Prospectively Randomized Control Clinical Trial of FOLFOXIRI Preoperative Chemotherapy Alone on Rectal Cancer in Local Advance Comparing to Oral Capecitabine Combined With Long-term Radiation

  • STATUS
    Recruiting
  • End date
    Sep 25, 2028
  • participants needed
    776
  • sponsor
    Sun Yat-sen University
Updated on 14 February 2022
renal function
calcium
fluorouracil
obstruction
metastasis
oxaliplatin
chemoradiotherapy
capecitabine
leucovorin
irinotecan
pelvic mri
adenocarcinoma
adenocarcinoma of rectum
rectal surgery
xelox
total mesorectal excision

Summary

Preoperative radiation and chemotherapy is the standard treatment for local advanced rectal cancer. The addition of oxaliplatin to capecitabine combined with radiotherapy does not improve local control and long-term survival. Most importantly,chemoradiotherapy significantly increased surgical complication and poor long-term quality of life .In the absence of effective measures of predicting chemo-sensitivity, there is considerable risk of using any two-drug regimen for neoadjuvant therapy. Simultaneous use of the three chemotherapeutic drugs may be able to reduce the likelihood of resistance to both dual drug regimen and single drug regimen. The purpose of this study is to compare the efficacy and safety of three chemotherapeutic regimen known as FOLFOXIRI (the drug 5-fluorouracil, oxaliplatin, Irinotecan) with standard radiotherapy combined with capecitabine in neoadjuvant therapy for local advanced rectal cancer. The drugs in the FOLFOXIRI regimen are all FDA(Food and Drug Administration) approved and have been used routinely to treat patients with advanced colorectal cancer.

Description

Outline: This is a multicenter,prospectively,randomized control ,phase III clinical study.Patients are stratified according to the distance from the tumor to the anal margin5cm>5cm and randomized to 1 of 2 treatment regimen.Patients will receive full supportive care while on this study.

Objectives

Primary: To compare neoadjuvant chemotherpay of FOLFOXIRI with conventional capecitabine single-agent radiotherapy in local advanced rectal cancer with respect to 3-year disease free survival rate (DFS) .

Secondary
  1. To compare postoperative 3-year local recurrence rate, 3-year distance metastasis free survival rate, 3-year overall survival between neoadjuvant FOLFOXIRI with capecitabine single-agent radiotherapy groups.
  2. To compare R0 Resection rate and surgical complication between the two groups.
  3. To evaluate the tumor regression grade(TRG) between the two groups.
  4. To evaluate the adverse event profile and Long term quality of life between the two groups.

Details
Condition Rectal Cancer
Treatment XELOX, FOLFOXIRI, Chemoradiotherapy, TME operation, efficacy evaluation
Clinical Study IdentifierNCT03671252
SponsorSun Yat-sen University
Last Modified on14 February 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Age: 18 to 75 years old
Histological diagnosis of rectal adenocarcinoma
Distance form anal margin 5cm: cT3-4aN + M0, there is no distant metastasis, lymph node positive, or the tumor breaking through the muscular layer, no invasion of the adjacent organs , positive MRF, it is estimated that R0 resection can be performed
From the anal margin>5cm: cT3c-4aN+M0, there is no distant metastasis, lymph node positive, or the tumor breaking through the muscular layer with invading the mesorectum more than 5mm, no invasion of the adjacent organs, positive MRF, it is estimated that R0 resection can be performed
Preoperative staging method: All patients undergoing anal examination, high-resolution MRI and/or EUS for preoperative staging. The diameter of parenteral lymph node 10mm, lymph node shape or the MRI characteristics is consistent with typical lymph node metastasis. If combined with EUS, the material should be submitted to the central assessment team for judgment when there is a contradiction in the staging method. Preoperative chest and abdomen CT, pelvic MRI are used for excluding distant metastasis
Confirmed as the lower edge of tumor is located within 12 cm from the anal margin by MRI examination
There is no signs of intestinal obstruction, or obstruction of intestinal after treating with proximal colostomy has been relieved
Patients did not previously receive rectal surgery, chemotherapy or radiation therapy , biological treatment , except for endocrine therapy
ECOG Performance Status :0-1
Life expectancy: more than 2 years
Laboratory valuesHematology: white blood cell count>4000/mm3; Platelet count>100000/mm3; Hemoglobin >10g/dL; Liver function: SGOT and SGPT < 1.5 upper limit of normal(ULN); Bilirubin< 1.5mg/dL; Renal function :Creatinine <1.8mg/dL

Exclusion Criteria

Tumor invasion of surrounding tissue organs (T4b) by preoperative staging assessment
Obturator lymph node metastasis
Arrhythmia requires treatment with antiarrhythmia (except for beta-blockers or digoxin), symptomatic coronary artery disease, myocardial ischemia (myocardial infarction within the last 6 months) or congestive heart failure exceeding NYHA class II
Severe hypertension with poor control
History of HIV infection or active phase of chronic hepatitis B or C infection with high copy viral DNA
Other active serious infections according to NCI-CTC version 4.0
There is preoperative evidence for distant metastasis outside pelvis
Cachexia and organ function decompensation
History of pelvic or abdominal radiotherapy
Multiple primary cancer
Patients with epilepcy requiring treatment ( steroids or antiepileptic treatment)
History of other malignant tumors within 5 years, except for cured cervical carcinoma in situ or skin basal cell carcinoma
Drug abuse and medical, psychological or social conditions interfering patient participation in research or the evaluation of research results
Any allergy to clinical research drugs or any drugs associated with this study
Any unstable condition or condition that may endanger safety and compliance of patients
Pregnancy or the lactating female without adequate contraception
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