Neoadjuvant therapy and radiation for rectal cancer

Phase 2 Study of Total Neoadjuvant mFOLFOX and Short-Course Radiotherapy in Resectable Rectal Cancer

This study is testing a new treatment plan that combines chemotherapy and radiation before surgery to see if it helps people with rectal cancer live longer without the disease coming back.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 54 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Virginia Commonwealth University (Academic / other)
• Drugs / interventions: chemotherapy, radiation
• Locations: 3 sites (Richmond, Virginia and 2 other locations)
• Trial ID: NCT04643366 on ClinicalTrials.gov

What this trial studies

This phase 2 trial evaluates the effectiveness of a treatment regimen combining four cycles of systemic chemotherapy with short-course radiation therapy for patients with resectable rectal cancer. Participants will receive concurrent 5-FU neoadjuvant chemoradiotherapy followed by additional chemotherapy cycles before surgery. The study aims to assess three-year disease-free survival rates, focusing on patients who achieve a clinical complete response or undergo total mesorectal excision. The trial seeks to determine the optimal approach to improve outcomes for rectal cancer patients.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with a pathologically confirmed diagnosis of adenocarcinoma of the rectum that meets specific staging criteria.

Not a fit: Patients with distant metastases or those with a performance status greater than 1 may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve disease-free survival rates for patients with resectable rectal cancer.

How similar studies have performed: Other studies have shown promising results with similar neoadjuvant approaches in rectal cancer, indicating potential for success in this trial.

Eligibility criteria

Inclusion Criteria:

* Pathologic diagnosis of adenocarcinoma of the rectum (diagnosis by tissue biopsy) within 90 days prior to registration. At least a portion of the tumor must be located below the peritoneal reflection or begin within 12 cm of the anal verge on flexible endoscopy
* Clinically staged (AJCC 8th ed.) T3-4 N0 M0 or T any N1-2 M0 based upon the following minimum diagnostic workup:

  * Colonoscopy, unless patient presents with an obstructing lesion
  * Within 30 days prior to registration:
* History/physical examination
* Imaging to exclude distant metastases: either contrast-enhanced CT of the chest, abdomen, and pelvis or whole-body PET-CT or MRI
* Pelvic MRI (preferred) or transrectal ultrasound (TRUS) for T staging Note: Patients may have initiated standard mFOLFOX6 treatment before study registration provided that they met the above criteria before initiating treatment and can feasibly continue to CRT according to the timeline described in Section
* ECOG Performance Status ≤2
* Age ≥ 18 years
* Adequate bone marrow function defined as follows:

  * Absolute neutrophil count (ANC) ≥ 1,200 cells/mm3
  * Platelets ≥ 100,000 cells/mm3
  * Hemoglobin ≥ 8.0 g/dL (Note: The use of transfusion or other intervention to achieve Hgb ≥8.0 g/dL is acceptable.)
* Adequate liver and renal function defined as follows:

  * AST and alkaline phosphatase \< 2.5 x upper limit of normal (ULN)
  * Bilirubin ≤ 2.5 ULN
  * Calculated creatinine clearance (CrCl) \> 30 mL/min using Cockcroft-Gault formula as calculated by the standard Cockcroft-Gault equation using age, actual weight, creatinine, and gender
* Must be deemed a candidate for curative resection by the surgical oncologist who will be performing the operation
* Women of childbearing potential (WCBP) must have a negative serum pregnancy test performed within 7 days prior to the start of chemotherapy.
* WCBP and men must agree to use a medically accepted form of birth control during the treatment and for 3 months following completion of chemotherapy.
* Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

* Prior RT that would result in unsafe overlap of RT fields with the planned study treatment, per the treating radiation oncologist
* Clinically significant cardiac disease, including major cardiac dysfunction, that in the opinion of the treating medical oncologist would preclude them from receiving systemic therapy with 5-fluorouracil, leucovorin or oxaliplatin.
* Serious (ie, ≥ grade 3) uncontrolled infection
* Pulmonary or respiratory condition that, in the opinion of the treating medical oncologist would preclude them from receiving systemic therapy with 5-fluorouracil, leucovorin or oxaliplatin.
* Major surgery within 28 days of study enrollment (other than diverting colostomy)
* History of inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis) requiring significant intervention (eg, hospitalization, surgery, immunosuppressive medications) that would, in the opinion of the investigator, preclude study therapy
* Prior known allergic reaction to 5-fluorouracil, leucovorin, or oxaliplatin
* Known dipyrimidine dehydrogenase deficiency (DPD)
* Any evidence of distant metastases (M1)
* Pregnant or breast feeding
* Medical, psychological, or social condition that, in the opinion of the investigator, may increase the patient's risk or limit the patient's adherence with study requirements

Where this trial is running

Richmond, Virginia and 2 other locations

• Virginia Cancer Institute — Richmond, Virginia, United States (Recruiting)
• Virginia Commonwealth University Massey Cancer Center — Richmond, Virginia, United States (Recruiting)
• VCU Community Memorial Healthcenter — South Hill, Virginia, United States (Recruiting)

Study contacts

• Principal investigator: Khalid Matin, MD — Massey Cancer Center
• Study coordinator: Massey IIT Research Operations, RN

Conditions Rectal Cancer; Resectable; Rectal