Resection vs no Resection of the Primary in Colorectal Cancer With Unresectable Metastases

NCT ID: NCT02015923

Last Updated: 2021-03-16

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

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

107 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-12-31

Study Completion Date

2020-02-29

Brief Summary

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Main outcome: Assess the impact of cancer-related survival at 2 years in patients with unresectable metastatic colorectal cancer treated with chemotherapy alone versus surgery followed by chemotherapy. To assess overall survival. To evaluate postoperative morbidity and mortality in patients treated with resection of the primary tumor. Assess complications and meed for surgery in patients treated with systemic chemotherapy only during the course of the disease. Identify and describe the complications related to chemotherapy and toxicity in the short and medium term systemic treatment. Assessing the quality of life questionnaire QLQ-C30 and QLQ-CR29. To study prognostic survival factors.

Method: multicenter randomized clinical trail (22 hospitals). Two parallel group in which to evaluate two therapeutic strategies for colorectal cancer metastasis unresectable stage IV: chemotherapy alone versus primary tumor resection plus chemotherapy.

Subjects: patients with unresectable nonmetastatic colorectal cancer. Hypothesis:Surgical resection of the primary tumor in stage IV colorectal patients with unresectable synchronous metastases increases by 14% overall survival compared to patients receiving systemic treatment with chemotherapy without resection of the primary tumor (survival of 34% vs 20%).

Detailed Description

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Intervention: Arm B (control): chemotherapy alone, regimen according to each center. Arm A (experimental): surgery (complete tumoral resection; R0) followed by chemotherapy, regimen according to each center. Statistical Analysis: A power analysis showed that to assure a significance level of 0,05 and a beta error 0.20. 168 patients are necessary in each arm. It has been estimated a loss rate of up to 10%.

Differences between groups will be analyzed by t, U, X2, exact test and survival will be assessed according to Kaplan and Meier method. Evaluation of safety of the trial will be made in the middle of the study statistically

Conditions

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Colonic Cancer Unresectable Metastasis Originating in Colonic Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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colonic resection

Arm A (experimental): surgery (complete tumoral resection; R0) followed by chemotherapy, regimen according to each center.

Group Type EXPERIMENTAL

Colonic resection

Intervention Type PROCEDURE

Colonic cancer resection, R0 No surgical intervention on metastasis

Chemotherapy- scheme

Intervention Type DRUG

Chemotherapy, specified in each center with or without biological drugs

Chemotherapy

Arm B (control): chemotherapy alone, regimen according to each center

Group Type ACTIVE_COMPARATOR

Colonic resection

Intervention Type PROCEDURE

Colonic cancer resection, R0 No surgical intervention on metastasis

Chemotherapy- scheme

Intervention Type DRUG

Chemotherapy, specified in each center with or without biological drugs

Interventions

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Colonic resection

Colonic cancer resection, R0 No surgical intervention on metastasis

Intervention Type PROCEDURE

Chemotherapy- scheme

Chemotherapy, specified in each center with or without biological drugs

Intervention Type DRUG

Other Intervention Names

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FOLFOX-4 FOLFOX-6 FOLFIRI FOLFOXIRI CAPOX CETUXIMAX / BEVACIZUMAB/PANITUMUMAB

Eligibility Criteria

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Inclusion Criteria

* colorectal cancer above to 12 cm from the anal verge
* unresectable synchronous metastases
* no contraindications for chemotherapy
* absence of peritoneal carcinomatosis, central nervous system o bone metastasis.
* performance status ECOG ≤ 2 (Eastern Cooperative Oncology Group)
* uncontrolled concomitant medical conditions that may compromise to chemotherapy
* significant symptomatic cardiac disease
* not pregnancy or breastfeeding

Exclusion Criteria

* Cases of rectal tumours below 12cm from anal verge, or locally advanced tumours invading blood vessels, nerves or bone.
* Multiple bone metastasis or central nervous system metastasis
* Other neoplastic disease in the 5 previous years, except squamous or basal cell skin carcinoma or cervical "in situ" carcinoma
* Significant heart disease (chronic congestive heart failure, symptomatic coronary disease) or myocardial infarction in the previous 6 months
* Peripheral neuropathy
* Patients who do not give informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Hospital Universitari de Bellvitge

OTHER

Sponsor Role lead

Responsible Party

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Sebastiano Biondo

Phd, MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sebastiano Biondo, Sponsor

Role: STUDY_CHAIR

Hospital Universitari de Bellvitge

Javier Vaqué

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario La Fe

Juan García Armengol

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario de Valencia

Laura Mora

Role: PRINCIPAL_INVESTIGATOR

Corporacion Parc Tauli

Ignasi Camps Ausàs

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari Gemans Tiras i Pujol

Miguel Pera Román

Role: PRINCIPAL_INVESTIGATOR

Hospital Univesitari del Mar

Eduardo Targarona Soler

Role: PRINCIPAL_INVESTIGATOR

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

Lorenzo Viso Pons

Role: PRINCIPAL_INVESTIGATOR

Hospital de Sant Joan Despí Moisès Broggi

José Manuel Ramírez Rodríguez

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Univeristario "Lozano Blesa"

David Julià Bergkvist

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari de Girona DrJosep Trueta

Teresa García Martínez

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario Universitario de Vigo

Mario Álvarez Gallego

Role: PRINCIPAL_INVESTIGATOR

Hospital Univerisitario La Paz

José María Enríquez Navascués

Role: PRINCIPAL_INVESTIGATOR

Hospital Donostia

Fernando de la Portilla de Juan

Role: PRINCIPAL_INVESTIGATOR

Hospitales Universitarios Virgen del Rocío

Miguel Angel Ciga

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario de Navarra

Eloy Espín Basany

Role: PRINCIPAL_INVESTIGATOR

hospital Universitari de la Vall D'Hebron

Manuel Ferrer Márquez

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario Torrecárdenas

Jesús Abrisqueta Carrión

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Virgen de la Arrixaca

José Errasti Alustiza

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Araba

Alberto Parajó Calvo

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario Universitario de Orense

Carlos Moreno Sanz

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario La Mancha Centro

Alejando Espí Macías

Role: PRINCIPAL_INVESTIGATOR

Hospital Clínico Universitario de Valencia

Ricard Frago Montanuy

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari de Bellvitge

Locations

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Hospital Universitario Araba

Vitoria-Gasteiz, Araba, Spain

Site Status

Hospital Universitari Germans Trias i Pujol

Badalona, Barcelona, Spain

Site Status

Hospital Universitari de Bellvitge

L'Hospitalet de Llobregat, Barcelona, Spain

Site Status

Corporació Sanitària Parc Taulí

Sabadell, Barcelona, Spain

Site Status

Hospital Moisès Broggi

Sant Joan Despí, Barcelona, Spain

Site Status

Complejo Hospitalario La Mancha Centro

Alcázar de San Juan, Ciudad Real, Spain

Site Status

Complejo Hospitalario de Navarra

Pamplona, Navarre, Spain

Site Status

Complejo Hospitalario Universitario de Vigo

Vigo, Pontevedra, Spain

Site Status

Complejo Hospitalario Torrecárdenas

Almería, , Spain

Site Status

Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

Site Status

Hospital del Mar

Barcelona, , Spain

Site Status

Hospital Univesitari Vall d'Hebron

Barcelona, , Spain

Site Status

Hospital Universitario Donostia

Donostia / San Sebastian, , Spain

Site Status

Hospital Universitari de Girona DrJosep Trueta

Girona, , Spain

Site Status

Hospital Univerisitario La Paz

Madrid, , Spain

Site Status

Hospital Clínico Universitario Virgen de la Arrixaca

Murcia, , Spain

Site Status

Complejo Hospitalario Universitario de Orense

Ourense, , Spain

Site Status

Hospital Universitario Virgen del Rocío

Seville, , Spain

Site Status

Hospital Clínico Universitario de Valencia

Valencia, , Spain

Site Status

Hospital General de Valencia

Valencia, , Spain

Site Status

Hospital Universitari i Politècnic la Fe

Valencia, , Spain

Site Status

Hospital Clínico Univeristario "Lozano Blesa"

Zaragoza, , Spain

Site Status

Countries

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Spain

References

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Rahbari NN, Biondo S, Frago R, Feisst M, Kreisler E, Rossion I, Serrano M, Jager D, Lehmann M, Sommer F, Dignass A, Bolling C, Vogel I, Bork U, Buchler MW, Folprecht G, Kieser M, Lordick F, Weitz J; SYNCHRONOUS and CCRe-IV Trial Groups. Primary Tumor Resection Before Systemic Therapy in Patients With Colon Cancer and Unresectable Metastases: Combined Results of the SYNCHRONOUS and CCRe-IV Trials. J Clin Oncol. 2024 May 1;42(13):1531-1541. doi: 10.1200/JCO.23.01540. Epub 2024 Feb 27.

Reference Type DERIVED
PMID: 38412408 (View on PubMed)

Biondo S, Frago R, Kreisler E, Espin-Basany E; Spanish CR4 Group. Impact of resection versus no resection of the primary tumor on survival in patients with colorectal cancer and synchronous unresectable metastases: protocol for a randomized multicenter study (CR4). Int J Colorectal Dis. 2017 Jul;32(7):1085-1090. doi: 10.1007/s00384-017-2827-3. Epub 2017 May 11.

Reference Type DERIVED
PMID: 28497402 (View on PubMed)

Other Identifiers

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2013-001688-22

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

01CCRe-IV

Identifier Type: -

Identifier Source: org_study_id

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