E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Adenocarcinoma of the medium/lower rectum in Stage II (cT3-4 N0) or Stage III (cT1-4, N1-2) |
Adenocarcinoma del retto medio/basso in stadio II (cT3-4 N0) o III (cT1-4, N1-2) |
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E.1.1.1 | Medical condition in easily understood language |
Tumor of the medium/lower rectal intestine in Stage II or Stage III |
Tumore dell'intestino retto medio/basso in stadio II o III |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10052360 |
E.1.2 | Term | Colorectal adenocarcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess if the risk of distant relapse in patients managed with Induction ChemoTherapy (ICT) and Chemo-RadioTherapy (CRT) followed by NOM and intensive follow-up is clinically acceptable |
Valutare il tasso di sopravvivenza senza comparsa di metastasi a distanza (distant relapse-free survival, DRFS) a 2,5 anni in pazienti gestiti con chemioterapia di induzione e chemio-radioterapia seguite da non-operative management (NOM) e follow-up intensivo. |
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E.2.2 | Secondary objectives of the trial |
- To assess whether the anticipation of standard adjuvant oxaliplatin-based chemotherapy prior to CRT increases the rate of clinical complete responses; - To assess the Local Recurrence (LR) rate, organ (rectum) preservation rate, and colostomy-free survival; - To assess Overall Survival (OS); - To assess the outcome of NOM in terms of patient-reported outcome measures [PROM] Translational Objectives, To determine association of: - 6-methylated gene panel (6-MGP) in liquid biopsy with local a/o relapse free survival; - ctDNA in liquid biopsy with local a/o relapse free survival; - stromal score in baseline tumor tissue biopsy with local response
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- Valutare se l¿anticipazione di chemioterapia prima di CRT aumenti il tasso di risposte cliniche complete; - Valutare il tasso di recidiva locale (LR), il tasso di conservazione dell'organo (retto) e la sopravvivenza libera da colostomia; - Valutare la sopravvivenza complessiva (OS); - Valutare l'esito della strategia NOM rispetto alla chirurgia standard in termini di patient reported outcome [PROM] Obiettivi Traslazionali, determinare l'associazione di: -pannello di geni metilati tumore-specifici (6-MGP) mediante biopsia liquida con sopravvivenza libera da recidive locali o a distanza; - DNA tumorale circolante (ctDNA) da biopsia liquida con sopravvivenza libera da recidive locali o a distanza; - stromal score nella biopsia del tessuto tumorale basale con risposta obiettiva locale.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Histologically confirmed diagnosis of adenocarcinoma of the medium/lower rectum; - Patients must have Stage II (cT3-4 N0) or Stage III (cT1-4, N1-2) tumor; - Locally advanced rectal cancer amenable to Total Mesorectal Excision (TME)/Abdominal-Perineal Amputation; - No evidence of distant metastases by chest, abdomen, and pelvis contrast enhanced CT scan (TC-PET WB is acceptable alternative in patient allergic to iodate contrast medium); - No prior pelvic radiation therapy; - No prior oncologic medical therapy or surgery for rectal cancer; - Age >18 years; - No infections requiring systemic antibiotic treatment; - Performance status 0-1 (ECOG Scale); - ANC > 1,5 cell/mm3, Hb > 8,0 g/dL, PLT > 150,000/mm3, total bilirubin or equal or 1,5 x upper limit of normal, AST < or equal to three times upper limit of normal, ALT < or equal to three times upper limit of normal; serum creatinine < or equal to 1,5 times the upper limit of normal; - Patients must read, agree to, and sign a statement of Informed Consent prior to participation; - Women with childbearing potential who are negative for pregnancy test (urine or blood) and who agree to use effective contraceptive methods; - Male subjects must also agree to use effective contraception |
