IMPROVE Intervention Trial Implementing Non-invasive Circulating Tumor DNA Analysis to Optimize the Operative and Postoperative Treatment for Patients With Colorectal Cancer (IMPROVE-IT)

Karen-Lise Garm Spindler

Status and phase: Enrolling; Phase 2

Conditions: Adjuvant Chemotherapy; Circulating Tumor DNA; Progression Free Survival; Colorectal Cancer

Treatments: Other: Intensified Follow-up Schedule; Drug: Capox (or FOLFOX) including flouropyrimidine and oxaliplatin combination chemotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT03748680

KFE-1803

Details and patient eligibility

About

A open label 1:1 randomized phase II exploratory study investigating adjuvant therapy in patients with molecular biologically detectable residual disease after primary resection for localized colorectal tumors.

Full description

The main clinical hypothesis is that patients having undergone radical resection from CRC do not present with detectable tumor DNA in the plasma, whereas patients with detectable tumor DNA two weeks' post surgery have residual microscopic disease, and consequently a high risk of diseases recurrence which can be prevented with adjuvant chemotherapy.

The primary aim of the present study is to investigate - in a randomized trial - if use of standard adjuvant chemotherapy therapy improves the disease free survival in patients with molecular biological residual disease where adjuvant chemotherapy is not standard treatment .

Secondary aims include investigating molecular biological response to adjuvant chemotherapy in patients with post-operative ctDNA.

Enrollment: 64 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Surgically removed Adenocarcinoma of the colon or rectum
• Pathologically stage I or II disease, and radical resection
• Detectable ctDNA in two weeks postoperative plasma sample
• No indication for adjuvant chemotherapy according to DCCG guidelines (website)
• Age at least 18 years
• ECOG performance status 0-2
• Clinically eligible for adjuvant chemotherapy at investigators decision.
• Adequate bone marrow, liver and renal function allowing systemic chemotherapy (Absolute neutrophil count ≥1.5x109/l and thrombocytes ≥ 100x109/l. Bilirubin ≤ 1.5 x upper normal value and alanine aminotransferase ≤ 3 x upper normal value, and Calculated or measured renal glomerular filtration rate at least 30 mL/min)
• Anticonception for fertile women and for male patients with a fertile partner. Intrauterine device, vasectomy of a female subject's male partner or hormonal contraceptive are acceptable •
• Written and verbally informed consent

Exclusion criteria

• Radiological evidence of distant metastasis, by CT- chest and abdomen
• Incapacity, frailty, disability and comorbidity to a degree that according to the investigator is not compatible with combination chemotherapy
• Previous treatment with 5FU or oxaliplatin
• Neuropathy NCI grade > 1
• Other malignant tumor within 5 years except non-melanoma skin cancer or carcinoma in situ cervicis uteri
• Pregnant (positive pregnancy test) or breast feeding women

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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64 participants in 2 patient groups

A

Active Comparator group

Description:

Intensified follow-up schedule

Treatment:

Other: Intensified Follow-up Schedule

B

Experimental group

Description:

Adjuvant chemotherapy + intensified follow-up schedule

Treatment:

Drug: Capox (or FOLFOX) including flouropyrimidine and oxaliplatin combination chemotherapy