Trial of Neoadjuvant Chemotherapy in Locally Advanced Colon Cancer

Colon Cancer Clinical Trial

— ECKINOXE  

Official title:

PRODIGE 22-ECKINOXE : Randomized Phase II Trial of Neoadjuvant FOLFOX 4 Versus FOLFOX 4 With Cetuximab Versus Immediate Surgery in Locally Advanced Colon Cancer

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01675999
• Other study ID #: P100131
• Status: Recruiting
• Phase: Phase 2
• First received: February 2, 2012
• Last updated: January 14, 2016
• Start date: May 2012
• Est. completion date: February 2021

Study information

• Verified date: January 2012
• Source: Assistance Publique - Hôpitaux de Paris
• Contact: Mehdi karoui, PH
• Phone: +33 (0) 1 42 17 56 11
• Email: mehdi.karoui[@]gmail.com
• Is FDA regulated: No
• Health authority: France: Ministry of Health
• Study type: Interventional

Clinical Trial Summary

In patients with locally advanced colon cancer (high risk stage II and stage III), curative surgery followed by adjuvant FOLFOX-4 chemotherapy has become the standard of care. However, for 30-40% of these patients, the current curative treatment strategy of surgical excision followed by adjuvant chemotherapy fails either to clear locoregional spread or to eradicate distant micrometastases, leading to disease recurrence. Preoperative chemotherapy is an attractive concept for locally advanced colon cancer and has the potential to impact upon both of these causes of failure. Optimum systemic therapy at the earliest possible opportunity may be more effective at eradicating distant metastases than the same treatment given after the delay and immunological stress of surgery. Added to this, shrinking the primary tumor before surgery may reduce the risk of incomplete surgical excision, and the risk of tumor cell shedding during surgery.

ECKINOXE is a multicenter randomized phase II trial designed to evaluate efficacy (response rate) and feasibility (safety, tolerance) of these two chemotherapy regimens (FOLFOX-4 alone and FOLFOX-4+Cetuximab) in a neoadjuvant strategy in patients with locally advanced colon cancer. Control arm includes patients for whom standard treatment comprises surgery followed by adjuvant FOLFOX-4 chemotherapy. This phase II study will assess the feasibility of a neoadjuvant strategy in these patients and determine which neoadjuvant regimen is the most effective in terms of response rate.

Description:

See Synopsis below

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 186
• Est. completion date: February 2021
• Est. primary completion date: May 2012
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 76 Years

Eligibility

Inclusion Criteria:

• Pathologically confirmed colon adenocarcinoma (= 15 cm from the anal verge)

• Assessment of RAS status of the primary colon cancer on biopsies (WT or mutated)

• Colon cancer classified: poor prognosis T3 (T3 bad) - T4 and/ or N2 by abdominal CT scan.

• Non metastatic colon cancer (lung, liver, peritoneal)

• Non complicated primary tumor (obstruction, perforation, bleeding), patients with cancer treated by stomie de derivation may be included in the study.

DPD deficency

• Absence of synchronous colorectal cancer

• Age = 18 years and < 76 years

• ECOG performance status 0-1

• No prior chemotherapy within the last 5 years

• No prior abdominal or pelvic irradiation within the last 5 years

• Life expectancy of 5 years or more

• No history of colorectal cancer within the last 5 years

• Patients with childbearing potential should use effective contraception during the study and the following 6 months

• White blood cell count of 3 x 109/L or more with neutrophils of1.5 x 109/L or more, platelet count of 100 x 109/L or more, hemoglobin of 9 g/dL (5,6 mmol/l) or more

• Total bilirubin of 1.5 x ULN (upper limit of normal) or less

• ASAT and ALAT of 2.5 x ULN or less

• Alkaline phosphatase of 1.5 x ULN or less

• Serum creatinine of 1.5 x ULN or less

• Signed written informed consent obtained prior to any study specific screening procedures

Exclusion Criteria:

• contra-indication to iodinated contrast medium injection including allergy to iodinated contrast medium and renal insufficiency proscribing iodinated injection

• Age > 70 years

• Rectal cancer located within 15 cm from the anal verge by endoscopy or under the peritoneal reflection at surgery or having received radiation therapy prior to surgery

• Complicated primary colon cancer (obstruction, bleeding, perforation)

• Synchronous colorectal cancer

• Metastatic spread at baseline assessment (lung, liver, peritoneal)

• History or current evidence on physical examination of central nervous system disease or peripheral neuropathy = grade 1 Common Toxicity Criteria for Adverse Events (CTCAE) v.3.0

• Known hypersensitivity reaction to any of the components of study treatments

• Presence of inflammatory bowel disease

• HNPCC syndrome or polyposis

• Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to study treatment start. Incompletely healed wounds or anticipation of the need for major surgical procedure during the course of the study

• Clinically relevant coronary artery disease or history of myocardial infarction in the last 12 months, or high risk of uncontrolled arrhythmia

• Pregnancy (absence to be confirmed by ß-hCG test) or breast-feeding period

• Previous malignancy in the last 5 years

• Medical, geographical, sociological, psychological or legal conditions that would not permit the patient to complete the study or sign informed consent

• Any significant disease which, in the investigator's opinion, would exclude the patient from the study.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Colon Cancer
• Locally Advanced Malignant Neoplasm
• Neoplasms

Intervention

Other:
• Perioperative simplified FOLFOX-4 chemotherapy
Preoperative chemotherapy
• Perioperative FOLFOX4+Cetuximab chemotherapy
Preoperative chemotherapy
• Surgery followed by FOLFOX4 chemotherapy
Preoperative chemotherapy

Locations

Country	Name	City	State
France	Hopital Henri Mondor	Paris

Sponsors (6)

Lead Sponsor	Collaborator
Assistance Publique - Hôpitaux de Paris	Association de Recherche Experimentale et Clinique en Chirurgie Digestive, Association Européenne de Recherche en Oncologie, Federation Francophone de Cancerologie Digestive, Merck Serono S.A., Geneva, UNICANCER

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Histological tumor response in the primary tumor according to the simplified Tumor Regression Grade (TRG) of Ryan	This primary outcome will be evaluated on the surgical specimens: Immediately after surgery (arm C) or after neoadjuvant chemotherapy (4 cycles) and surgery (arms A and B)	2 years	No
Secondary	Safety and tolerability and efficacy of the neoadjuvant chemotherapy	Tolerability of the neoadjuvant therapies. SAFETY ISSUE; Postoperative morbidity at 60 days. SAFETY ISSUE	9 years	Yes
Secondary	•Disease free survival and regression free survival at 3 years		3 years	Yes
Secondary	•Overall survival at 6 and 7 years		6 and 7 years	Yes
Secondary	•Quality of life (EORTC QLQ-C30, QLQ-CR29)		5 years	No
Secondary	•Quality and radicality of the surgical excision		2 years	No
Secondary	•Accuracy of pre-treatment CT scan staging and evaluation of radiological response to chemotherapy		2 years	No
Secondary	•Correlation between radiological and histological response		2 years	No
Secondary	•Evaluation of another histopathological grade		2 years	No