Description:
PEGASUS is a prospective multi-centric study designed to prove the feasibility of using
liquid biopsy to guide the post-surgical and post-adjuvant clinical management in 140
microsatellite stable Stage-III and T4N0 Stage-II colon cancer patients.
Title
- Brief Title: Post-surgical Liquid Biopsy-guided Treatment of Stage III and High-risk Stage II Colon Cancer Patients: the PEGASUS Trial
- Official Title: Post-surgical Liquid Biopsy-guided Treatment of Stage III and High-risk Stage II Colon Cancer Patients
Clinical Trial IDs
- ORG STUDY ID:
IFOM-CPT005/2019/PO004
- SECONDARY ID:
2019-002074-32
- NCT ID:
NCT04259944
Conditions
Interventions
Drug | Synonyms | Arms |
---|
CAPOX | | Liquid Biopsy-Guided Adjuvant Treatment |
Capecitabine | | Liquid Biopsy-Guided Adjuvant Treatment |
FOLFIRI | | Liquid Biopsy-Guided Adjuvant Treatment |
Purpose
PEGASUS is a prospective multi-centric study designed to prove the feasibility of using
liquid biopsy to guide the post-surgical and post-adjuvant clinical management in 140
microsatellite stable Stage-III and T4N0 Stage-II colon cancer patients.
Detailed Description
The LUNAR1 Test (Guardant Health, Redwood City, CA, USA) will be used for ctDNA
determination. For the efficacy analysis, the PEGASUS cohort will be compared with a cohort
of 420 patients from the TOSCA trial (NCT00646607) population matched 3:1 for all known
prognostic phenotypes.
A post-surgical LB executed 2-4 weeks after surgery will guide a "Molecular Adjuvant"
treatment as follows: i) ctDNA+ patients will receive CAPOX for 3 months; ii) ctDNA- patients
will receive capecitabine (CAPE) for 6 months but will be retested after 1 cycle, and if
found ctDNA+ will be switched to CAPOX treatment.
Immediately after the end of the "Molecular Adjuvant" treatment a further LB will be
performed and instruct subsequent treatment. Positive patients (ctDNA+/+ and ctDNA-/+) will
receive an up-scaled "Molecular Metastatic" systemic treatment for 6 months or until
radiological progression or toxicity as follows: i) ctDNA+/+ patients will be treated with
FOLFIRI; ii) ctDNA-/+ patients with CAPOX. These patients will be subjected to a LB after 3
months at the end of treatment and in case of positivity will be switched to FOLFIRI.
Patients experiencing ctDNA conversion to negative (ctDNA+/-) will receive a de-escalated
treatment with CAPE for 3 months. 3 LB will be performed within 3 months and in case of
positivity the patient will be switched to FOLFIRI. Patients with ctDNA-/- will be subjected
to an interventional follow-up comprising 2 further LB and in case of positivity they will be
switched to CAPOX treatment. PEGASUS is piggybacked to AlfaOmega (NCT04120935), a Master
Observational Protocol that will follow patients from diagnosis to 5 years or
recurrence/death (whichever comes first), collecting clinical data, radio-images and
biological samples. AlfaOmega provides a clinical and logistic ecosystem for the seamless
integration of PEGASUS clinical results with the biological underpinning of colon cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Liquid Biopsy-Guided Adjuvant Treatment | Experimental | A post-surgical LB executed 2-4 weeks after surgery will guide a "Molecular Adjuvant" treatment:
ctDNA+ patients: CAPOX for 3 months
ctDNA- patients: capecitabine (CAPE) for 6 months. LB after 1 cycle and if found ctDNA+ will be switched to CAPOX.
A post-Molecular Adjuvant treatment LB will be performed and instruct subsequent treatment:
ctDNA+/+ patients: up-scale to a "Molecular Metastatic" treatment with FOLFIRI for 6 months or until radiological progression or toxicity;
ctDNA-/+ patients: up-scale to a "Molecular Metastatic" treatment with CAPOX for 6 months or until radiological progression or toxicity. LB after 3 months at the end of treatment and in case of positivity switch to FOLFIRI.
ctDNA+/- patients: de-escalate treatment to CAPE for 3 months. 3 LB performed within 3 months and in case of positivity switch to FOLFIRI.
ctDNA-/- patients: interventional follow-up comprising 2 further LB and in case of positivity switch to CAPOX treatment. | |
Eligibility Criteria
Inclusion Criteria:
- Pegasus trial written informed consent.
- Age ≥ 18 years.
- Histologically confirmed diagnosis of operable stage III or T4N0 stage II colon cancer
located 12 cm from the anal verge by endoscopy and above the peritoneal reflection at
surgery.
- Availability of plasma collected prior to surgery.
- Availability of the original FFPE tumor tissue.
- Acceptance to undergo at least all the interventional liquid biopsies.
- ECOG performance status 0-1.
- Normal organ functions. (as defined in section 9.3)
- Women with childbearing potential should complete a pregnancy test and be willing to
use highly effective contraceptive methods.
Exclusion Criteria:- Patients having a MSI-H/MMRd tumor are excluded from the study (done
according to standard clinical practice).
- History of another neoplastic disease, unless in remission for ≥ 5 years. Participants
with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or
carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ) that have undergone
potentially curative therapy are not excluded.
- Had an incomplete diagnostic colonoscopy and/or polyps removal.
- Macroscopic or microscopic evidence of residual tumor (R1 or R2 resections). Patients
should never have had any evidence of metastatic disease (including presence of tumor
cells in the peritoneal lavage).
- Current or recent treatment with another investigational drug or participation in
another investigational study
- Patient unable to comply with the study protocol owing to psychological, social or
geographical reasons.
- Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the study.
- Inadequate contraception (male or female patients) if of childbearing or procreational
potential.
- Clinically relevant cardiovascular disease.
- Acute or subacute intestinal occlusion or history of inflammatory bowel disease.
- Pre-existing neuropathy > grade 1. Known grade 3 or 4 allergic reaction to any of the
components of the treatment.
- Has a known DPD (DihydroPyrimidine Dehydrogenase) deficiency.
- Has a known Gilbert Syndrome or UGT1A1 homozygous *28/*28 germline variant.
- Has a known history of Human Immunodeficiency Virus (HIV). Note: No HIV testing is
required.
- Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg]
reactive) or known active Hepatitis C virus infection. Note: no testing for Hepatitis
B and Hepatitis C is required unless mandated by local health authority.
- Has a known history of active TB (Bacillus Tuberculosis).
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of post-surgery and post-adjuvant false negative cases after a double ctDNA-negative detection |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Cases that become positive at subsequent interventional LB or that experience radiological relapse |
Secondary Outcome Measures
Measure: | Disease-Free Survival (DFS) |
Time Frame: | 2 & 3 years |
Safety Issue: | |
Description: | |
Measure: | Overall Survival (OS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | Safety and tolerability according to CTCAE version 5.0 |
Time Frame: | 2 years |
Safety Issue: | |
Description: | |
Measure: | Assessment of QLQ-C30 and CR-29 EORTC questionnaires |
Time Frame: | 2 years |
Safety Issue: | |
Description: | |
Measure: | Number of patients experiencing ctDNA seroconversion (i.e. ctDNA+ that become ctDNA-) after any chemotherapy regimen remaining disease free |
Time Frame: | 2 & 3 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | IFOM, The FIRC Institute of Molecular Oncology |
Trial Keywords
- liquid biopsy
- colon cancer
- adjuvant treatment
- ctDNA
Last Updated
October 6, 2020