- Diagnosi istologicamente confermata di adenocarcinoma del retto medio/basso; - Tumore in stadio II (cT3-4 N0) o III (cT1-4, N1-2); - Tumore rettale localmente avanzato per cui sia possibile total mesorectal excision (TME) / amputazione addomino-perineale; - Assenza di metastasi distanti mediante TC del torace-addome-pelvi (la TCPET WB è un’alternativa accettabile in pazienti allergici al mezzo di contrasto iodato); - Nessuna precedente radioterapia pelvica; - Nessuna precedente terapia medica oncologica o chirurgia per il cancro rettale; - Età > 18 anni; - Nessuna infezione che richiede un trattamento antibiotico sistemico; - Performance status 0-1 (scala ECOG); - ANC > 1,5 cellule mm3, Hb > 8,0 g/dL, PLT > 150,000/mm3, bilirubina totale <= 1,5 limiti superiori al normale, AST <= tre volte al limite superiore della norma, ALT <= tre volte al limite superiore della norma; livello creatinina <= 1,5 volte al limite superiore della norma; - I pazienti devono leggere, accettare e firmare una dichiarazione di consenso informato prima della partecipazione; - Le donne con potenziale riproduttivo devono risultare negative per il test di gravidanza (urina, sangue) e accettare l’adozione di metodi contraccettivi efficaci; - I soggetti maschi devono accettare di utilizzare una efficace contraccezione |
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E.4 | Principal exclusion criteria |
- Recurrent rectal cancer; - Patients with a history of any arterial thrombotic event within the past 6 months, including angina (stable or unstable), MI, or CVA; - Intolerance or contraindication to MR procedure; - Patients with any other concurrent medical or psychiatric condition that are unstable or could jeopardize the safety of the patient and his/her compliance in the study; - Gastro-intestinal abnormalities, inability to take oral medication, any condition affecting absorption; - Patients with a history of a prior malignancy within the past 5 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ cervical cancer; - Patients with a history of thrombotic episodes, such as deep venous thrombosis, pulmonary embolus, MI, or CVA occurring more than 6 months prior to enrollment may be considered for protocol participation, provided they are on stable doses of anticoagulant therapy. Patients who are anticoagulated for atrial fibrillation or other conditions may participate, provided they are on stable doses of anticoagulant therapy; - Patients receiving other anticancer or experimental therapy. |
- Cancro rettale recidivato; - Pazienti con anamnesi di qualsiasi evento trombotico arterioso negli ultimi 6 mesi, compresa l'angina (stabile o instabile), infarto del miocardio o CVA; - Pazienti con qualsiasi altra condizione medica o psichiatrica concomitante, che sono instabili o potrebbero mettere a repentaglio la sicurezza del paziente e la sua aderenza allo studio; - Anomalie gastrointestinali, incapacità di assumere farmaci orali, qualsiasi condizione che influenzi l'assorbimento di farmaci; - Precedente tumore maligno negli ultimi 5 anni, ad eccezione del tumore della cute basocellulare o squamocellulare trattati adeguatamente o del cancro della cervice uterina in situ. - I pazienti con anamnesi di episodi trombotici, quali trombosi venosa profonda, embolia polmonare, infarto del miocardio o CVA che si sono verificati più di 6 mesi prima dello screening, possono essere considerati per ‘arruolamento nel protocollo, purché siano in dosi stabili di terapia anticoagulante. Possono partecipare anche pazienti che sono in terapia anticoagulante per fibrillazione atriale o altre condizioni, a condizione che siano in dosi stabili di terapia anticoagulante; - Pazienti che ricevono altre terapie antitumorali o sperimentali. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Distant Relapse-Free Survival (DRFS) rate at 2.5 year |
Tasso di sopravvivenza libera da recidiva a distanza (distant relapse-free survival, DRFS) a 2,5 anni
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Clinical complete response rate; Local recurrence and organ preservation rate, colostomy-free survival; Overall survival; Patient reported outcomes (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30 and its colorectal cancer specific module QLQ-38) |
Tasso di risposta clinica completa; Tasso di recidiva locale, tasso di preservazione d¿organo (retto) e sopravvivenza libera da posizionamento di colostomia; Sopravvivenza complessiva (overall survival); Patient reported outcomes (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30 and its colorectal cancer specific module QLQ-38) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
5 years; 5 years; 5 years; 5 years |
5 anni; 5 anni; 5 anni; 5 anni |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Confronto con dati di letteratura riguardanti tasso di recidive a distanza a 2.5 anni. |
Comparison with literature data concerning recurrence rates at 2.5 years. |
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E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |