Radiation Therapy, Irinotecan, and Cetuximab in Treating Patients Who Are Undergoing Surgery for Stage III or Stage IV Rectal Cancer

Sponsor

Centre Hospitalier Universitaire Vaudois (Other)

Overall Status

Unknown status

CT.gov ID

NCT00392470

Collaborator

(none)

Enrollment

Locations

6.7

Patients Per Site

Study Details

Study Description

Brief Summary

RATIONALE: Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs used in chemotherapy, such as irinotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving radiation therapy together with irinotecan and cetuximab before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

PURPOSE: This phase I trial is studying the side effects and best dose of irinotecan when given together with cetuximab and radiation therapy in treating patients who are undergoing surgery for stage III or stage IV rectal cancer.

Condition or Disease	Intervention/Treatment	Phase
Colorectal Cancer	Biological: cetuximab Drug: irinotecan hydrochloride Procedure: conventional surgery Procedure: neoadjuvant therapy Radiation: 3-dimensional conformal radiation therapy Radiation: intensity-modulated radiation therapy	Phase 1

Detailed Description

OBJECTIVES:

Primary

Determine the toxicity of irinotecan hydrochloride and cetuximab in patients with stage III or IV rectal cancer undergoing conformal or intensity-modulated radiotherapy.

Secondary

Determine the rate of pathologic response and histological degree of tumor regression in patients treated with this regimen.
Determine the complete resection rate (R0) in patients treated with this regimen.
Determine the sphincter preservation rate in patients treated with this regimen.
Determine the 30-day postoperative complication rate in patients treated with this regimen.
Determine the local and distant relapse rate and site of disease failure in patients treated with this regimen.
Estimate the predictive value of fludeoxyglucose F 18 positron emission tomography/CT scan for treatment response compared to endoscopic ultrasonography (EUS), CT scan, and MRI in patients treated with this regimen.
Determine the late toxicity of this regimen in these patients.
Determine the clinical (radiological) tumor response (i.e., MRI, CT scan, EUS) in patients treated with this regimen.

OUTLINE: This is a dose-escalation study of irinotecan hydrochloride.

Patients receive cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, 36, and 43 followed by irinotecan hydrochloride IV over 30 minutes on days 1, 8, 15, 22, and 29. Patients also undergo conformal radiotherapy or intensity-modulated radiotherapy on days 1-5 for 5 weeks. Patients undergo radical surgery 3-4 weeks after completion of neoadjuvant therapy.

Cohorts of 3-6 patients receive escalating doses of irinotecan hydrochloride until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

After completion of study treatment, patients are followed periodically for at least 5 years.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

20 participants

Primary Purpose:

Treatment

Official Title:

Neoadjuvant Conformal Radiotherapy and Concomitant CPT-11 and EGFR Inhibition With Cetuximab in Patients With Rectal Cancer Phase I Study

Study Start Date :

Aug 1, 2006

Outcome Measures

Primary Outcome Measures

Radiological (clinical) tumor response before surgery []
Pathologic response rate and histological degree of tumor regression as measured by Mandard TRG score []

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 74 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed adenocarcinoma of the rectum
T3-4 and/or N+ (stage IIIB, IIIC, or IV disease)
Liver or lung metastasis allowed
No recurrent disease

PATIENT CHARACTERISTICS:

WHO performance status 0 or 1
Hematologic, liver, and renal function normal
Considered fit for chemotherapy, radiotherapy, and surgery
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 3 months after completion of study treatment
No symptomatic heart disease or myocardial infarction during the past 6 months
No chronic inflammatory bowel disease
No malignant tumor during the past 5 years except for completely surgically resected carcinoma of the cervix or squamous cell carcinoma of the skin
No other concurrent malignant tumor

PRIOR CONCURRENT THERAPY:

No prior chemotherapy or radiotherapy for rectal cancer
No prior radiotherapy to the pelvis

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	Kantonsspital Aarau	Aarau	Switzerland	CH-5000
2	Institut Ludwig de Recherche sur le Cancer	Epalinges	Switzerland	1066
3	Centre Hospitalier Universitaire Vaudois	Lausanne	Switzerland	CH-1011