Clinical Trials /

S0820, Adenoma and Second Primary Prevention Trial

NCT01349881

Description:

The investigators hypothesize that the combination of eflornithine and sulindac will be effective in reducing a three-year event rate of adenomas and second primary colorectal cancers in patients previously treated for Stages 0 through III colon or rectal cancer.

Related Conditions:
  • Colorectal Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: S0820, Adenoma and Second Primary Prevention Trial
  • Official Title: A Double Blind Placebo-Controlled Trial of Eflornithine and Sulindac to Prevent Recurrence of High Risk Adenomas and Second Primary Colorectal Cancers in Patients With Stage 0-III Colon or Rectal Cancer, Phase III - Preventing Adenomas of the Colon With Eflornithine and Sulindac (PACES)

Clinical Trial IDs

  • ORG STUDY ID: S0820
  • SECONDARY ID: U10CA037429
  • SECONDARY ID: NCI-2012-02067
  • NCT ID: NCT01349881

Conditions

  • Colorectal Neoplasms

Interventions

DrugSynonymsArms
Eflornithine placebo & sulindac placeboeflornithine placebo & sulindac placebo
eflornithine & sulindac placeboEflornithine & sulindac placebo
Eflornithine placebo & sulindacEflornithine placebo & sulindac
Eflornithine plus sulindacEflornithine plus sulindac

Purpose

The investigators hypothesize that the combination of eflornithine and sulindac will be effective in reducing a three-year event rate of adenomas and second primary colorectal cancers in patients previously treated for Stages 0 through III colon or rectal cancer.

Detailed Description

      The purpose of this study is to assess whether the combination of eflornithine 500 mg and
      sulindac 150 mg (compared to corresponding placebos) has efficacy against colorectal lesions
      with respect to high-grade dysplasia, adenomas with villous features, adenomas 1 cm or
      greater, multiple adenomas, any adenomas >/= 0.3 cm, total advanced colorectal events, or
      total colorectal events.
    

Trial Arms

NameTypeDescriptionInterventions
eflornithine placebo & sulindac placeboPlacebo ComparatorEflornithine placebo 2 tablets, PO, daily for 3 years. Sulindac placebo, 1 tablet, PO, daily for 3 years.
  • Eflornithine placebo & sulindac placebo
Eflornithine & sulindac placeboExperimentalEflornithine two 250 mg tablets PO daily for 3 years. Sulindac placebo one tablet PO daily for 3 years.
  • eflornithine & sulindac placebo
Eflornithine placebo & sulindacExperimentalEflornithine placebo 2 tablets PO daily for 3 years. Sulindac one 150 mg tablet PO daily for 3 years.
  • Eflornithine placebo & sulindac
Eflornithine plus sulindacExperimentalEflornithine two 250 mg tablets PO daily for 3 years. Sulindac one 150 mg tablet PO daily for 3 years.
  • Eflornithine plus sulindac

Eligibility Criteria

        Inclusion Criteria:

          -  History of Stage 0-III colon or rectal cancer with primary resection 1 year previously

          -  Post-operative colonoscopy and CT scans of chest, abdomen & pelvis showing no evidence
             of disease

          -  Must not have cardiovascular risk factors including unstable angina, history of
             myocardial infarction, or cerebrovascular accident, coronary artery bypass surgery, or
             NY Heart Assoc Class III or IV heart failure.

          -  Patients must not have known uncontrolled hyperlipidemia (defined as LDL-C >/= 190
             mg/dL or triglycerides >/= 500 mg/dL within the past 3 years or uncontrolled high
             blood pressure (systolic blood pressure > 150 mm Hg) within 28 days prior to
             registration

          -  At least 30 days from completion of adjuvant chemo and RT.

          -  Presence of gastroesophageal reflux disease acceptable if controlled with medications

          -  Not receiving or planning to receive concomitant intravenous corticosteroids on a
             regular basis,nonsteroidal anti-inflammatory drugs (NSAIDs), nor anticoagulants on a
             regular predictable intermittent basis. NSAID use must not exceed 10 days per month;
             Maximum aspirin dose

               -  100 mg per day or ≤ two 325 mg tablets per week. Inhaled steroids (i.e. for
                  asthma or related conditions) are allowed.

          -  Able to swallow oral medications

          -  Laboratory: WBC ≥ 4.0 x 1000/mcL, platelets ≥ 100,000/mcL and hemoglobin > 11.0 g/dL.
             (A total WBC ≥ 3.1 x 1000/mcL is allowed for non-Hispanic black males and total WBC ≥
             3.4 x 1000/mcL for non-Hispanic black females. Serum bilirubin ≤ 2.0 mg/dL and AST
             (SGOT) or ALT(SGPT) ≤ 2 x IULN. Serum creatinine ≤ 1.5 x IULN

          -  Zubrod PS 0-1, 18 years of age or older

          -  Will not participate in any other clinical trial for the treatment or prevention of
             cancer unless off protocol treatment, on follow-up phase only

          -  Offered opportunity to participate in blood specimen banking

        Exclusion Criteria:

