Clinical Trials /

Chemotherapy and Maximal Tumor Debulking of Multi-organ Colorectal Cancer Metastases

NCT01792934

Description:

The purpose of this study is to compare overall survival rates of colorectal cancer patients with multi-organ metastases with an indication for first line systemic treatment randomized for treatment with combination chemotherapy or treatment with combination chemotherapy and additional maximal tumor debulking including surgical tumor resection, RFA, (DEBIRI-)TACE and SBRT, depending on best clinical judgement according to a standardized treatment algorithm. Our hypothesis is that maximal tumor debulking in addition to systemic treatment with chemotherapy and biologicals will provide an improvement in progression free and overall survival in this patient group.

Related Conditions:
  • Colorectal Carcinoma
Recruiting Status:

Recruiting

Phase:

N/A

Trial Eligibility

Document

Title

  • Brief Title: Chemotherapy and Maximal Tumor Debulking of Multi-organ Colorectal Cancer Metastases
  • Official Title: A Randomized Multicenter Clinical Trial for Patient With Multi-organ, Colorectal Cancer Metastases Comparing the Combination of Chemotherapy and Maximal Tumor Debulking Versus Chemotherapy Alone.

Clinical Trial IDs

  • ORG STUDY ID: 2012-073
  • NCT ID: NCT01792934

Conditions

  • Multi-organ Metastatic Colorectal Cancer

Interventions

DrugSynonymsArms
XELOX regimen according to standard proceduresXELOX or FOLFOX regimen
FOLFOX regimen according to standard proceduresXELOX or FOLFOX regimen
BevacizumabXELOX or FOLFOX regimen

Purpose

The purpose of this study is to compare overall survival rates of colorectal cancer patients with multi-organ metastases with an indication for first line systemic treatment randomized for treatment with combination chemotherapy or treatment with combination chemotherapy and additional maximal tumor debulking including surgical tumor resection, RFA, (DEBIRI-)TACE and SBRT, depending on best clinical judgement according to a standardized treatment algorithm. Our hypothesis is that maximal tumor debulking in addition to systemic treatment with chemotherapy and biologicals will provide an improvement in progression free and overall survival in this patient group.

Trial Arms

NameTypeDescriptionInterventions
XELOX or FOLFOX regimenActive ComparatorXELOX or FOLFOX regimen
  • XELOX regimen according to standard procedures
  • FOLFOX regimen according to standard procedures
  • Bevacizumab
XELOX or FOLFOX regimen and maximal tumor debulkingExperimentalXELOX or FOLFOX regimen and maximal tumor debulking including Surgery, radiofrequency ablation (RFA), transarterial chemo-embolization using irinotecan drug-eluted beads ((DEBIRI)-TACE) or stereotactic body radiation therapy (SBRT).
  • XELOX regimen according to standard procedures
  • FOLFOX regimen according to standard procedures
  • Bevacizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Histological or cytological documentation of cancer is required.

          -  Indication for first line palliative systemic treatment for metastatic colorectal
             cancer (mCRC).

          -  Patients with CRC metastases in (the primary tumor is excluded as metastatic site)

               -  ≥ 2 different organs if at least >1 extra-hepatic metastases or

               -  ≥ 2 different organs including >5 hepatic metastases not located to one lobe or

               -  ≥ 2 different organs including either a positive para-aortal lymph nodes or
                  celiac lymph nodes or adrenal metastases or pleural carcinomatosis or peritoneal
                  carcinomatosis

          -  Feasible radical tumor debulking. Incomplete tumor debulking is allowed only if at
             least 80% of metastases can be treated.

          -  To meet the inclusion criteria a cytological analysis should be performed in case of
             any uncertainty about the presence of a lesion e.g. a false positive or false negative
             result on imaging.

          -  Age ≥ 18 years.

          -  WHO performance status 0 - 1.

          -  Life expectancy of at least 12 weeks.

