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Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Had Surgery for Stage II or Stage III Rectal Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), January 2009
Sponsors and Collaborators: Eastern Cooperative Oncology Group
National Cancer Institute (NCI)
National Surgical Adjuvant Breast and Bowel Project (NSABP)
North Central Cancer Treatment Group
National Cancer Institute of Canada
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00303628
  Purpose

RATIONALE: Drugs used in chemotherapy, such as oxaliplatin, leucovorin, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving more than one drug (combination chemotherapy) together with bevacizumab after surgery may kill any tumor cells that remain after surgery. It is not yet known whether oxaliplatin, leucovorin, and fluorouracil is more effective with or without bevacizumab in treating rectal cancer.

PURPOSE: This randomized phase III trial is studying combination chemotherapy to see how well it works with or without bevacizumab in treating patients who have had surgery for stage II or stage III rectal cancer.


Condition Intervention Phase
Colorectal Cancer
Drug: bevacizumab
Drug: fluorouracil
Drug: leucovorin calcium
Drug: oxaliplatin
Phase III

MedlinePlus related topics: Cancer Colorectal Cancer
Drug Information available for: Leucovorin Calcium Citrovorum factor Folinic acid calcium salt pentahydrate Leucovorin Bevacizumab Fluorouracil Oxaliplatin Calcium gluconate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized
Official Title: Intergroup Randomized Phase III Study of Postoperative Oxaliplatin, 5-Fluorouracil and Leucovorin vs Oxaliplatin, 5-Fluorouracil, Leucovorin and Bevacizumab for Patients With Stage II or III Rectal Cancer Receiving Pre-Operative Chemoradiation

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Tolerability [ Designated as safety issue: Yes ]
  • Patterns of failure (local/regional and distant recurrence) [ Designated as safety issue: No ]
  • Disease-free survival [ Designated as safety issue: No ]

Estimated Enrollment: 2100
Study Start Date: February 2006
Estimated Primary Completion Date: May 2020 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Active Comparator
Patients receive oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV on day 1 followed by fluorouracil IV continuously over 46 hours on days 1 and 2. Treatment repeats every 2 weeks for up to 12 courses.
Drug: fluorouracil
Given IV
Drug: leucovorin calcium
Given IV
Drug: oxaliplatin
Given IV
Arm II: Experimental
Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive oxaliplatin, leucovorin calcium, and fluorouracil as in arm I.
Drug: bevacizumab
Given IV
Drug: fluorouracil
Given IV
Drug: leucovorin calcium
Given IV
Drug: oxaliplatin
Given IV

Detailed Description:

OBJECTIVES:

Primary

  • Compare the overall survival of patients who have undergone prior surgery and neoadjuvant chemoradiotherapy for clinical stage II or III rectal cancer treated with adjuvant oxaliplatin, leucovorin calcium, fluorouracil with vs without postoperative bevacizumab.

Secondary

  • Evaluate tolerance of treatment, patterns of failure, and disease-free survival in patients treated with these regimens.
  • Assess long-term rectal function using the Patient Bowel Function/Uniscale questionnaire and the Functional Assessment of Cancer (FACT)-Diarrhea subscale in patients treated with these regimens.
  • Validate the FACT-Diarrhea subscale.
  • Assess long-term symptoms of oxaliplatin-related neurotoxicity using the FACT/GOG-Neurotoxicity subscale in patients treated with these regimens.
  • Correlate TS, DPD and TP expression (key targets for fluorouracil); retention of chromosome 18q alleles and microsatellite instability (MSI) with TGFβ1RII mutation (markers for fluorouracil efficacy); ERCC1, ERCC2, and XPF expression (participants in repair of adducts from oxaliplatin); and p53 gene mutation and possibly other molecular markers pertinent to vascular endothelial growth factor in tumor tissue specimens with treatment efficacy in these patients.
  • Correlate tumor molecular prognostic markers (chromosome 18q allelic loss and MSI) with survival in patients treated with this regimen.