          -  History of colon resection > 40 cm

          -  Mid-low rectal cancer

          -  Recurrent or metastatic disease

          -  High cardiovascular risk; Uncontrolled hypertension

          -  Planned radiation therapy or additional chemotherapy

          -  Documented history of gastric/duodenal ulcer within last 12 months and/or current
             treatment or active symptoms of gastric/duodenal ulcer

          -  Known history of familial adenomatous polyposis, hereditary nonpolyposis colorectal
             cancer, or inflammatory bowel disease

          -  ≥ 30 dB uncorrectable hearing loss for age of any of the five tested frequencies on
             prestudy audiogram

          -  Known hypersensitivity to sulindac or excipient byproducts. Previous asthma,
             urticaria, or allergic-type reaction to aspirin or other NSAIDs

          -  Significant medical or psychiatric condition that would preclude study completion (8
             years)

          -  No other prior malignancy except adequately treated basal cell or squamous cell skin
             cancer, in situ cervical cancer, or other cancer for which the patient has been
             disease-free for > 5 years

          -  Pregnant or nursing women. Women/men of reproductive potential must agree to use
             effective contraception
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Event rate, defined as rate of high-risk adenoma or second primary colorectal cancer (CRC)
Time Frame:3 years after registration
Safety Issue:
Description:High risk adenoma is defined as either advanced adenoma (villous or tubulovillous histology, size >= 1 cm, or high grade dysplasia) or multiple adenomas (3 or more each > 0.3 cm). The primary analysis of the 3-year event rate will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A two-arm binomial design without continuity correction will be used.

Secondary Outcome Measures

Measure:Total advanced colorectal event rate, defined as the number of patients with at least one high risk adenoma, second primary CRC, CRC recurrence, or metastasis
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Colon cancer recurrence
Time Frame:Up to 8 years
Safety Issue:
Description:Statistical assessments of association between the biomarker and the recurrence endpoints will be performed after converting the biomarker scores to ranks, which will facilitate detection of monotonic relationship(s).
Measure:High-grade dysplasia
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Adenomas with villous features, defined as villous histology (villous and tubulovillous adenomas)
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Adenomas >= 1 cm
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Multiple adenomas, defined as 3 or more adenomas all measuring > 0.3 cm
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:The number of patients with development of any adenoma > 0.3 cm
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Total colorectal event rate, defined as the number of patients with at least one colorectal event (advanced colorectal event or adenoma > 0.3 cm)
Time Frame:Up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Time to first clinically apparent high-risk adenoma or second primary CRC
Time Frame:From date of registration to date at which high-risk adenoma or second primary CRC is detected, up to 8 years
Safety Issue:
Description:The analysis will be performed using logistic regression, testing the main effect of treatment and adjusting for the baseline stratification factor. A time-to-event analysis will be conducted if there is no evidence of differential rates of on-study colonoscopies. To evaluate whether intervention effects are enduring, an analysis of post-treatment follow-up, examining colorectal event rates through year 8 will be performed.
Measure:Toxicity
Time Frame:Up to 3 years
Safety Issue:
Description:Qualitative and quantitative assessment of toxicity, collected as CTCAE adverse events. Particular adverse events of interest include thrombotic cardiovascular and ototoxic events at or above a specified grade (e.g., Grade III or worse). All patients who receive any treatment will be included in the analysis of adverse events.
Measure:Baseline statin use
Time Frame:Up to 3 years
Safety Issue:
Description:The analysis of the interaction of statin use and the 3-year event rate will be performed using logistic regression.
Measure:Baseline meat consumption
Time Frame:Up to 3 years
Safety Issue:
Description:The analysis of the interaction of meat consumption and the 3-year event rate will be performed using logistic regression.
Measure:PK analysis
Time Frame:Up to 3 years
Safety Issue:
Description:SNPs with minor allele frequencies greater than 0.20 will be selected for SNP genotyping. The smallest set of SNPs that tag the common variation (frequency > 0.20) in all of the representative ethnic groups will be used. The genotype data, treatment characteristics and endpoints of interest will be analyzed using the pharmacogenetic-environment interaction approach described by Wacholder and colleagues.
Measure:Biomarker identification based on Integrated Comprehensive Droplet Digital Detection technology
Time Frame:Up to 3 years (though the timing of this isn't clear to me)
Safety Issue:
Description:The nature of the relationship between biomarker values identified by Integrated Comprehensive Droplet Digital Detection technology and the aggregate primary endpoint (high-risk adenoma or second primary CRC) will be assessed. Statistical assessments of association between the biomarker and the recurrence endpoints will be performed after converting the biomarker scores to ranks, which will facilitate detection of monotonic relationship(s).
Measure:Type of cancer at baseline: colorectal vs rectal
Time Frame:Up to 3 years
Safety Issue:
Description:The analysis of the interaction of cancer type and the 3-year event rate will be performed using logistic regression.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Southwest Oncology Group

Trial Keywords

  • Eflornithine/sulindac prevention trial

Last Updated

February 25, 2021