surgery within 4 weeks from the last chemotherapy dose. If the surgical oncologist's reassessment reveals that the patient is not a candidate for an R0 resection, the patient will proceed to standard pre-operative radiation with synchronous Capecitabine.

Conditions

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Rectum Cancer

Keywords

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rectum intermediate risk cancer rectum neoadjuvant

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Single arm

Neoadyuvant chemotherapy with XELOX: Xeloda 1000mg/m2/12h dayly, day one in the afternoon until day 15 in the morning; plus oxaliplatin 130mg/m2 (day 1); and Bevacizumab 7.5 mg/kg (day 1)during 3 cycles (each cycle of 3 weeks).

Followed by a selective use of chemoradiotherapy with radiotherapy (50.4Gy, 28 sesions of 1.8Gy during 5 weeks) plus Xeloda 825mg/m2/12h dayly.

Group Type EXPERIMENTAL

Capecitabine

Intervention Type DRUG

PO 1000 mg/m2 bid during day 1 to 15 for 3 cycles (every cycle has 3 weeks)

Oxaliplatin

Intervention Type DRUG

IV 130 mg/m2 during day 1 for 3 cycles (every cycle has 3 weeks)

Bevacizumab

Intervention Type DRUG

IV 7.5 mg/Kg during 30 minutes day 1 during 4 cycles (every cycle has 3 weeks)

Radiotherapy

Intervention Type RADIATION

Total dose 50.4 Gy administered during 28 days (1.8 Gy/day in 5 weeks).

Capecitabine during all Radiotherapy period

Intervention Type DRUG

825 mg/m2 bid

Total Mesorectal Excision (TME)

Intervention Type PROCEDURE

4 weeks from the last chemotherapy dose. In those patients who receive radiation TME wil be performed six weeks after

Interventions

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Capecitabine

PO 1000 mg/m2 bid during day 1 to 15 for 3 cycles (every cycle has 3 weeks)

Intervention Type DRUG

Oxaliplatin

IV 130 mg/m2 during day 1 for 3 cycles (every cycle has 3 weeks)

Intervention Type DRUG

Bevacizumab

IV 7.5 mg/Kg during 30 minutes day 1 during 4 cycles (every cycle has 3 weeks)

Intervention Type DRUG

Radiotherapy

Total dose 50.4 Gy administered during 28 days (1.8 Gy/day in 5 weeks).

Intervention Type RADIATION

Capecitabine during all Radiotherapy period

825 mg/m2 bid

Intervention Type DRUG

Total Mesorectal Excision (TME)

4 weeks from the last chemotherapy dose. In those patients who receive radiation TME wil be performed six weeks after

Intervention Type PROCEDURE

Other Intervention Names

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Xeloda Avastin Neoadjuvant Radiotherapy Xeloda

Eligibility Criteria

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Inclusion Criteria

* Patient ≥18 years
* Tumor biopsy with histopathologic confirmation of rectal adenocarcinoma as primary histology
* Patient with measurable disease at the baseline visit
* T3 tumor that meets all the following criteria in high-resolution magnetic resonance imaging (MRI) (3-mm slices) of the pelvis: distal border of tumor more than 5cm form the external edge of the anus and below the sacral promontory (located in the anatomy rectum).
* Candidate for complete surgical resection (R0) with sphincter preservation surgery, prior to the administration of any therapy
* Candidate for systemic therapy with XELOX/BVZ
* ECOG: 0-2
* ANC≥1.5 cells/mm3, Hb\>8.0 g/dL, platelets\>150,000/mm3 in 2 previous weeks
* Patient who signed the informed consent

Exclusion Criteria

* Stage T4.
* Distant metastases
* Tumor with an intraperitoneal distal border
* Tumor presenting initially in a low location and judged, prior to any treatment, to require abdominoperineal resection
* Previous chemotherapy for colorectal cancer or incomplete recovery from oncologic surgery or other previous major surgery that, in the opinion of the investigator, precludes the use of a combined modality therapy
* Serum creatinine \<1.5 ULN
* Patient who has received previous pelvic radiotherapy
* Patient with an uncontrolled infection
* Presence of a high degree of obstruction (intestinal lumen ≤ 1 cm), unless the patient has undergone protective surgical bypass or an endoscopic stent procedure
* Pt with a history of an arterial thromboembolic event during the previous year.This includes angina (stable or unstable),myocardial infarction (MI),cerebrovascular accident (CVA),or other relevant history in the opinion of the investigator.Note: A patient with a history of thrombotic events, such as deep venous thrombosis, pulmonary embolism, MI or ACV, within the 6 months preceding recruitment may be considered for participation in the clinical trial if they are receiving stable doses of anticoagulant therapy. Similarly, patients being anticoagulated for atrial fibrillation or other conditions can participate if they are receiving a stable dosage of anticoagulant therapy. Clinicians must consider the higher risk of therapy with BVZ among patients with a history of thromboembolic disorders so the decision to allow the patients to participate remains at the discretion of the physician
* Previous treatment with another investigational antitumoral therapy in the 30 days prior to beginning treatment
* History of previous malignancy in the past 5 years, excepting basocellular or squamous cell skin cancer, or properly treated cervix cancer in situ
* Woman with a positive pregnancy test in urine or serum during recruitment, prior to the administration of the study medication, or within 72 hours of beginning to take the study medication, or a woman who is nursing
* WOCBP who does not wish to use or cannot use an effective contraceptive method to avoid pregnancy during the complete study period up to 4 weeks after ending the study.Male subjects also must agree to use an effective method of contraception.Note: WOCBP refers to any woman who has experienced menarche and has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea≥12 consecutive months,or women with hormonal replacement therapy and documented serum levels of follicle stimulating hormone).Even women who are using oral, implanted or injectable contraceptive hormones, mechanical products such as an intrauterine device or barrier methods to prevent pregnancy,or who practice abstinence or have a sterile partner, must be assumed to be WOCBP
* Patient with any other condition or concurrent medical or psychiatric disease who,in opinion of the investigator, is not eligible to enter the study
* Known hypersensitivity to any component of the study drug (XELOX/bevacizumab) or radiotherapy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Royal Marsden NHS Foundation Trust

