Radiochemotherapy With Panitumumab in the Localised Epidermoid Carcinoma of the Anus

Federation Francophone de Cancerologie Digestive

Status and phase: Completed; Phase 2; Phase 1

Conditions: Epidermoid Carcinoma; Anus

Treatments: Drug: radiochemotherapy; Drug: Panitumumab

Study type: Interventional

Funder types: Other

Identifiers

NCT01581840

FFCD 0904

Details and patient eligibility

About

Treatment is based on radiochemotherapy for locally advanced tumours. The objective of treatment is to provide a cure without resorting to abdominoperineal amputation, while preserving sphincter function.

The prognosis is mainly related to tumour size and lymph node invasion. The large majority of patients do not show any spread remote from the tumour at the time of diagnosis (2).

Recurrences are mainly of a local/regional nature and require abdominoperineal amputation. This type of intervention is not always possible or complete, which then gives rise to the particularly distressing risk of local progression, with survival at 3 years of approximately 30% (3).

It is therefore very important to achieve a complete and permanent tumour response from initial treatment with radiochemotherapy.

Furthermore, the use of an anti-EGFR antibody in combination with exclusive radiotherapy in ENT cancer was able to increase recurrence-free survival and overall survival in these patients. These data are in favour of the use of a combination of chemotherapy and anti-EGFR antibodies in epidermoid cancer of the anus.

Enrollment: 45 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologically proven epidermoid carcinoma of the anus
• Locally advanced tumour without metastases
• Stage T2>3 cm or T3 or T4, irrespective of N
• Stage N1-N3 irrespective of T stage (T1 to T4)
• General condition WHO 0-1
• Life expectancy > 3 months
• Signed informed consent form
• Age > 18 years
• Effective contraception in female and/or male patients having reached sexual maturity during treatment and up to 6 months after the end of treatment
• CD4 > 400 / mm3
• Measureable tumor on at least one of the following exams : MRI, endoscopic ultrasonography, clinical exam

Exclusion criteria

• Presence of metastases
• Previous anti-EGFR therapy
• Stage T1N0 or T2 < 3 cm N0
• History of pelvic radiotherapy
• At least one of the following laboratory test results: Neutrophils < 1500 /mm3, platelets < 100 000 /mm3, Hb < 9 g/dl, leukocytes < 3000/mm3, blood bilirubin > 1.5 times the upper limit of the normal range, transaminase (ASAT and ALAT) > 2.5 times the upper limit of the normal range, creatinine clearance < 50 mL/min (Cockcroft's formula Appendix x), Mg2+ < the lower limit of the normal range, Ca2+ < the lower limit of the normal range
• Significant coronary artery disease or myocardial infarction in the past year
• Follow-up not possible due to psychological or geographic reasons
• History of interstitial pneumonitis or pulmonary fibrosis
• History of malignant disease in the past five years apart from basocellular skin carcinoma or in situ cervical carcinoma having received adequate treatment
• Pregnant or breast-feeding women, women of child-bearing potential not having taken a pregnancy test.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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45 participants in 1 patient group

5Fu-mitomycine-panitumumab + radiotherapy

Experimental group

Description:

5 FU = 400 or 600 or 80 or 1000 mg depending of phase I results, days 1 to 4 weeks 1, 5 and 8 mitomicyne = 10 mg/m² day 1 week 1 and days 1, weeks 5 and 8 Panitumumab = 3 or 6 mg/kg (depending of phase I results) days 1, weeks: 1, 3, 5, 8 and 10

Treatment:

Drug: Panitumumab

Drug: radiochemotherapy