Study Evaluating Two Treatment Strategies for Rectal Cancer in Patients ≥75 Years Old

NCT ID: NCT07118800

Last Updated: 2025-08-12

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: PHASE3
• Total Enrollment: 160 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-12-15
• Study Completion Date: 2032-01-15

Brief Summary

The primary objective of the NACRE-2 trial is to assess whether the addition of chemotherapy after short-course radiotherapy is more effective than short-course radiotherapy alone in elderly patients with locally advanced rectal cancer. Secondary objectives will assess the efficacy and safety profile of the combination, as well as its effect on patients' quality of life.

Patients will be separated into two groups to receive their assigned treatment:

• Group 1: Short-duration radiotherapy according to standard practice lasting one week, followed by chemotherapy with FOLFOX4s consisting of oxaliplatin (85 mg/m²), folinic acid (400 mg/m²) and 5-Fluoro-Uracil (400 mg/m² administered in hospital, followed by 2400 mg/m² administered over 46 hours at home) every two weeks for 3 months
• Group 2: Short-duration radiotherapy according to standard practice, lasting one week To receive treatment, patients must come to the hospital where, at each visit, the medical team will carry out medical examinations, prior to administering treatment, to assess the patient's general state of health and tolerance to treatment.

A radiological assessment of the disease will be carried out 11 weeks after the end of radiotherapy. Patients whose tumors have not shrunk will undergo surgery to remove them and enter the follow-up phase. Patients whose tumors have shrunk will not undergo surgery, and will enter a surveillance phase. At 21 weeks, patients whose tumors are still present will undergo surgery and enter the follow-up phase. Patients whose tumors have disappeared will remain in a surveillance phase.

During the surveillance or follow-up phases, patients will be monitored in hospital every 3 months (if no progression is observed). In the case of surgery, patients will be monitored every 6 months. The maximum duration of treatment is 3 years.

Detailed Description

Comparative interventional prospective phase III, multicenter, randomised, open-label trial evaluating management strategies of locally advanced rectal cancer treatment with SCRT+/-FOLFOX4s+/-TME to optimize chemotherapy use and increase organ preservation in patients ≥ 75 years

Conditions

Locally Advanced Rectal Adenocarcinoma

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Short Course Radiotherapy (SCRT)

SCRT 25 Gy in 5 fractions of 5 Gy delivered in one week

Group Type: ACTIVE_COMPARATOR

Short Course Radiotherapy

Intervention Type: RADIATION

25Gy in 5 fractions of 5Gy delivered in one week (short-course radiotherapy)

Short Course Radiotherapy followed by FOLFOX4s

SCRT 25Gy in 5 fractions of 5Gy delivered in one week followed by 6 cycles of FOLFOX4s intravenously: Oxaliplatin 85mg/m² over 2h, folinic acid 400mg/m2 (or L-folinic acid 200 mg/m2) over 2h, Fluorouracil "bolus" 400mg/m², Fluorouracil: 2400mg/m² over 46h, every 14 days for 12 weeks (max: 6 cycles). FOLFOX4s regimen will be started 2-4 weeks after completion of radiotherapy.

Group Type: EXPERIMENTAL

FOLFOX4s

Intervention Type: DRUG

6 cycles of FOLFOX4s intravenously: Oxaliplatin 85mg/m² over 2h, folinic acid 400mg/m2 (or L-folinic acid 200 mg/m2) over 2h, Fluorouracil "bolus" 400mg/m², Fluorouracil: 2400mg/m² over 46h, every 14 days for 12 weeks (max: 6 cycles). FOLFOX4 regimen will be started 2-4 weeks after completion of radiotherapy

Short Course Radiotherapy

Intervention Type: RADIATION

25Gy in 5 fractions of 5Gy delivered in one week (short-course radiotherapy)