OTHER

Sponsor Role collaborator

Grupo Espanol Multidisciplinario del Cancer Digestivo

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Carlos Fernández Martos, Oncologist

Role: STUDY_CHAIR

Instituto Valenciano de Oncología (IVO)

Carles Pericay, Oncologist

Role: STUDY_DIRECTOR

Complejo Sanitario Parc Taulí

Antonieta Salud, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Arnau de Villanova (Lérida)

Vicente Alonso, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Miguel Servet

María José Safont, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

Ruth Vera, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital de Navarra

Pilar Escudero, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Universitario Lozano Blesa

Joan Maurel, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic i provincial de Barcelona

Jorge Aparicio, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital La Fe

Jaime Feliú, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital La Paz

Mengual, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Instituto Valenciano de Oncología (IVO)

Moisés Miraflores, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital Arnau de Vilanova (Lérida)

Martín Tejedor Gutierrez, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital Miguel Servet

Ana Hernández Machancoses, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

Fernando Arias de la Vega, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital de Navarra

Javier Valencia, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Universitario Lozano Blesa

Carles Conill, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic i provincial de Barcelona

Alejandro Tormo Micó, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital La Fe

María Elena Sánchez Santos, Radiotherapy

Role: PRINCIPAL_INVESTIGATOR

Hospital La Paz

Jorge Campos, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Instituto Valenciano de Oncología (IVO)

Enrique Sierra Grañón, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital Arnau de Vilanova (Lérida)

Andrés Monzón, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital Miguel Servet

José Vicente Roig, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

Javier Suárez Alecha, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital de Navarra

Eloy Tejero, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Universitario Lozano Blesa

Antonio Lazy, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic i provincial de Barcelona

Rafael Estevan, Surgeon

Role: STUDY_DIRECTOR

Hospital La Fe

Damián García Olmo, Surgeon

Role: PRINCIPAL_INVESTIGATOR

Hospital La Paz

Jesús Santos, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Instituto valenciano de Oncología (IVO)

Ana Darnell, Radiologist

Role: STUDY_DIRECTOR

Complejo Sanitario Parc Taulí

Luís Sarriá, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Miguel Servet

Vicente Martínez Sanjuán, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

Javier Jiménez, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital de Navarra

José Antonio Fernández Gómez, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Universitario Lozano Blesa

Juan Ramón Ayuso, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic i provincial de Barcelona

Fernando Mas Estellés, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital La Fe

Paula Alegría Hidalgo, Radiologist

Role: PRINCIPAL_INVESTIGATOR

Hospital La Paz

Anna Caltrava, Pathologist

Role: STUDY_DIRECTOR

Instituto Valenciano de Oncología (IVO)

Alex Casalots, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Complejo Sanitario de Parc Taulí

Xavier Matias-Guiu Guia, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Arnau de Vilanova (Lérida)

Carlos Hörndler, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Miguel Servet

Encarna Martínez, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

María Luisa Gómez Dorronsoro, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital de Navarra

Javier Ortego, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinico Universitario Lozano Blesa

María José Artes, Pathologist

Role: PRINCIPAL_INVESTIGATOR

Hospital La Fe

Marta Martín Richard, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Manuel Gallén, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital del Mar

Javier Gallego, Oncologist

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Elche

Locations

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Hospital General Universitario de Elche

Elche, Alicante, Spain

Site Status

Hospital del Mar

Barcelona, Barcelona, Spain

Site Status

Hospital de La Santa Creu I Sant Pau

Barcelona, Barcelona, Spain

Site Status

Hospital Clinic i Provincial de Barcelona

Barcelona, Barcelona, Spain

Site Status

Complejo Sanitario Parc Taulí

Sabadell, Barcelona, Spain

Site Status

Hospital Arnau de Vilanova

Lleida, Lérida, Spain

Site Status

Hospital La Paz

Madrid, Madrid, Spain

Site Status

Hospital de Navarra

Pamplona, Pamplona, Spain

Site Status

Hospital La Fe

Valencia, Valencia, Spain

Site Status

Instituto Valenciano de Oncología (IVO)

Valencia, Valencia, Spain

Site Status

Hospital General de Valencia

Valencia, Valencia, Spain

Site Status

Hospital Miguel Servet

Zaragoza, Zaragoza, Spain

Site Status

Countries

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Spain

References

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Fernandez-Martos C, Brown G, Estevan R, Salud A, Montagut C, Maurel J, Safont MJ, Aparicio J, Feliu J, Vera R, Alonso V, Gallego J, Martin M, Pera M, Sierra E, Serra J, Delgado S, Roig JV, Santos J, Pericay C. Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial. Oncologist. 2014 Oct;19(10):1042-3. doi: 10.1634/theoncologist.2014-0233. Epub 2014 Sep 10.

Reference Type DERIVED
PMID: 25209376 (View on PubMed)

Other Identifiers

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GEMCAD-0801

Identifier Type: -

Identifier Source: org_study_id