Celecoxib Combined With Fluorouracil and Leucovorin in Treating Patients With Resected Stage III Adenocarcinoma (Cancer) of the Colon

Study Overview
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Brief Summary
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RATIONALE: Drugs used in chemotherapy, such as fluorouracil and leucovorin, work in different ways to stop tumor cells from dividing so they stop growing or die. Celecoxib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. It is not yet known whether fluorouracil and leucovorin are more effective with or without celecoxib in treating resected stage III adenocarcinoma (cancer) of the colon. PURPOSE: This randomized phase III trial is studying celecoxib, fluorouracil, and leucovorin to see how well they work compared to fluorouracil and leucovorin in treating patients who have undergone surgery for stage III colon cancer.

Detailed Description
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OBJECTIVES: Primary Compare disease-free survival of patients with curatively resected stage III adenocarcinoma of the colon treated with adjuvant fluorouracil and leucovorin calcium with or without celecoxib. Secondary Compare the overall survival, the occurrence of new primary colon cancer, and the development of new polyps in patients treated with these regimens. OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to ≥ 4 tumor-positive lymph nodes (yes vs no), form of adjuvant chemotherapy (infusional vs bolus), low-dose aspirin for cardiovascular prophylaxis (yes vs no), and participating center. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive fluorouracil and leucovorin calcium IV for up to 6 courses in the absence of disease recurrence or unacceptable toxicity. Patients also receive oral celecoxib twice daily. Arm II: Patients receive oral placebo twice daily and fluorouracil and leucovorin calcium as in arm I. In both arms, treatment with celecoxib or placebo continues for 3 years in the absence of disease recurrence or unacceptable toxicity. Patients are followed annually for 2 years. PROJECTED ACCRUAL: A total of 1,450 patients (725 per treatment arm) will be accrued for this study within 2 years.

Official Title
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Multicenter, Double-Blind, Placebo-Controlled Randomized Phase III Study of Adjuvant Therapy With Celecoxib in Combination With Chemotherapy in Patients With Curatively Resected Stage III Colon Cancer

Conditions
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Colorectal Cancer

Intervention / Treatment
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* Drug: celecoxib
* Drug: fluorouracil
* Drug: leucovorin calcium
* Procedure: adjuvant therapy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed adenocarcinoma of the colon 15 cm above anal verge Stage III disease (any pT, N1-2, M0) No rectal cancer Must have undergone curative radical resection (R0 resection) within the past 6 weeks PATIENT CHARACTERISTICS: Age 18 and over Performance status WHO 0-1 Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hepatic AST ≤ 5 times upper limit of normal (ULN) Bilirubin ≤ 1.5 times ULN Renal Creatinine ≤ 1.5 times ULN Cardiovascular None of the following conditions within the past 6 months: Myocardial infarction Unstable angina Symptomatic congestive heart failure Serious uncontrolled cardiac arrhythmia Cerebrovascular accident or transient ischemic attack Deep vein thrombosis Other significant thromboembolic event Pulmonary No pulmonary embolism within the past 6 months Gastrointestinal No active gastric or duodenal ulceration within the past year No gastrointestinal bleeding within the past year No partial or complete bowel obstruction No known chronic malabsorption No active inflammatory bowel disease or chronic diarrhea (more than 4 stools/day) Other Not pregnant or nursing Fertile patients must use effective contraception HIV negative No AIDS-related illness No prior hypersensitivity to fluorouracil, leucovorin calcium, celecoxib, other COX-2 inhibitors, NSAIDs, salicylates, or sulfonamides No other severe acute or chronic medical condition or laboratory abnormality that would preclude study participation, study drug administration, or study results interpretation No psychological, familial, sociological, or geographical condition that would preclude study compliance No concurrent active infection No other malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or basal cell or squamous cell skin cancer PRIOR CONCURRENT THERAPY: Biologic therapy No concurrent sargramostim (GM-CSF) or molgramostim Chemotherapy Not specified Endocrine therapy No more than 4 weeks of concurrent orally/nasally inhaled steroids over a 6-month period Concurrent mometasone (or fluticasone) allowed if patients require ≥ 4 weeks of inhaled steroid therapy At least 30 days since other prior steroids No concurrent hormonal therapy Radiotherapy No concurrent radiotherapy Surgery See Disease Characteristics No prior total colectomy or other major surgery that would result in substantial alteration in transit to absorption of oral medication Other More than 30 days since prior investigational medication No prior systemic anticancer treatment for colon cancer No concurrent prophylactic fluconazole No concurrent lithium No concurrent chronic* use of full dose aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or cyclo-oxygenase-2 (COX-2) inhibitors Aspirin at cardioprotective doses (i.e., 80 mg daily or equivalent) allowed No concurrent participation in any other clinical study No other concurrent experimental agents (e.g., other COX-2 inhibitors, matrix metalloproteinase inhibitors, inhibitors of the vascular endothelial growth factor/Flk-1 pathway, or inhibitors of the epidermal growth factor receptor pathway) NOTE: *Chronic use is defined as a frequency of 7 consecutive days (1 week) for more than 3 weeks/year or more than 21 days throughout the year

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 120 Years

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
Masking: Double


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: celecoxib|nan|
|Drug: fluorouracil|nan|
|Drug: leucovorin calcium|nan|
|Procedure: adjuvant therapy|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease-free survival as measured by Logrank every 3 months in year 1, every 6 months in years 2-3, and annually thereafter |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival as measured by Logrank every 3 months in year 1, every 6 months in years 2-3, and annually thereafter |  |  | 
| Time occurrence of new primary colon cancer and new polyps as measured by Logrank every 3 months in year 1, every 6 months in years 2-3, and annually thereafter |  |  | 
| Toxicity as measured by CTC AE version 2.0 every 3 months in year 1, every 6 months in years 2-3, and annually thereafter |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adenocarcinoma of the colon, stage III colon cancer