This is a phase 2, randomized study where the aim of the study is to investigate the tolerance of adjuvant chemotherapy, measured by functional decline, after surgery for colon cancer stage III in elderly patients. Secondary aims are disease-free survival, toxicity, late functional outcome, quality of life, to establish a geriatric assessment for selection of patients, and to examine the prognostic value of gene signature tests / biomarkers for stage III colon cancer.
Patients ≥ 75 years who have undergone surgery for colon cancer stage III, are eligible for inclusion in the study. Non-eligibility includes patients with obvious impaired cognitive or physical function or patients living in nursing homes. After signing informed consent, the patients first undergo geriatric assessment. Patients that are classified as having fit or intermediate function, and with no significant cardiovascular disease, are randomized with a 2:1 randomization process to either chemotherapy (Arm A: Capecitabine 1000 mg/m2 bid day 1-14 q3 weeks, 8 cycles) or no chemotherapy (Arm B: observation). The purpose of this study is to examine the tolerability of chemotherapy in elderly (\> 75 years) patients operated on for colon cancer stage III. There is little evidence of benefit and tolerability of this therapy in the elderly; it is recommended individual consideration in elderly. In the study, a comprehensive geriatric a comprehensive geriatric assessment is performed first, to exclude frail patients or patients with serious comorbidities such as cardiovascular disease. Fit or intermediate patients will then be randomized so that 2/3 will receive chemotherapy with capecitabine tablets for 6 months, and 1/3 will not receive chemotherapy. A new geriatric assessment is performed after 6 and 12 months. The main objective of the study is to examine whether chemotherapy leads to significant loss of function, but secondary aims include survival, quality of life, and prognostic effect of biomarkers. The study may provide useful information on selection of patients who tolerate and benefit from adjuvant chemotherapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
170
Capecitabine is a prodrug to 5-fluorouracil. It is used for adjuvant chemotherapy after surgery for colon cancer. The tablets are either 150 mg or 500 mg
Oslo University Hospital
Oslo, Norway
Functional decline in instrumental activities of daily living (IADL) and/or activities of daily living (ADL)
Tolerance of adjuvant chemotherapy in elderly patients, measured as functional decline or independency, by ADL and IADL questionnaires.
Time frame: 1 year after surgery
Relative dose intensity; i.e the percentage of planned chemotherapy dose the patient actually receives
Number of planned chemotherapy cycles given, total dose given
Time frame: through study completion
Toxicity of chemotherapy
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time frame: During treatment and follow-up 1 year after surgery
Disease-free survival
Follow-up, 3-year disease-free survival
Time frame: 3 years after surgery
Quality of life questionnaire 1
EQ-5D-5L
Time frame: Time of randomization, 6 months and 1 year after surgery
Quality of life questionnaire 2
EORTC QLQ-C30
Time frame: Time of randomization, 6 months and 1 year after surgery
Quality of life questionnaire 3
QLQ-ELD14
Time frame: Time of randomization, 6 months and 1 year after surgery
Validation of the performance of prognostic biomarkers in estimating disease-free survival
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Prognostic biomarkers validated for performance in estimating 3-year disease-free survival
Time frame: 3 years after surgery
Overall survival
Follow-up, 5-year disease-free survival
Time frame: 5 years after surgery