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.
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
Interventions
Drug | Synonyms | Arms |
---|
Eflornithine placebo & sulindac placebo | | eflornithine placebo & sulindac placebo |
eflornithine & sulindac placebo | | Eflornithine & sulindac placebo |
Eflornithine placebo & sulindac | | Eflornithine placebo & sulindac |
Eflornithine plus sulindac | | Eflornithine 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
Name | Type | Description | Interventions |
---|
eflornithine placebo & sulindac placebo | Placebo Comparator | Eflornithine placebo 2 tablets, PO, daily for 3 years. Sulindac placebo, 1 tablet, PO, daily for 3 years. | - Eflornithine placebo & sulindac placebo
|
Eflornithine & sulindac placebo | Experimental | Eflornithine two 250 mg tablets PO daily for 3 years. Sulindac placebo one tablet PO daily for 3 years. | - eflornithine & sulindac placebo
|
Eflornithine placebo & sulindac | Experimental | Eflornithine placebo 2 tablets PO daily for 3 years. Sulindac one 150 mg tablet PO daily for 3 years. | - Eflornithine placebo & sulindac
|
Eflornithine plus sulindac | Experimental | Eflornithine 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