          -  Adequate bone marrow, liver and renal function as assessed by the following laboratory
             requirements to be conducted within 7 days prior to screening:

               -  Hemoglobin ≥ 5.6 mmol/L;

               -  Absolute neutrophil count (ANC) ≥ 1,500/mm3;

               -  Platelet count ≥ 100*109/l;

               -  Total bilirubin ≤ 1.5 times the upper limit of normal;

               -  ALT and AST ≤ 2.5 x upper limit of normal (≤ 5 x upper limit of normal for
                  subjects with liver involvement of their cancer);

               -  Albumin > 30 g/l;

               -  Serum creatinine ≤ 1.5 x upper limit of normal or a MDRD ≥ 50 ml/min;

               -  Prothrombin time or INR < 1.5 x ULN, unless coumarin derivates are used. Due to
                  interactions with capecitabine, all patients using coumarin derivates will be
                  treated with LMWH instead.

               -  Activated partial thromboplastin time < 1.25 x ULN (therapeutic anticoagulation
                  therapy is allowed if this treatment can be interrupted as judged by the treating
                  physician).

          -  Written informed consent.

        Exclusion Criteria:

          -  Prior (neo-)adjuvant chemotherapy for < 6 months after last treatment and first
             detection of extra-hepatic metastases, except for neoadjuvant capecitabine in the
             context of chemoradiation for rectal carcinoma.

          -  Candidates for HIPEC.

          -  Patients with liver metastases only

          -  Evidence of brain metastases.

          -  History of other prior malignancy except for adequately treated basal cell or squamous
             cell skin cancer or in situ cervical cancer. Patients with other malignancies are
             eligible if they have remained disease free for at least 5 years.- History of cardiac
             disease:

               -  Congestive heart failure >NYHA class 2;

               -  Active Coronary Artery Disease (defined as myocardial infarction within 6 months
                  prior to screening);

               -  Cardiac arrhythmias requiring anti-arrhythmic therapy (beta blockers or digoxin
                  are permitted).

          -  Uncontrolled hypertension. Blood pressure must be ≤160/95 mm Hg at the time of
             screening on a stable antihypertensive regimen. Blood pressure must be stable on at
             least 3 separate measurements on at least 2 separate days.

          -  Uncontrolled infections (> grade 2 NCI-CTC version 4.0).

          -  Pregnant or breast-feeding women. Women of childbearing potential must have a negative
             pregnancy test performed within 7 days of the start of treatment. Both men and women
             enrolled in this trial must agree to use adequate barrier birth control measures
             (e.g., cervical cap, condom, and diaphragm) or intrauterine device during the course
             of the trial. Oral birth control methods alone will not be considered adequate on this
             study, because of the potential pharmacokinetic interaction between study drug and
             oral contraceptives. Concomitant use of oral and barrier contraceptives is advised.

          -  Concurrent anticancer chemotherapy, immunotherapy or investigational drug therapy
             during the study or within 4 weeks of the start of study drug.

          -  Concomitant use of dexamethasone, anticonvulsants and anti-arrhythmic drugs other than
             digoxin or beta blockers.

          -  Severe allergy for contrast media not controlled with premedication.

          -  Substance abuse, medical, psychological or social conditions that may interfere with
             the subject's participation in the study or evaluation of the study results.

          -  Any condition that is unstable or could jeopardize the safety of the subject and their
             compliance in the study.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall survival
Time Frame:from date of study inclusion until the date of death or until the end of follow up, assessed up to 10 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Progression free survival rates
Time Frame:date of study inclusion to the first event defined as local recurrence or progression, distant recurrence or death from any cause assessed up to 10 years
Safety Issue:
Description:
Measure:Response rates
Time Frame:assessed every 3 months, after a follow up of 3 years assessed every 6 months
Safety Issue:
Description:
Measure:Safety and efficacy of the additional local treatment measured by number of serious adverse events.
Time Frame:assessed after inclusion of 25, 50 and 100 patients, after 30% of the patients are included in the study for 12 months and after the end of follow up, assessed up to 10 years
Safety Issue:
Description:

Details

Phase:N/A
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Radboud University

Trial Keywords

  • Debulking, cytoreduction, RFA, SABR, palliative chemotherapy

Last Updated

June 23, 2021