Neoadjuvant Chemotherapy for the Treatment of Resectable Locally Advanced Colon Cancer

Nanjing Medical University

Status and phase: Unknown; Phase 3; Phase 2

Conditions: Colon Cancer

Treatments: Drug: Postoperative chemotherapy; Drug: Neoadjuvant chemotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT02882269

CRSYM201608

Details and patient eligibility

About

A randomized controlled clinical trial to compare the short and long outcomes of Neoadjuvant chemotherapy with postoperative chemotherapy in patients with resectable locally advanced colon cancer

Full description

For resectable locally advanced colon cancer, the preferred treatment is colectomy with en bloc removal of the regional lymph nodes followed by chemotherapy of about 6 months. However, surgery may postpone the administration of chemotherapy due to postoperative complications such as anastomosis leakage, abdominal infection, thus leads to a poor survival. Some scholars suggested that for patients with locally advanced colon cancer, chemotherapy given before surgery might shrink or downstage tumor, facilitate surgery and promote a better oncological outcome. Whether adjuvant chemotherapy benefits these patients with better outcome still remains controversial.

In this study, eligible patients will be randomly allocated to receive either adjuvant chemotherapy or not. For patients receiving adjuvant chemotherapy, surgery will be performed 3-4 weeks later. Preoperative and postoperative chemotherapy will be given for a total of about 6 months. For patients receiving no preoperative chemotherapy, chemotherapy will be given for about 6 months postoperatively. The recommended chemotherapy regimes includes FOLFOX, CapeOX, FOLFIRI, Capecitabine monotherapy. Patients will be followed up every 3 months for 2 year, every 6 months for 3 years postoperatively.

Enrollment: 400 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients suitable for curative surgery between 18 to 80 years old;
• American Society of Anesthesiologists(ASA) grade I-III;
• Pathological diagnosis of adenocarcinoma;
• Tumor located between the cecum and sigmoid colon;
• Enhanced CT scan of chest, abdominal and pelvic cavity: preoperative assessment of tumor stage is T3-T4 N0 or T any N+ (according to the National Comprehensive Cancer Network(NCCN) clinical practice guidelines in oncology: colon cancer version 2.2015);there is no distant metastasis;
• Informed consent;
• No preoperative chemoradiotherapy;
• No history of familial adenomatous polyposis, ulcerative colitis or Crohn's disease.

Exclusion criteria

• Pregnant patient;

• History of psychiatric disease;

• Use of systemic steroids;

• Simultaneous multiple primary colorectal cancer;

• Preoperative imaging examination results show:

  1. distant metastasis;
  2. unable to perform R0 resection;

• Postoperative pathology of T1-T2 N0;

• History of any other malignant tumor in recent 5 years;

• Patients need emergency operation: mechanic ileus, perforation.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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400 participants in 2 patient groups

Postoperative chemotherapy

Active Comparator group

Description:

Patients receive 6 months of chemotherapy after surgery.

Treatment:

Drug: Postoperative chemotherapy

Neoadjuvant chemotherapy

Experimental group

Description:

Patients receive 3-4 cycles of chemotherapy before surgery. Preoperative and postoperative chemotherapy will be given for a total of 6 months.

Treatment:

Drug: Neoadjuvant chemotherapy