E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Locally recurrent rectal cancer |
Lokaal recidief rectum carcinoom |
|
E.1.1.1 | Medical condition in easily understood language |
Locally recurrent rectal cancer |
Lokaal teruggekeerde endeldarmkanker |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare the rate of resections with clear margins between both arms. |
Het vergelijken van het aantal radicale resecties tussen de beide behandelarmen. |
|
E.2.2 | Secondary objectives of the trial |
• To compare the local re-recurrence free survival.
• To compare the progression free survival
• To compare the metastasis free survival
• To compare the disease free survival
• To compare the overall survival
• To determine and compare the pathologic response
• To assess the objective radiological response to the neoadjuvant treatment
• To determine the toxicity related to the administration of induction chemotherapy
• To determine the compliance to induction chemotherapy in the experimental arm
• To compare the toxicity related to the administration of chemoradiotherapy
• To compare the compliance to chemoradiotherapy
• To compare the number of patients undergoing surgery
• To compare surgical characteristics
• To compare the rate of major surgical complications
• To compare the quality of life
• To determine the cost-effectiveness and –utility
• To systematically collect blood and tissue samples from enrolled patients for future translational research |
• Vergelijken van de lokaal recidief vrije overleving
• Vergelijken van de progressie vrije overleving
• Vergelijken van de metastase vrije overleving
• Vergelijken van de ziektevrije overleving
• Vergelijken van de algehele overleving
• Vergelijken van de pathologische respons
• Vaststellen van de objectieve radiologische respons op de neoadjuvante behandeling
• Inductie chemotherapie gerelateerde toxiciteit
• Therapietrouw inductie chemotherapie
• Chemoradiotherapie gerelateerde toxiciteit
• Therapietrouw chemoradiotherapie
• Vergelijken van het aantal patiënten dat geopereerd wordt tussen beide armen.
• Vergelijken chirurgische karakteristieken tussen beide armen.
• Vergelijken chirugische complicaties tussen beide armen.
• Vergelijken kwaliteit van leven tussen beide armen.
• Bepalen kosteneffectiviteit en - utiliteit.
• Afname bloed en weefsel samples voor toekomstig translationeel onderzoek. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• 18 years or older
• Confirmed local recurrent rectal cancer after total or partial mesorectal resection for rectal cancer either by histopathology ór clinically proven (evidence on imaging in combination with clinical findings, with consensus in MDT)
• Resectable disease determined by magnetic resonance imaging (MRI) or deemed resectable after neoadjuvant treatment with chemoradiotherapy
• WHO performance score 0-1
• Written informed consent |
• 18 jaar of ouder
• Lokaal recidief na eerdere totale of partiele mesorectale resctie bevestigd middels hisopathologie óf klinisch bewezen door middel van een combinatie van beeldvorming en klinische gegevens, waarbij consensus in MDO
• Resectabel ziekte, middels MRI beoordeeld, danwel resectabel geachte ziekte na neoadjuvante behandeling met chemoradiotherapie
• WHO performance status 0-1
• Geschreven informed consent |
|
E.4 | Principal exclusion criteria |
• Radiological evidence of systemic metastatic disease (e.g. liver, lung) at time of randomisation or in the six months prior to randomisation
• Homozygous DPD deficiency
• Any chemotherapy in the past 6 months
• Any contraindication for the planned chemotherapy (e.g. severe allergy, pregnancy, kidney dysfunction with creatinine clearance of <30ml/min, thrombocytopenia of <100x109/L), as determined by the medical oncologist
• Radiotherapy in the past 6 months for primary rectal cancer
• Any contraindication for the planned chemoradiotherapy (e.g. severe allergy to chemotherapy agent, no possibility for radiotherapy due to previous radiotherapy), as determined by the medical oncologist and/or radiation oncologist
• Any contraindication for surgery, as determined by the surgeon and/or anaesthesiologist
• Concurrent malignancies that interfere with the planned study treatment or the prognosis of resected LRRC. |
• Radiologische aanwijzingen voor afstandsmetastasen ten tijde van randomisatie of in de afgelopen 6 maanden
• Homozygote DPD deficiëntie
• Chemotherapie in de afgelopen 6 maanden
• Contraindicatie voor de geplande chemotherapie (bijv. allergie, zwangerschap, nierfalen met een kreatinine klaring <30ml/min, thrombocytopenie <100x109/L), zoals bepaald door de medisch oncoloog
• Radiotherapie in de afgelopen maanden in verband met primair rectum carcinoom
• Contraindicatie voor de geplande chemoradiotherapie (bijv. allergie, geen mogelijk tot het geven van radiotherapie in verband met eerdere radiotherapie), zoals bepaald door de medisch oncoloog en/of radiotherapeut
• Contraindicatie voor chirurgie, zoals bepaald door de chirurg en/of anesthesist
• Het aanwezig zijn van een andere maligniteit die interfereert met de geplande studie behandeling of de prognose van geopereerd recidief rectum carcinoom |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Rate of patients with a clear resection margin |
Percentage patiënten met een radicale resectie |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
After histopatholical evaluation.