OUTLINE: This is a randomized study. Patients are stratified according to ECOG performance status (0 vs 1), clinical staging (high risk [T3, N+, M0 or T4, any N, M0] vs low risk [T1-2, N+, M0 or T3, N0, M0]), prior pre-operative oxaliplatin (yes vs no), and prior radiotherapy dose (40-50 Gy vs > 50-55.8 Gy pre-operatively). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV on day 1 followed by fluorouracil IV continuously over 46 hours on days 1 and 2. Treatment repeats every 2 weeks for up to 12 courses* in the absence of disease progression or unacceptable toxicity.
  • Arm II: Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive oxaliplatin, leucovorin calcium, and fluorouracil as in arm I*.

NOTE: *Patients who received prior neoadjuvant oxaliplatin including patients on protocol NSABP-R-04 receive up to 9 courses of treatment followed by leucovorin calcium IV and fluorouracil IV with (arm II) or without (arm I) bevacizumab for up to 3 courses.

Patients complete 10-15 minute questionnaires about bowel function 4 times during study treatment.

After completion of study treatment, patients are followed periodically for approximately 10 years.

PROJECTED ACCRUAL: A total of 2,100 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed adenocarcinoma of the rectum meeting 1 of the following clinical (e.g., before neoadjuvant therapy) or pathologic staging criteria:

    • T3, N+, M0
    • T3, N0, M0
    • T4, N0, M0
    • Any T, N1-2, M0
    • T4, N0-2, M0 disease must meet 1 of the following criteria:

      • Clinically fixed tumor on rectal examination with tumor adherent to the pelvic sidewall or sacrum
      • Hydronephrosis on CT scan or IVP
      • Ureteric or bladder invasion as documented by cystoscopy and cytology or biopsy
      • Invasion into prostate
      • Vaginal or uterine involvement
  • Must have undergone complete tumor resection ≥ 28 days ago and able to begin treatment by day 56

    • No evidence of metastatic disease on the surgical/intraoperative examination
  • Must have undergone concurrent neoadjuvant chemoradiotherapy*

    • Must have undergone prior radiotherapy at a dose of 40-55.8 Gy** AND received 1 of the following chemotherapy regimens:

      • Continuous infusion of fluorouracil with or without oxaliplatin
      • Fluorouracil and leucovorin calcium
      • Capecitabine with or without oxaliplatin
      • Oxaliplatin and capecitabine OR a continuous infusion of fluorouracil and oxaliplatin received on protocol NSABP-R-04 NOTE: *Neoadjuvant chemoradiotherapy received on protocol NSABP-R-04 allowed provided it met these criteria

NOTE: **Intensity-modulated radiotherapy allowed

  • No evidence of metastatic disease confirmed by CT scan, MRI, or ultrasound of the liver or chest CT scan or chest x-ray within the past 6 months
  • No evidence of tumor outside of the pelvis, including liver metastases, peritoneal seeding, or metastatic inguinal lymphadenopathy

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • Platelet count ≥ 100,000/mm^3
  • Absolute granulocyte count ≥ 1,500/mm^3
  • Bilirubin normal (unless chronic grade 1 bilirubin elevation due to Gilbert's disease or similar syndrome due to slow conjugation of bilirubin)
  • Alkaline phosphatase (AP) < 2.5 times upper limit of normal (ULN) and AST < 1.5 times ULN
  • Hepatitis B and C negative (for patients with AP > normal) unless previously vaccinated
  • Serum creatinine ≤ 1.5 times ULN
  • Urine protein:creatinine (UPC) ratio < 1.0 OR urine protein < 1 g on 24-hour urine collection
  • INR ≤ 1.5

    • INR > 1.5 allowed provided patient is on full-dose anticoagulants AND meets all of the following criteria:

