Optimisation of Response for Organ Preservation in Rectal Cancer : Neoadjuvant Chemotherapy and Radiochemotherapy vs. Radiochemotherapy

NCT ID: NCT02514278

Last Updated: 2024-08-14

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

218 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-28

Study Completion Date

2024-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Standard treatment of rectal cancer is rectal excision with neoadjuvant radiochemotherapy. A new concept suggests organ preservation as an alternative to rectal excision in good responders after neoadjuvant radiochemotherapy to decrease surgical morbidity and increase quality of life. The rational is the fact that 15% of patients have sterilized tumours after radiochemotherapy for T3T4 rectal cancer. The French GRECCAR 2 trial is the first phase III trial investigating this strategy: patients with T2T3 low rectal carcinomas (size ≤4 cm) received 50 Gy with capecitabine and good clinical responders (≤2 cm) were randomized between local and rectal excision. The main findings were: the rate of complete pathologic response was higher after radiochemotherapy for small T2T3 than for T3T4 tumours (40% vs 15% ypT0) and good pathologic responders (ypT0-1) were associated with zero positive mesorectal nodes.

The objective of the new trial is to increase the proportion of patients treated with organ preservation by optimizing tumour response. As compared to Folfiri, tritherapy Folfirinox has been shown to enhance the response rate. In patients with colorectal metastases, response rate and R0 resection were twice higher, resulting in improved survival. Folfirinox also increases response and chance of R0 resection rates in initially unresectable colorectal metastases, compared to standard or intensified bi-chemotherapy regimens. Adding two months of neoadjuvant chemotherapy (Folfirinox) before radiochemotherapy, the investigators expect to increase chance of organ preservation rate, as compared to radiochemotherapy alone.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Rectal Cancer

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Chemotherapy and Radiochemotherapy

Neoadjuvant chemotherapy Folfirinox, 4 cycles:

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2 (DL form) or 200 mg/m2 (L form)
* 5FU: 2400 mg/m2

Radiochemotherapy : 2 to 4 weeks after chemotherapy, 5 weeks (50 Gy, 2 Gy/session; 25 fractions) + capecitabine (1600 mg/m2 daily 5 days/7)

Group Type EXPERIMENTAL

Neoadjuvant chemotherapy Folfirinox, 4 cycles

Intervention Type DRUG

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2 (DL form) or 200 mg/m2 (L form)
* 5FU: 2400 mg/m2

50 Gy, 2 Gy/session; 25 fractions

Intervention Type RADIATION

Radiochemotherapy 5 weeks

Local excision in good responders

Intervention Type PROCEDURE

If local excision:

* Surveillance if ypT0-1 or ypT2Nx/cN0 (no lymph node at baseline imaging)
* Complementary rectal excision if ypT2Nx/cN1, ypT3 or R1.

Rectal excision in bad responders

Intervention Type PROCEDURE

Capecitabine

Intervention Type DRUG

1600 mg/m2 daily 5 days/7

Radiochemotherapy

Radiochemotherapy: 5 weeks (50 Gy, 2 Gy/session ; 25 fractions) + capecitabine (1600 mg/m2 daily 5 days/7, excluding weekends)

Group Type ACTIVE_COMPARATOR

50 Gy, 2 Gy/session; 25 fractions

Intervention Type RADIATION

Radiochemotherapy 5 weeks

Local excision in good responders

Intervention Type PROCEDURE

If local excision:

* Surveillance if ypT0-1 or ypT2Nx/cN0 (no lymph node at baseline imaging)
* Complementary rectal excision if ypT2Nx/cN1, ypT3 or R1.

Rectal excision in bad responders

Intervention Type PROCEDURE

Capecitabine

Intervention Type DRUG

1600 mg/m2 daily 5 days/7

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Neoadjuvant chemotherapy Folfirinox, 4 cycles

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2 (DL form) or 200 mg/m2 (L form)
* 5FU: 2400 mg/m2

Intervention Type DRUG

50 Gy, 2 Gy/session; 25 fractions

Radiochemotherapy 5 weeks

Intervention Type RADIATION

Local excision in good responders

If local excision:

* Surveillance if ypT0-1 or ypT2Nx/cN0 (no lymph node at baseline imaging)
* Complementary rectal excision if ypT2Nx/cN1, ypT3 or R1.

Intervention Type PROCEDURE

Rectal excision in bad responders

Intervention Type PROCEDURE

Capecitabine

1600 mg/m2 daily 5 days/7

Intervention Type DRUG

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Rectal adenocarcinoma
* cT2T3
* cN0-1 (≤ 3 positive lymph nodes or size ≤8mm)
* Tumour size ≤4 cm
* Location ≤10 cm from the anal verge
* No distant metastasis
* Patient ≥18 years
* ECOG ≤2
* Effective contraception during the study
* Patient and doctor have signed informed consent

Exclusion Criteria

* T1 or T4
* Tumour size \>4cm
* N2 (\>3 positive lymph nodes or size \>8mm)
* Tumour \> 10 cm from the anal verge
* Distant metastasis
* Chronic intestinal inflammation and/or bowel obstruction
* Contra indication for chemotherapy and/or radiotherapy
* Previous pelvic radiotherapy or chemotherapy
* Severe renal, hepatic insufficiency (serum creatinine\<30ml/min)
* Peripheral neuropathy \> grade 1
* Complete or partial Dihydropyrimidine deshydrogenase (DPD) deficiency (uracilemia ≥ 16 ng/mL)
* Concomitant treatment with millepertuis, yellow fever vaccine, phenytoin or sorivudine (or chemically equivalent)
* Pregnant or breast-feeding woman.
* Persons deprived of liberty or under guardianship
* Impossibility for compliance to follow-up
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University Hospital, Bordeaux

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Christophe LAURENT, Prof.

Role: PRINCIPAL_INVESTIGATOR

University Hospital Bordeaux, France

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Service de Chirurgie Digestive, CHU Amiens Picardie

Amiens, , France

Site Status

Service de Chirurgie Digestive, CHU de Besançon

Besançon, , France

Site Status

Service de Chirurgie Digestive, Hôpital Haut-Lévêque - CHU de Bordeaux

Bordeaux, , France

Site Status

Service de Chirurgie Digestive, Institut Bergonié

Bordeaux, , France

Site Status

Service de Chirurgie Digestive, CHU Estaing - CHRU Clermont Ferrand

Clermont-Ferrand, , France

Site Status

Service de Chirurgie Digestive, Hôpital Beaujon - APHP

Clichy, , France

Site Status

Service de Chirurgie Digestive, Centre Georges François Leclerc - Dijon

Dijon, , France

Site Status

Service de Chirurgie Digestive, Hôpital Albert Michallon - CHU de Grenoble

La Tronche, , France

Site Status

Service de Chirurgie Digestive, Centre Oscar Lambret - Lille

Lille, , France

Site Status

Service de Chirurgie Digestive, Centre Léon Bérard - Lyon

Lyon, , France

Site Status

Service de Chirurgie Digestive, Hôpital Lyon Sud - CHU Lyon

Lyon, , France

Site Status

Service de Chirurgie Digestive, CHU de la Timone - Marseille

Marseille, , France

Site Status

Service de Chirurgie Digestive, Institut Paoli Calmette - Marseille

Marseille, , France

Site Status

Service de Chirurgie Digestives, Hôpital Européen de Marseille

Marseille, , France

Site Status

Service de Chirurgie Digestive, Institut du Cancer de Montpellier

Montpellier, , France

Site Status

Service d'Oncologie et Radiothérapie, Centre Azuréen de Cancérologie

Mougins, , France

Site Status

Service de Chirurgie Digestive,Institut de Cancérologie de Lorraine

Nancy, , France

Site Status

Service de Chirurgie Digestive, Hôtel Dieu - CHU de Nantes

Nantes, , France

Site Status

Service de Chirurgie Digestive, CHU Carémeau - Nîmes

Nîmes, , France

Site Status

GH Paris Saint Joseph

Paris, , France

Site Status

Service de Chirurgie Digestive et Oncologique, Hôpital Bicêtre - APHP

Paris, , France

Site Status

Service de Chirurgie Digestive, Hôpital les Diaconnesses

Paris, , France

Site Status

Service de Chirurgie Digestive, Hôpital Saint-Antoine - APHP

Paris, , France

Site Status

Service de Chirurgie Digestive, Hôpital Saint-Louis - APHP Paris

Paris, , France

Site Status

Service de Chirurgie Digestive, Hôpital Pontchaillou - CHU Rennes

Rennes, , France

Site Status

Service de Chirurgie Digestive, Hôpital Charles Nicolle - CHU de Rouen

Rouen, , France

Site Status

Service de Chirurgie Digestive, Hôpital Purpan - CHU de Toulouse

Toulouse, , France

Site Status

Service de chirurgie digestive, CHRU de Nancy -Hôpital de Brabois

Vandœuvre-lès-Nancy, , France

Site Status

Département de chirurgie digestive, Institut Gustave Roussy

Villejuif, , France

Site Status

Countries

Review the countries where the study has at least one active or historical site.

France

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

CHUBX 2014/33

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

No Surgery Trial / Two Dose-escalation Strategies
NCT03051464 RECRUITING PHASE2/PHASE3