Consolidative Radiotherapy Plus Maintenance Chemotherapy for Metastatic Colorectal Cancer

Study Overview
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Brief Summary
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This study is a randomized phase II trial of maintenance chemotherapy versus consolidative radiotherapy plus maintenance chemotherapy for patients with unresectable metastatic colorectal cancer (MCRC).

Detailed Description
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Prior to accrual on the trial, patients with unresectable metastatic colorectal cancer will be treated with palliative chemotherapy. And patients who achieve a partial response or stable disease by imaging criteria will receive maintenance chemotherapy. In our study, these group patients will be randomized to maintenance chemotherapy or consolidative radiotherapy to all sites of disease (followed by maintenance chemotherapy at the medical oncologist's discretion). Choices of palliative and maintenance chemotherapy will be determined by the medical oncologist based on clinical appropriateness.

Official Title
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Maintenance Chemotherapy Versus Consolidative Radiotherapy Plus Maintenance Chemotherapy for Unresectable Metastatic Colorectal Cancer: A Randomized Phase II Trial

Conditions
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Metastatic Colorectal Cancer, Radiotherapy

Intervention / Treatment
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* Drug: maintenance chemotherapy
* Radiation: Consolidative Radiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients must have biopsy proven unresectable MCRC. Patients must have received induction chemotherapy for 3-6 months, and achieved stable disease or a partial response. Age ≥ 18 years Patients must have measurable disease at baseline. Patients can have up to only 5 discrete active extracranial lesions (≤3 in the liver and ≤3 in the lung) identified by position-emission tomography (PET) scan and also seen on correlative plain film, CT scan, or MRI within 8 weeks prior to the initiation of radiotherapy. Patients who previously received radiotherapy to the primary site will be ineligible if there is CT evidence of disease progression within the past 3 months. Patients must have a Karnofsky Performance Scores (KPS) >60 Aspartate aminotransferase, alanine aminotransferase & Alkaline phosphates must be ≤ 2.5 times the upper limit of normal (ULN). Total bilirubin must be within the limit of normal. Patients should have adequate bone marrow function as defined by peripheral granulocyte count of ≥1500/mm³. Patients should have adequate renal function (serum creatinine ≤1.5 times the ULN). Females of childbearing potential should have a negative pregnancy test. Patients who would be receiving radiation for lung lesions who are known or suspected by the treating radiation oncologist to have compromised lung function must have a documented forced expiratory volume in 1 second (FEV1) ≥ 1 litre. Patients must provide verbal and written informed consent to participate in the study. Total bilirubin: within normal institutional limits Exclusion Criteria: Patients with either untreated brain metastases or brain metastases treated within the past three months are ineligible Patients with serious, uncontrolled, concurrent infection(s). Significant weight loss (>10%) in the prior 3 months. Treatment for other carcinomas within the last five years, except cured non-melanoma skin and treated in-situ cancers. Patients with more than 5 discrete metastatic lesions. Participation in any investigational drug study within 4 weeks preceding the start of study treatment. Unwillingness to participate or inability to comply with the protocol for the duration of the study. Patients who are pregnant. Patients with reproductive capability will need to use adequate contraception during the time of participation in the study
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Radiation: SBRT or IMRT Drug: Maintenance chemotherapy
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Maintenance chemotherapy<br>FDA approved drugs for the study population: Bevacizumab, Xeloda | Drug: maintenance chemotherapy<br>* National Comprehensive Cancer Network (NCCN) or European Society for Medical Oncology (ESMO) suggested maintenance chemotherapy regimens: xeloda, bevacizumab<br>|
| Experimental: Radiotherapy<br>consolidative radiotherapy plus maintenance chemotherapy | Radiation: Consolidative Radiotherapy<br>* Stereotacticbodyradiationtherapy (SBRT) or intensity modulated radiation therapy (IMRT) for metastatic sites (less than 5)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression free survival | Evaluate the effect of consolidative radiotherapy with or without maintenance chemotherapy versus maintenance chemotherapy alone on progression free survival | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Actuarial rate in-field local control | To describe the actuarial rate in-field local control and rate of out-of-field disease progression | 2 years | 
| Toxicities | Acute toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v3.0 criteria during and up to 3 months after radiotherapy. Late toxicity was graded using the Radiation Therapy Oncology Group (RTOG)/European Organisation for the Research and Treatment of Cancer (EORTC) criteria. | 2 years | 
| Overall survival | To evaluate overall survival after consolidative radiotherapy followed by maintenance chemotherapy in comparison to maintenance chemotherapy alone. | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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maintenance treatment