Interventions

FOLFOX4s

6 cycles of FOLFOX4s intravenously: Oxaliplatin 85mg/m² over 2h, folinic acid 400mg/m2 (or L-folinic acid 200 mg/m2) over 2h, Fluorouracil "bolus" 400mg/m², Fluorouracil: 2400mg/m² over 46h, every 14 days for 12 weeks (max: 6 cycles). FOLFOX4 regimen will be started 2-4 weeks after completion of radiotherapy

Intervention Type: DRUG

Short Course Radiotherapy

25Gy in 5 fractions of 5Gy delivered in one week (short-course radiotherapy)

Intervention Type: RADIATION

Other Intervention Names

Chermotherapy; 5FU + Oxaliplatin + folinic acid; SCRT; Radiotherapy

Eligibility Criteria

Inclusion Criteria

1. Histologically confirmed diagnosis of adenocarcinoma of the rectum

2. Age ≥75 years

3. WHO performance status 0-1

4. cT3a-b with maximum diameter > 5 cm, T3c-d or cT4 tumor on pretreatment pelvic MRI

5. General condition considered suitable for radical pelvic surgery and a systemic therapy with FOLFOX,

6. Distal part of the tumor ≤10 cm from the anal margin, the measurement done by pelvic MRI

7. Oncogeriatrician approval

8. Adequate biological function defined by:

1. Neutrophils ≥ 1500/mm3

2. Platelets ≥ 100 000/mm3

3. Hemoglobin ≥ 10g/dL

4. Total bilirubin ≤ 1,5 x ULN

5. Alkaline phosphatases ≤ 1,5 x ULN

6. Creatinine clearance >50mL/mn (MDRD)

9. Men must agree to use adequate contraception methods for the duration of study treatment and for within 6 months after completing treatment

10. Patients must be affiliated to a Social Security System (or equivalent).

11. Patient must have signed a written informed consent prior to any trial specific procedures. When the patient is physically unable to give their written consent, a trusted person of their choice, independent from the investigator or the sponsor, can confirm in writing the patient's consent

12. Patients must be willing and able to comply with the protocol for the duration of the study including scheduled visits, treatment plan, laboratory tests and other study procedures.

Exclusion Criteria

1. Metastatic disease

2. Other cancer within 3 years prior to rectal cancer diagnosis (except for in situ cancer and basal cell carcinoma of the skin)

3. Non resectable cancer, including extension to prostate or extension to perineal muscles

4. History of pelvic irradiation

5. Contraindication to FOLFOX 4s chemotherapy and/or radiotherapy and/or TME surgery

6. Contraindication to MRI

7. Microsatellite instability (MSI) and/or mismatch repair deficiency (dMMR)

8. Complete or partial Dihydropyrimidine Deshydrogenase (DPD) deficiency (uracilemia ≥ 16 ng/mL)

9. Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 months before start of treatment

10. Any other serious concomitant disease or disorder that may interfere with the patient's participation in the study and safety during the study (e.g., severe liver, heart, kidney, lung, metabolic, or psychiatric disorders).

11. Concurrent treatment with other experimental drugs or other anti-cancer therapy, treatment in a clinical trial within 30 days prior to randomization

12. Any psychiatric disorder precluding understanding of information of trial related topics and giving informed consent

13. No prior chemotherapy or surgery for rectal cancer

14. Any serious underlying medical condition (as judged by the investigator) that could impair the ability of the patient to participate in the trial

15. Persons deprived of their liberty or under protective custody or guardianship.

16. Patients unwilling or unable to comply with the medical follow-up required by the trial because of geographic, familial, social, or psychological reasons.

• Minimum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

UNICANCER

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ludovic EVESQUE

Role: PRINCIPAL_INVESTIGATOR

Centre Antoine Lacassagne

Central Contacts

Nicolas DE SOUSA CARVALHO

Role: CONTACT

n-de-sousa@unicancer.fr

01 71 93 67 09

Other Identifiers

2025-521619-37-00

Identifier Type: CTIS

Identifier Source: secondary_id

UC-GIG-2408

Identifier Type: -

Identifier Source: org_study_id