The purpose of this study is to determine whether the combination of paclitaxel, capecitabine, mitomycin and intensity-modulated radiotherapy is more effective than the standard combination of capecitabine, mitomycin and intensity-modulated radiotherapy (IMRT) in patients with squamous-cell anal cancer.
This trial aims to investigate the efficacy of chemoradiotherapy with or without paclitaxel in squamous-cell anal cancer. This is a prospective multicenter open-label randomized phase III clinical trial. Patients will be randomized using an online randomization system to receive either standard IMRT with capecitabine and mitomycin or IMRT with capecitabine, mitomycin and paclitaxel. A stratification will be performed based on T stage, N stage and clinical center. Doses of capecitabine and mitomycin in experimental group were reduced for better treatment tolerance. The target accrual is 157 patients in each treatment arm (including 10% potential data loss) based on potential benefit of 15% 3-yr disease-free survival (70% vs 85%), α=0,05, power 80% in the experimental arm. An interim analysis is planned after 50% of the patients will reach a 3-year followup. Pelvic Magnetic Resonance Imaging (MRI) is performed in all patients for staging and followup. Pelvic MRI and histological diagnosis are subject to central review. Conduction of this study and data collection are controlled by a local institutional board.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
314
45 mg/m2, IV, weekly during the radiation. Number of infusions: 5.
625 mg/m2, bid, per os, only on days of radiation (Monday through Friday)
825 mg/m2, bid, per os, only on days of radiation (Monday through Friday)
10 mg/m2, IV, on day 1. Number of infusions: 1.
12 mg/m2, IV, on day 1. Number of infusions: 1.
Dose: 44 Gy on regional nodes, 52-58 Gy on primary tumor, based on T stage
3-year disease-free survival
Time frame: 3 years
Complete response at 26 weeks
Time frame: 26 weeks
3-year colostomy-free survival
Time frame: 3 years
3-year cancer-specific survival
Time frame: 3 years
3-year overall survival
Time frame: 3 years
Acute toxicity measured according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v.4.0
Toxicity measured according to NCI-CTCAE v.4.0
Time frame: 30 days
Late toxicity measured according to Radiation Therapy Oncology Group (RTOG) criteria
Late toxicity measured according to RTOG criteria
Time frame: 3 years
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