RATIONALE: Drugs used in chemotherapy, such as capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy that uses a 3-dimensional (3-D) image of the tumor to help focus thin beams of radiation directly on the tumor, and giving radiation therapy in higher doses over a shorter period of time, may kill more tumor cells and have fewer side effects. Monoclonal antibodies, such as panitumumab, 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. It is not yet known whether giving capecitabine together with 3-D conformal radiation therapy is more effective with or without panitumumab in treating patients with advanced rectal cancer. PURPOSE: This randomized phase II trial is studying giving capecitabine together with radiation therapy to see how well it works with or without panitumumab in treating patients with advanced rectal cancer.
OBJECTIVES: * To assess the efficacy and safety of neoadjuvant capecitabine and concurrent 3-dimensional conformal radiotherapy with vs without panitumumab in patients with advanced K-ras unmutated rectal cancer. OUTLINE: This is a multicenter study. Patients are stratified according to participating center, T stage (T3 vs T4), tumor localization measured from caudal part of the tumor to the anocutaneous line (\< 10 cm vs ≥ 10 cm), and number of EGFR gene copies (\< 2.9 vs ≥ 2.9). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive panitumumab IV over 30-90 minutes on days 1, 15, 29, 43, and 57 and oral capecitabine twice daily on days 8-40. Beginning on day 8, patients undergo daily fractions of 3-D conformal radiotherapy 5 days a week for 5 weeks. Beginning approximately 6 weeks after completion of panitumumab and chemoradiotherapy, patients undergo surgery. * Arm II: Patients receive oral capecitabine twice daily on days 1-33. Patients undergo concurrent 3-D conformal radiotherapy 5 days a week for 5 weeks. Beginning 6 weeks after completion of chemoradiotherapy, patients undergo surgery. After completion of study therapy, patients are followed periodically for up to 3 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
68
Given IV
Given orally
Patients undergo surgical resection
Patients undergo radiotherapy
Szent Laszlo Korhaz
Budapest, Hungary
Hirslanden Klinik Aarau
Aarau, Switzerland
Kantonspital Aarau
Aarau, Switzerland
Kantonsspital Baden
Baden, Switzerland
Saint Claraspital AG
Basel, Switzerland
Universitaetsspital-Basel
Basel, Switzerland
Istituto Oncologico della Svizzera Italiana
Bellinzona, Switzerland
Inselspital Bern
Bern, Switzerland
Spitalzentrum Biel
Biel, Switzerland
Kantonsspital Bruderholz
Bruderholz, Switzerland
...and 14 more locations
Pathological complete or near-complete response (Dworak grade 3 and 4)
Time frame: after 13 weeks.
Pathological response
Time frame: after 13 weeks.
R0 or R1 resection
Time frame: after 13 weeks.
Postoperative complications (within 8 weeks after surgery)
Time frame: within 8 weeks after surgery
Time to local relapse
Time frame: calculated from randomization to documented relapse or censored at the last CT and/or endorectal ultrasound without local relapse.
Time to distant failure
Time frame: calculated from randomization to documented distant (metastatic) failure or censored at the last CT without distant (metastatic) failure.
Disease-free survival
Time frame: calculated from randomization to first relapse or death (whichever occurs first).
Adverse events
Time frame: All AEs will be assessed according to NCI CTCAE v3.0.
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