      • In-range INR (i.e., between 2 and 3) on a stable dose of warfarin or low molecular weight heparin
      • No active bleeding or pathological condition that is associated with a high risk of bleeding
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for at least 3 months after study treatment
  • No other previous or concurrent malignancy except nonmelanoma skin cancer, breast cancer in situ, carcinoma in situ of the cervix, or previously treated nonpelvic cancer that has been disease-free for > 5 years

    • Patients with a history of breast cancer (without evidence of disease) who remain on hormonal therapy for > 5 years are eligible
  • No active bleeding not related to the primary rectal tumor within the past 6 months
  • No active inflammatory bowel disease or other serious medical illness which might limit the ability of the patient to receive protocol therapy
  • No active gastroduodenal ulcer determined by endoscopy
  • No serious or nonhealing wound, skin ulcer, or bone fracture
  • No clinically significant peripheral sensory or motor neuropathy ≥ grade 2
  • No nonmalignant systemic disease (e.g., cardiovascular, renal, or hepatic) that would preclude study treatment including, but not limited to, any of the following:

    • New York Heart Association class III or IV congestive heart failure
    • Concurrent symptomatic arrhythmia
  • No transient ischemic attack or cerebrovascular accident
  • No arterial thromboembolic event, unstable angina, or myocardial infarction within the past 12 months
  • No significant peripheral vascular disease
  • No psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude study requirements
  • Patients with a history of hypertension must have blood pressure < 150/90 mm Hg AND be on a stable regimen of antihypertensive therapy
  • No significant traumatic injury within the past 28 days
  • No known allergy to platinum compounds

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No other prior chemotherapy or pelvic radiotherapy except as neoadjuvant treatment for current diagnosis of rectal cancer
  • No prior invasive procedure, including either of the following:

    • Major surgical procedure or open biopsy within the past 28 days
    • Core biopsy or other minor procedure, except placement of a vascular access device, within the past 7 days
  • No concurrent major surgery
  • Concurrent participation on protocol NSABP-R-04 allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00303628

  Show 613 Study Locations
Sponsors and Collaborators
Eastern Cooperative Oncology Group
National Surgical Adjuvant Breast and Bowel Project (NSABP)
North Central Cancer Treatment Group
National Cancer Institute of Canada
Investigators
Study Chair: Al B. Benson, MD, FACP Robert H. Lurie Cancer Center
Investigator: Neal J. Meropol, MD Fox Chase Cancer Center
Study Chair: Nicholas J. Petrelli, MD Helen F. Graham Cancer Center at Christiana Hospital
Study Chair: Frank Sinicrope, MD Mayo Clinic
Study Chair: J. D. Brierley, MD Princess Margaret Hospital, Canada
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site
Featured trial article  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000467561, ECOG-E5204, NSABP-ECOG-E5204, NCCTG-ECOG-E5204
Study First Received: March 15, 2006
Last Updated: January 15, 2009
ClinicalTrials.gov Identifier: NCT00303628  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage II rectal cancer
stage III rectal cancer
adenocarcinoma of the rectum

Study placed in the following topic categories:
Digestive System Neoplasms
Rectal Neoplasms
Gastrointestinal Diseases
Colonic Diseases
Leucovorin
Bevacizumab
Intestinal Diseases
Rectal Diseases
Intestinal Neoplasms
Rectal neoplasm
Calcium, Dietary
Oxaliplatin
Digestive System Diseases
Fluorouracil
Gastrointestinal Neoplasms
Adenocarcinoma
Rectal cancer
Colorectal Neoplasms

Additional relevant MeSH terms:
Antimetabolites
Antimetabolites, Antineoplastic
Vitamin B Complex
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Growth Substances
Physiological Effects of Drugs
Angiogenesis Inhibitors
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Vitamins
Growth Inhibitors
Angiogenesis Modulating Agents
Micronutrients

ClinicalTrials.gov processed this record on January 16, 2009