RESOLUTE Trial Aims to Investigate the Value of Adding Local Ablative Treatment to Standard Systemic Treatment for Unresectable Oligometastatic Colorectal Cancer

Colorectal Cancer Clinical Trial

— RESOLUTE  

Official title:

Randomised Phase II Trial to Evaluate Progression-Free Survival in Integrating Local Ablative Therapy With First-Line Systemic Treatment for Unresectable Oligometastatic Colorectal Cancer

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05862051
• Other study ID #: RESOLUTE
• Status: Recruiting
• Phase: N/A
• Start date: December 14, 2021
• Est. completion date: June 14, 2025

Study information

• Verified date: October 2023
• Source: Australasian Gastro-Intestinal Trials Group
• Contact: Sukanya Sathyamurthie
• Phone: +61 2 7208 2719
• Email: sukanya[@]gicancer.org.au
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study aims to assess the clinical benefit of local ablative therapy (LAT) following initial standard first-line systemic treatment including the impact on survival, compared to continued standard first-line systemic treatment for oligometastatic colorectal cancer.

Description:

Who is this study for:

Adults with unresectable oligo-metastatic colorectal who have demonstrated treatment benefit (partial response or stable disease as per RECIST criteria) after 3-4 months of standard first-line systemic treatment.

Study details

Participants will be randomly allocated to either a LAT arm, who will receive metastasis-directed LAT such as radiotherapy or thermal ablation following initial standard first-line systemic treatment, or a control arm who will receive continued first-line systemic treatment alone. Those receiving LAT will return to systemic treatment 16 weeks post-randomisation. Information on progression-free survival and treatment outcomes will be collected.

Data from this study will inform investigators of the potential benefit of local ablative therapy in the therapeutic setting for metastatic colorectal cancer.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 75
• Est. completion date: June 14, 2025
• Est. primary completion date: June 14, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Metastatic colorectal adenocarcinoma that is not amenable to potentially oncological curative surgery alone.

• Primary tumour must be controlled if the primary is intact, with no evidence of progression at primary site prior to study entry

• Imaging demonstrating ongoing treatment benefit (partial response or stable disease as per RECIST criteria) after 3-4 months of standard first-line systemic treatment.

• At least one metastatic lesion detected on CT +/- FDG-PET scan prior to first line systemic treatment AND on screening FDG-PET and CT scans, meeting the following criteria:

1. max of 3 lesions per organ except for the liver and lung

2. max of 5 lesions in the lung

3. no limitation to the number of liver lesions provided they are all amenable to LAT

4. max of 3 involved organs including a lymph node station

5. only one lymph node station involvement is allowed

6. for patients with liver metastases, a quadruple phase contrast enhanced CT or MRI liver is required to fully stage the liver; this can be performed prior to or within 4 weeks of commencing first line systemic treatment

7. staging FDG-PET scan is encouraged and can be performed prior to or within 4 weeks of commencing first line systemic treatment

• All lesions can be safely treated by LAT as determined by multidisciplinary team meeting.

Exclusion Criteria:

• Deficient mismatch repair (dMMR) or microsatellite instability-high (MSI-high) tumour

• BRAFV600E mutated tumour

• Concurrent or previous other malignancy within 2 years of study entry, except curatively treated basal or squamous cell skin cancer, prostate intraepithelial neoplasm, carcinoma in-situ of the cervix, Bowen's disease or prostate cancer with a Gleason score =6.

• Presence of brain, peritoneal, omental or ovarian metastases

• Malignant pleural effusion or ascites.

Related Conditions & MeSH terms

• Colorectal Cancer
• Colorectal Neoplasms
• Oligometastatic Disease

Intervention

Procedure:
• Local Ablative Therapy
LAT modalities allowed include surgical resection, stereotactic radiotherapy (SRT), laparoscopic or percutaneous thermal ablation [radiofrequency ablation (RFA) or microwave ablation (MWA)]. The LAT modalities will be delivered by specialists in the field (surgeons, radiation oncologists and/or interventional radiologists). The precise mode of delivery and number of times the LAT modality is delivered is case-dependent and is determined at a multi-disciplinary meeting (MDM).
• Standard first-line systemic treatment
Standard of care as determined by the treating clinician. The following standard chemotherapy regimens are allowed: single agent fluoropyrimidine, CAPOX, FOLFOX, FOLFIRI, CAPIRI or FOLFOXIRI. Treatment with a biologic is allowed including bevacizumab or an anti-EGFR antibody (cetuximab or panitumumab). For patients receiving a doublet or triplet regimen, treatment may be de-escalated to maintenance fluoropyrimidine +/- biologics or anti-EGFR monotherapy at any point after trial entry at clinician discretion.

Locations

Country	Name	City	State
Australia	Border Medical Oncology	Albury	New South Wales
Australia	Bendigo Hospital	Bendigo	Victoria
Australia	Eastern Health	Box Hill	Victoria
Australia	The Northern Hospital	Epping	Victoria
Australia	St Vincent's Hospital Melbourne	Fitzroy	Victoria
Australia	Peter MaCallum Cancer Centre	Melbourne	Victoria
Australia	Peninsula Health	Rosebud	Victoria
Australia	Western Health	Saint Albans	Victoria
Australia	Northeast Health Wangaratta	Wangaratta	Victoria

Sponsors (3)

Lead Sponsor	Collaborator
Australasian Gastro-Intestinal Trials Group	Cancer Council Victoria, Walter and Eliza Hall Institute of Medical Research

Country where clinical trial is conducted

Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Progression free survival (PFS)	To compare the efficacy of metastasis-directed LAT following initial standard first-line systemic treatment vs continued first-line systemic treatment alone, as measured by Progression-Free Survival (PFS)	12 Months from randomisation
Secondary	Overall survival	To compare the efficacy of LAT following initial standard first-line systemic treatment, compared to continued first-line systemic treatment alone, as measured by Overall Survival (OS)	12 Months from randomisation and through study completion, an average of 1 year
Secondary	Efficacy of local ablative therapy	To compare the efficacy of LAT following initial standard first-line systemic treatment, compared to continued first-line systemic treatment alone, on: time to development of new metastatic lesions.; time to initiation of 2nd line systemic treatment.	12 Months from randomisation and through study completion, an average of 1 year
Secondary	Time to progression following local ablative therapy	To assess the time to progression of LAT treated lesions.	Through study completion, an average of 1 year
Secondary	Systemic treatment-free interval	To compare systemic treatment-free interval between the two treatment groups.	Through study completion, an average of 1 year
Secondary	Rate of high-grade toxicities	To assess and compare rate of high-grade (Grade 3-5) toxicities between the two treatment groups.	Through study completion, an average of 1 year
Secondary	Quality of life measure	To compare quality of life measures between the two treatment groups using patient questionnaire - The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) using the 4-point ordinal scale (not at all, a little, quite a bit and very much)	Through study completion, an average of 1 year