There is increasing evidence of a role of EGFR, treatment with EGFR-inhibitors in anal cancer and synergies of EGFR-inhibitors with radiotherapy. Addition of the human anti-EGFR antibody Panitumumab to chemoradiotherapy seems therefore solidly justified. This trial investigates concurrent panitumumab/capecitabine/mitomycin concurrent to IMRT-radiotherapy. Treatment components used in this study have been selected on scientific rationale. The trial regimen should be feasible with acceptable toxicity and outcome similar to historic series.
OBJECTIVES: Primary: -To assess efficacy of treatment regimen composed of capecitabine, mitomycin, panitumumab, and radiotherapy in terms of locoregional control rate in patients with stage II-IIIB squamous-cell carcinoma of the anal canal. Secondary: * To further assess efficacy of this regimen based on complete response (CR) rate, colostomy-free survival, functional colostomy-free survival, overall survival (OS), and progression-free survival (PFS). * To assess the tolerability and safety profile of this regimen. * To assess the role of PET for staging and outcome prediction (for those patients who had PET following local standards).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
External beam radiotherapy (daily fraction dose 1.8Gy) on Monday through Friday starting on study day 1. * Days 1-28, dose of 36 Gy in 1.8 Gy/fraction (20 fractions) to the clinical target volume 1 (CTV1) including the primary tumor and involved lymph nodes and areas at risk for metastatic spread (which includes gross tumour volumes (GTV) and a 1-cm expansion, mesorectal space, inguinal, femoral, external iliac, internal iliac, and common iliac vessels). * Days 29-45, a boost dose of 23.4 Gy in 1.8 Gy/fraction (13 fractions) to the GTV.
6 mg/kg IV administered over 60 min infusion on days 1,15 and 29.
10 mg/m2 IV administered over 15 min infusion on days 1 and 29.
825mg/m2 orally twice daily on study days 1 through 45.
Inselspital
Bern, Switzerland
Hôpitaux Universitaires de Genève (HUG)
Geneva, Switzerland
Centre Hospitalier Universitaire Vaudois
Lausanne, Switzerland
Hôpital du Valais (RSV)
Sion, Switzerland
Efficacy
Time frame: 2-year locoregional control in patients, which is defined as the absence of locoregional recurrence 2 years after treatment start.
Complete response (CR) rate
Tumor assessment will be done by the investigator according to the RECIST 1.1. criteria.
Time frame: 5 years
Colostomy-free survival
2-year colostomy-free survival (patients without colostomy two-years after treatment start).
Time frame: 2 and 5 years
Functional colostomy-free survival
2-year functional colostomy-free survival (patients without colostomy and without stool incontinence or other sphincter symptoms interfering with activities of daily life two years after treatment start, which correspond to grade 3 toxicity according to common toxicity criteria National Cancer Institute-Common Toxicity Criteria for Adverse Event (NCI-CTCAE) version 4.0.
Time frame: 2 and 5 years
Overall survival (OS)
2-year overall survival (proportion of patients alive two years after treatment start) and median overall survival (median of the interval (days) between treatment start and death for any cause).
Time frame: 2 and 5 years
Progression-free survival (PFS)
2-year PFS (proportion of patients progression-free two years after treatment start) and median PFS according to the RECIST 1.1 criteria. PFS is defined as the interval (days) between registration and the date of progression (based on the actual tumor assessment date), or death for any cause, whichever comes first. The death of a patient without a reported progression will be considered as an event on the date of death. Patients who have neither progressed nor died will be censored on the date of last evaluable tumor assessment. Patients who had no post-baseline assessments and did not have an event will be censored at the time of registration.
Time frame: 2 and 5 years
Tolerability and safety profile of this regimen.
Toxicities will be assessed according to the NCI-CTCAE (version 4.0).
Time frame: Early (6 weeks after treatment) and late (up to 2 and 5 years after treatment).
Role of PET for staging and outcome prediction.
Predictive value of PET for PFS. Comparison of PET for determination of complete response with radiologic response and clinical response.
Time frame: 5 years
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