Study of Micrometastases in Patients With Stage I or Stage II Localized Colon Cancer That Can Be Removed by Surgery

Colorectal Cancer Clinical Trial

Official title:

The Influence of Micrometastases on Prognosis and Survival in Stage I-II Colon Cancer Patients: The EnRoute+ Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01097265
• Other study ID #: JBZ-EnRoute+
• Secondary ID: CDR0000668525EUD
• Status: Recruiting
• Phase: Phase 2/Phase 3
• First received: March 31, 2010
• Last updated: August 9, 2013
• Start date: July 2010

Study information

• Verified date: September 2011
• Source: National Cancer Institute (NCI)
• Contact: n/a
• Is FDA regulated: No
• Health authority: Unspecified
• Study type: Interventional

Clinical Trial Summary

RATIONALE: Diagnostic procedures such as sentinel lymph node mapping may help doctors find patients who are at risk of developing micrometastases and plan better treatment.

PURPOSE: This randomized phase II/III trial is studying micrometastases in patients with stage I or stage II localized colon cancer that can be removed by surgery.

Description:

OBJECTIVES:

• To determine the subset of patients with stage I or II localized, resectable colon cancer (pN0) at risk for developing systemic metastases.

• To determine the clinical and prognostic relevance of occult nodal isolated tumor cells and micrometastases in these patients.

• To determine the benefits of adjuvant chemotherapy in patients with pN0micro+ colon cancer.

OUTLINE: This is a phase II feasibility study (stage 1) followed by a phase III multicenter, open-label, randomized, and controlled study (stage 2).

• Stage 1 (phase II feasibility study) After undergoing planned curative resection followed by ex vivo sentinel lymph node mapping (SLNM). Resected samples are examined. The sentinel lymph nodes of those deemed pN0 disease (no macroscopic metastases or angioinvasion) are further evaluated for micrometastases by serial sectioning and immunohistochemistry using pan-cytokeratin. pN0micro+ disease are defined as isolated tumor cells (ITC) < 0.2 mm or micrometastasis 0.2 - 2 mm. Patients with pN0 disease are followed-up once every 6 months for 3 years and then annually for 2 years.

• stage 2 (phase III randomized study): Patients undergo planned surgery and ex vivo SLNM as in stage 1. Patients with pN0micro- disease are assigned to arm C; patients with pN0micro+ disease are randomized to 1 of 2 intervention arms (arms A and B). .

• Arm A (pN0micro+): Patients receive oral capecitabine twice daily on days 1-14 and oxaliplatin IV over 2 hours on day 1 OR oral capecitabine twice daily on days 1-14 alone according to standard protocol. Treatment repeats every 4 weeks for up to 8 courses. Patients are followed-up once every 6 months for 3 years and then annually for 2 years.

• Arm B (pN0micro+): Patients are followed-up once every 6 months for 3 years and then annually for 2 years.

• Arm C (pN0micro-): Patients are followed-up once every 6 months for 3 years and then annually for 2 years.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 1500
• Est. primary completion date: January 2015
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

DISEASE CHARACTERISTICS:

• Histologically or radiologically confirmed primary colon cancer

• Stage I or II disease

• Clinically localized disease judged potentially resectable for cure, without intraoperatively gross nodal involvement

• Planning to undergo elective resection of the tumor

• No histologically or radiologically confirmed locoregional lymph node or distant metastasis

• No disseminated disease

• No clinical tumor perforation or obstruction

• Patients enrolled in stage 2 and undergoing randomization must also meet the following criteria:

• pN0micro+ disease as evidenced by detection of sentinel lymph node isolated tumor cells (<0.2 mm) or micrometastasis (0.2 - 2 mm)

• No high-risk pN0 disease meeting any of the following criteria:

• Less then 10 lymph nodes detected in resected specimen

• Invasion in other organs (T4, Nx, Mx)

• Colon perforation at presentation

• Obstruction at presentation

• Angioinvasion at pathological examination

• No rectal cancer

• No clinically positive nodal tumors or advanced disease (stage III or Dukes stage C disease)

PATIENT CHARACTERISTICS:

• Patients enrolled in stage 2 and undergoing randomization must also meet the following criteria:

• WHO performance status 0-1 or American Society of Anesthesiologists Physical Status classification 1-2

• Not pregnant or nursing

• Able to comply with requirements of the study

• Must be fit to undergo chemotherapy treatment

• No other current serious illness or medical conditions, including any of the following:

• Severe cardiac illness (NYHA class III-IV disease)

• Significant neurologic or psychiatric disorders

• Uncontrolled infections

• Active disseminated intravascular coagulation

• Other serious underlying medical conditions that could impair the ability of the patient to participate in the study

• No known hypersensitivity to study drugs

• No definite contraindications for the use of corticosteroids

PRIOR CONCURRENT THERAPY:

• No prior colorectal surgery

• Patients enrolled in stage 2 and undergoing randomization must also meet the following criteria:

• No prior chemotherapy (for patients enrolled in stage 2 and undergoing randomization only)

• At least 4 weeks since prior and no other concurrent experimental drugs

• No concurrent immunosuppressive or antiviral drugs

Study Design

Allocation: Randomized, Masking: Open Label, Primary Purpose: Diagnostic

Related Conditions & MeSH terms

• Colorectal Cancer

Intervention

Drug:
• capecitabine

• oxaliplatin

Other:
• active surveillance

• laboratory biomarker analysis

Procedure:
• adjuvant therapy

• lymph node mapping

• sentinel lymph node biopsy

Locations

Country	Name	City	State
Netherlands	Jeroen Bosch Ziekenhuis	's-Hertogenbosch
Netherlands	Academisch Medisch Centrum at University of Amsterdam	Amsterdam
Netherlands	Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital	Amsterdam
Netherlands	Vrije Universiteit Medisch Centrum	Amsterdam
Netherlands	Catharina Ziekenhuis	Eindhoven
Netherlands	University Medical Center Groningen	Groningen
Netherlands	Leiden University Medical Center	Leiden
Netherlands	Academisch Ziekenhuis Maastricht	Maastricht
Netherlands	Universitair Medisch Centrum St. Radboud - Nijmegen	Nijmegen
Netherlands	University Medical Center Rotterdam at Erasmus Medical Center	Rotterdam
Netherlands	University Medical Center Utrecht	Utrecht

Sponsors (1)

Lead Sponsor	Collaborator
Jeroen Bosch Ziekenhuis

Country where clinical trial is conducted

Netherlands, 

References & Publications (1)

Lips DJ, Koebrugge B, Liefers GJ, van de Linden JC, Smit VT, Pruijt HF, Putter H, van de Velde CJ, Bosscha K. The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute? Study. BMC Surg. 2011 May 11;11:11. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Accrual rate (total number of pN0 patients included in the registration study monthly/center) (stage 1)			No
Primary	Rate of upstaging in pN0 colon cancer patients (stage 1)			No
Primary	Disease-free survival (DFS) at 3 years (stage 2)			No
Primary	Percentage of successful sentinel lymph node mapping procedures using multivariate analysis (stage 2)			No
Secondary	Overall survival (OS) at 3 years (stage 2)			No
Secondary	Stratified analysis of DFS and OS according to total harvested lymph nodes per resected specimen and chemotherapy regimen (capecitabine and oxaliplatin versus capecitabine alone) (stage 2)			No