For the last included patient, this will be approximately 4.5 years after inclusion of the first patient. |
Na histopathologische evaluatie.
Voor de laatst geïncludeerde patiënt zal dit ongeveer 4.5 jaar na inclusie van de eerste patiënt zijn. |
|
E.5.2 | Secondary end point(s) |
• local re-recurrence free survival > 3&5 year follow-up
• progression free survival > 3&5 year follow-up
• metastasis free survival > 3&5 year follow-up
• disease free survival > 3&5 year follow-up
• overall survival > 3&5 year follow-up
• pathologic response > after histopathological evaluation postoperative
• toxicity of induction chemotherapy > 1 months achter finishing induction chemotherapy
• compliance rate to induction chemotherapy > after restaging MRI/before start of chemoradiotherapy in case of stable or responsive disease
• toxicity of chemoradiotherapy > 1 month after finishing chemoradiotherapy
• compliance rate to chemoradiotherapy > after restaging MRI/before surgery in case of stable or responsive disease
• number of patients undergoing surgery > after last patient finished neoadjuvant treatment and did/did not proceed to surgery
• surgical characteristics > directly postoperative
• major surgical morbidity rate > 90-days postoperative
• radiological response > after restaging MRI has been performed after finishing neoadjuvant treatment
• quality of life > at inclusion, and 3 and 12 months postoperative
• cost-effectiveness > at inclusion, and 3 and 12 months postoperative |
• lokaal recidief vrije overleving > 3&5 jaar follow-up
• progressive vrije overleving > 3&5 jaar follow-up
• metastase vrije overleving > 3&5 jaar follow-up
• ziektevrije overleving > 3&5 jaar follow-up
• algehele overleving > 3&5 jaar follow-up
• pathologische respons > na histopathologische evaluatie postoperatief
• toxiciteit van inductie chemotherapie > 1 maand na het beëindigen van de inductie chemotherapie
• percentage patiënten dat volledige inductie chemotherapie completeert > na de MRI herstadiëring/voor de start van de chemoradiotherapie in het geval van stabiele of responderende ziekte
• toxiciteit van chemoradiotherapie > 1 maand na het beëindigen van de chemoradiotherapie
• percentage patiënten dat volledige chemoradiotherapie completeert > na de MRI herstadiëring/voor operatie in het geval van stabiele of responderende ziekte
• aantal patiënten dat geopereerd wordt > nadat de laatste patiënt neoadjuvante behandeling beëindigd heeft en wel/niet geopereerd wordt
• chirurgische karakteristieken > direct postoperatief
• ernstige chirurgische morbiditeit > 90-dagen postoperatief
• radiologische response > nadat herstadiërings MRI is gemaakt na het beëindigen van de neoadjuvante behandeling
• kwaliteit van leven > bij inclusie en 3 en 12 maanden postoperatief
• kosteneffectiviteit > bij inclusie en 3 en 12 maanden postoperatief |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
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 | No |
E.6.5 | Efficacy | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
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 | Yes |
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 |
Geen inductie chemotherapie |
No induction chemotherapy |
|
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 5 |
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 | Yes |
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
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 9 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 8 |