Clinical trial NCT03594630: Active Surveillance and Chemotherapy Before Surgery in Treating Participants With Stage II-III Rectal Cancer
Official title: Organ Preservation With Active Surveillance After Chemoradiation in Rectal Cancer (OPTION)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: EARLY_PHASE1
Conditions: Rectal Adenocarcinoma
Stage II Rectal Cancer AJCC v8
Stage IIA Rectal Cancer AJCC v8
Stage IIB Rectal Cancer AJCC v8
Stage IIC Rectal Cancer AJCC v8
Stage III Rectal Cancer AJCC v8
Stage IIIA Rectal Cancer AJCC v8
Stage IIIB Rectal Cancer AJCC v8
Stage IIIC Rectal Cancer AJCC v8
Lead sponsor: M.D. Anderson Cancer Center
Sponsor class: OTHER
Collaborators: name: National Cancer Institute (NCI)
First posted: 2018-07-20
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This pilot trial studies how well active surveillance and chemotherapy before surgery work in treating participants with stage II-III rectal cancer. Active surveillance involves monitoring participants for additional tumor growth after receiving cancer treatment. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether deferring surgery after active surveillance and chemotherapy will work better in treating participants with stage II-III rectal cancer.

Detailed description: PRIMARY OBJECTIVES:

I. To quantify the rates of organ preservation and tumor regrowth with non-operative management of locally advanced rectal cancer in patients achieving a clinical complete response (cCR).

SECONDARY OBJECTIVES:

I. To correlate clinical, radiographic, and pathologic findings after neoadjuvant therapy for rectal cancer.

II. To determine the impact of active surveillance with deferral of surgery on oncologic outcomes.

III. To assess decision quality for patients with rectal cancer facing multiple treatment options.

IV. To explore the impact of patient-provider communication on patient decisions for surgical versus nonsurgical treatment decision for rectal cancer.

V. To assess safety of deferral of surgery in distal rectal cancer patients with possibility of cohort expansion to more proximal locally advanced rectal cancer patients.

CORRELATIVE OBJECTIVES:

I. Obtain tissue to monitor treatment response and any future biomarker analyses

OUTLINE: Participants are assigned to 1 of 2 groups.

GROUP I: Participants who have achieved clinical complete response undergo standard surgical resection.

GROUP II: Participants who have achieved clinical complete response receive active surveillance and consolidated chemotherapy for up to 4 months in the absence of disease progression or unacceptable toxicity. Participants with incomplete response or regrowth of tumor, undergo surgical resection as in Group I.

After the completion of study treatment, participants in Group I are followed up at 6 and 12 months, and then once a year for up to 3 years. Participants in Group II are followed up every 3 months for 18 months, every 6 months for 2 years, and then every year for up to 3 years.

Eligibility criteria: Inclusion Criteria:

* Histologically confirmed diagnosis of rectal adenocarcinoma
* Eligible for curative resection of rectal adenocarcinoma
* Rectal tumor location =\< 12 cm from the anal verge as determined by endoscopy or magnetic resonance imaging (MRI) (if endoscopy report is not available or deemed inadequate my treating oncologist)
* Nodal involvement confined to the radiation field
* Radiologically measurable or clinically evaluable disease as defined in the protocol
* Eastern Cooperative Oncology Group (ECOG) performance status (PS): 0, 1 or 2
* Clinical Stage: Stage II and III. N2 disease is to be estimated as four or more lymph nodes that are \>= 10 mm. Clinical staging should be estimated based on the combination of the following assessments: physical exam by the primary surgeon including digital rectal exam (DRE), computed tomography (CT) or positron emission tomography (PET)/CT scan of the chest/abdomen/pelvis and a pelvic MRI. If a pelvic MRI is performed, it is acceptable to perform CT of the chest/abdomen, omitting CT imaging of the pelvis. PET/CT is optional.
* No known contraindication to standard (fluoropyrimidine-based) pelvic chemoradiation (e.g. dihydropyrimidine dehydrogenase \[DPD\] deficiency)
* Patient of child-bearing potential is willing to employ adequate contraception during treatment and after treatment, as directed by treating clinical team
* Willing to provide written informed consent
* Willing to return to enrolling medical site for all study assessments

Exclusion Criteria:

* Diagnosis of inflammatory bowel disease (IBD)
* Diagnosis of MSI-H colorectal cancer at time of consent
* Recurrent rectal cancer
* Tumor is causing symptomatic bowel obstruction (patients who have diverting ostomy are eligible)
* Any prior pelvic radiation
* Other invasive malignancy undergoing active treatment. Patients receiving prior treatment that precludes standard chemoradiation or ability to receive consolidation/adjuvant chemotherapy will be excluded from survival analyses
* Patients unwilling or unable to undergo pelvic MRI

Primary outcomes:
measure: Overall organ preservation rate
timeFrame: At 12 months
measure: Local tumor regrowth rate
timeFrame: At 12 months
measure: Time to surgery or death
timeFrame: Up to 12 months
Secondary outcomes:
measure: Decision quality assessment determined by European Organization for Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ30+CR29)
timeFrame: Up to 3 years
measure: Overall survival (OS)
timeFrame: Up to 5 years
measure: Regression-free survival (RFS)
timeFrame: Up to 5 years
measure: Incidence of adverse events graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
timeFrame: Up to 5 years
measure: Surgical success rates
timeFrame: Up to 5 years
measure: Radiographic Findings
timeFrame: Up to 5 years
measure: Pathologic Findings
timeFrame: Up to 5 years
Other outcomes:
Locations:
city: Houston
country: United States
facility: M D Anderson Cancer Center
state: Texas
Study officials:
affiliation: M.D. Anderson Cancer Center
name: George Chang
role: PRINCIPAL_INVESTIGATOR
References: