E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rectal cancer |
Cáncer de recto |
|
E.1.1.1 | Medical condition in easily understood language |
rectal cancer |
cáncer de recto |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10038038 |
E.1.2 | Term | Rectal cancer |
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 evaluate the efficacy of neoadjuvant chemotherapy combination (5FU/LV + Oxaliplatin + nal-IRI) to determine the percentage of clinical responses after neoadjuvant treatment in patients with LARC. |
Evaluar la eficacia de la combinación de quimioterapia neoadyuvante (5FU / LV + Oxaliplatino + Nal-IRI) para determinar el porcentaje de respuestas clínicas después del tratamiento neoadyuvante en pacientes con cáncer rectal local avanzado (CRLA) |
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E.2.2 | Secondary objectives of the trial |
- Safety profile of neoadjuvant chemotherapy combination (5FU/LV + Oxaliplatin + Nal-IRI). - Efficacy in terms of OS, PFS and assessment of patients that will be able to go on a “watch-and-wait” strategy |
- Perfil de seguridad de la combinación de la quimioterapia neoadyuvante (5FU/LV + Oxaliplatin + Nal-IRI). - Eficacia en términos de SG (supervivencia global), SLP (supervivencia libre de progression) y evaluación de pacientes que podrán pasar a realizer la estrategia “watch & wait”. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or females, aged > or = 18 years. 2. Agree to participate and sign voluntary written ICF before any study specific procedure. 3. Patients with confirmed histopathological diagnosis of rectal cancer. 4. Patients with locally advanced rectal cancer T3-T4N0M0 or TxN+M0 and selected T2N0M0 candidates to watch & wait program. 5. Patients considered for neoadjuvant treatment according to usual clinical practice may also be potential candidates. 6. ECOG performance status 0 or 1. 7. Patients who can receive radiotherapy and chemotherapy. 8. No prior or concurrent malignant disease unless in complete remission for more than three years, except for adequately treated in situ carcinoma of the cervix, basal or squamous skin cell carcinoma or in situ transitional bladder cell carcinoma. 9. Women of childbearing potential (WOCBP) must have a negative serum pregnancy test before study entry. Both women and men must agree to use a highly effective contraceptive measure throughout the treatment period and for six months after discontinuation of treatment. 10. Adequate hematologic function 11. Adequate hepatic function 12. Adequate renal function 13. No peripheral neuropathy (< Grade 2) 14. No known history of dihydropyrimidine dehydrogenase deficiency (DPD) |
1. Hombres o mujeres, de edad > o = 18 años. 2. Aceptar participar y firmar voluntariamente el ICF por escrito antes de realizar cualquier procedimiento específico del estudio. 3. Pacientes con diagnóstico histopatológico confirmado de cáncer rectal. 4. Pacientes con cancer rectal local avanzado T3-T4N0M0 o TxN+M0 i T2N0M0 seleccionados candidatos para programa de “watch & wait“ 5. Los pacientes que son considerados para tratamiento neoadyuvante de acuerdo con la práctica clínica habitual también pueden ser candidatos potenciales para este estudio. 6. ECOG 0 o 1. 7. Pacientes que pueden recibir radioterapia y quimioterapia. 8. Ausencia de enfermedad maligna previa oactual, a menos que esté en remisión completa desde hace más de tres años. Excepción para carcinoma in situ del cuello uterino, el carcinoma de células cutáneas basales o escamosas o el carcinoma in situ de células transicionales de la vejiga adecuadamente tratados. . 9. Las mujeres en edad fértil deben tener una prueba de embarazo en suero negativa antes de su inclusión en elestudio. Tanto las mujeres como los hombres deben aceptar utilizar un método anticonceptivo altamente efectivo durante todo el período de tratamiento y durante seis meses después de la suspensióndel tratamiento. 10. Función hematológica adecuada 11. Función hepática adecuada 12. Función renal adecuada 13. Sin neuropatía periférica (<Grado 2) 14. Sin antecedentes conocidos de deficiencia de dihidropirimidina deshidrogenasa (DPD) |
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E.4 | Principal exclusion criteria |
1. Patients with ECOG performance status > or =2. 2. T1N0M0)or stage IV (TxNxM1) AJCC rectal cancer. 3. Any illness that the investigator considers will substantially increase the risk if the patient participates in the study. 4. Pregnant or breast-feeding woman. 5. Chronically active hepatitis B or C virus infection. 6. Active uncontrolled infection. 7. History, within last year, or presence of unstable angina, myocardial infarction, symptomatic congestive heart failure or asymptomatic left ventricular ejection fraction < 50% (assessed by multiple-gated acquisition scan or equivalent by ultrasound) or clinically significant valvular heart disease. 8. Peripheral neuropathy (> Grade 1) 9. Known history of dihydropyrimidine dehydrogenase deficiency (DPD) 10. Known or suspected reactions to any component of the study medication (5-FU, leucovorin, irinotecan or oxaliplatin) or to components of similar chemical or biologic composition. 11. Any phycological, familiar, sociological or geographical condition potentially hampering compliance with the study protocol or follow-up schedule. 12. Concurrent participation in any other clinical trial likely to interfere with the therapeutic schedule. 13. Patients that had received any previous treatment for their rectal cancer (surgery, chemotherapy or radiotherapy). |
1. Pacientes con estado de la repercusión funcional de la enfermedad ECOG > o = 2. 2. Cáncer rectal T1N0M0 o estadio IV (TxNxM1) según la clasificación AJCC TNM 3. Cualquier enfermedad que el investigador considere que aumentará sustancialmente el riesgo si el paciente participa en el estudio. 4. Mujer embarazada o lactante. 5. Infección crónicamente activa del virus de la hepatitis B o C. 6. Infección activa no controlada. 7. Antecedentes médicos, durante el año anterior, o presencia actual de angina inestable, infarto de miocardio, insuficiencia cardíaca congestiva sintomática o fracción de eyección ventricular izquierda asintomática <50% (evaluada por la adquisición de conducto múltiple o equivalente por ultrasonido) o enfermedad cardíaca valvular clínicamente significativa. 8. Neuropatía periférica (> Grado 1) 9. Antecedentes conocidos de deficiencia de dihidropirimidina deshidrogenasa (DPD) 10. Reacciones conocidas o sospechadas a cualquier componente de la medicación del estudio (5- FU, leucovorin, irinotecan u oxaliplatin) o a componentes de composición química o biológica similar. 11. Cualquier afección psicológica, o condición sociológica o geográfica que potencialmente pueda obstaculizar el cumplimiento del protocolo de estudio o el calendario de seguimiento. 12. Participación simultánea en cualquier otro ensayo clínico que pudiese interferir con el plan terapéutico. 13. Pacientes que han recibido algún tratamiento previo para su cáncer rectal (cirugía, quimioterapia o radioterapia). |
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E.5 End points |
E.5.1 | Primary end point(s) |
cCR rate (ycT0N0) in LARC patients treated with chemo - chemoradiation. |
Tasa de Respuesta Clínica Completa (ycT0N0) en pacientes CRLA tratados con quimio-quimioradioterapia. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
at 7-8 months |
a los 7-8 meses |
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E.5.2 | Secondary end point(s) |
Efficacy: • Overall survival: will be determined from the initiation date of chemotherapy treatment to the date of death from any cause. • Relapse-free survival or disease-free survival: will be determined by the length of time after chemo – chemoradiotherapy treatment during which no disease is found. Patient survives without any signs and symptoms of the cancer. • Percentage of patients that follow the “watch-and-wait” surveillance protocol.
Safety: • Overall toxicity: acute and late toxicity of neoadjuvant treatment (chemo and chemoradiotherapy) according to the Common Toxicity Criteria (CTC) for adverse events (AE). |
Eficacia: • Supervivencia global: se determinará desde la fecha de inicio del tratamiento de quimioterapia hasta la fecha de fallecimiento por cualquier causa. • Supervivencia libre de recaída o supervivencia libre de enfermedad: se determinará en función del tiempo transcurrido después del tratamiento con quimio - quimioradioterapia durante el cual no se manifiesta ninguna enfermedad. Esto es, el paciente sobrevive sin signos ni síntomas del cáncer. • Porcentaje de pacientes que siguen el protocolo de seguimiento "watch & wait".
Seguridad • Toxicidad general: toxicidad aguda y tardía del tratamiento neoadyuvante (quimioterapia y quimiorradioterapia) según el CTCAE (“Common Toxicity Criteria for Adverse Events”). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Efficacy: Through the study Safety: Through the study |
Eficacia: a lo largo del estudio Seguridad: a lo largo del estudio |
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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 | No |
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 | No |
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 | 4 |
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 | No |
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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Last Subject Last Visit |
Última visita del último paciente |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 2 |