Exosomes in Rectal Cancer

Study Overview
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Brief Summary
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The primary aims of this study is to characterize exosomal biomarker levels in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation therapy. Compare rates of exosomal expression before during and after chemoradiation therapy with pathologic response rates at the time of APR or LAR. The researchers will also examine the functionality of these exosomes in malignant colonic organoids and mouse models of colorectal cancer.

Detailed Description
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All male and female patients, aged 18 and older with a histologically proven diagnosis of rectal adenocarcinoma, treated on this study will receive neo adjuvant chemotherapy (consisting of 5 FU or capecitabine) given concurrently with external beam radiation therapy to a dose of 50.4 Gy in 28 fractions. Radiation treatments will be administered daily, Monday thru Friday. Within one week prior to beginning chemotherapy and radiation treatments, a serum sample will be obtained from each patient. Patients will also have serum samples collected every two weeks during radiation, and on the last day of radiation therapy, as well as at their one month follow up visit after completion of radiation and prior to planned surgery. A final serum sample will be collected within one month after definitive surgery. Each serum sample collected will be less than 50 mL. The study will involve obtaining serum samples from patients before during and after chemoradiation therapy. These serum samples will be analyzed to determine exosomal biomarker levels, which will be correlated with clinical, imaging, laboratory, and pathologic data obtained from the medical record. Additional data from the patients' medical records will be collected, including demographic data, clinical information from notes in the medical record, radiology images and reports, results of diagnositic tests, and information from procedure notes and pathology reports.

Official Title
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Exosomal as Correlative Biomarker in Clinical Outcomes in Patients Undergoing Neoadjuvant Chemoradiation Therapy for Rectal Cancer

Conditions
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Rectal Cancer

Intervention / Treatment
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* Diagnostic Test: Blood Draw


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and Female Patients aged 18 and older histologically proven diagnosis of rectal adenocarcinoma will be receiving neoadjuvant chemoradiation therapy prior to a planned definitive surgical resection Exclusion Criteria: Age less than 18. Patients who are unable or unwilling to undergo definitive surgery. Patients with a prior history of pelvic external beam radiation, brachytherapy, or chemotherapy. Patients with a prior history of cancer (excluding non-melanoma skin cancers). Patients who are immunocompromised.

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Arm A<br>All patients enrolled will be placed in Arm A. Serum blood draw samples will be collected as well as additional data from medical records will be collected. This data includes demographic data, clinical information from notes, radiology images and reports, diagnostic test results, and procedure and pathology reports. | Diagnostic Test: Blood Draw<br>* Serum samples will be obtained from each patient enrolled<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Exosomal Biomarkers Assessment | Characterize exosomal biomarker levels in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation therapy. | up to 10 years after treatment completion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Exosomal Expression | Compare rates of exosomal expression before during and after chemoradiation therapy with pathologic response rates at the time of APR or LAR. Response rates will be graded based on College of American Pathologists Guidelines on neoadjuvant treatment effect, which consist of a 4 tiered grading system categorizing response to neoadjuvant chemoradiation as complete, moderate, minimal, or poor. These grades are routinely documented in pathology reports for patients undergoing neoadjuvant chemoradiation for rectal cancer and will be obtained from review of pathology reports in the patient medical records. | up to 10 years after treatment completion | 
| Exosomal Functionality Assessment | Examine the functionality of these exosomes in malignant colonic organoids and mouse models of colorectal cancer. | up to 10 years after treatment completion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neoadjuvant chemoradiation therapy, Low anterior resection, abdominoperineal resection, exosomes, biomarkers, external beam radiation