Currently, chemotherapies are empirically administered to patients treated for colorectal cancer (CRC). Selection is based on the efficacy of a protocol previously determined on the largest number (consensus treatment), the decision-making process being weighted by patient's intrinsic criteria. However, each patient is unique, due to the inter- and intratumoral heterogeneity inherent in any cancer, partly explaining the unsatisfactory response rates observed for available chemotherapies. Functional sensitivity tests offer the possibility to adapt the treatment to each patient: they are based on an ex vivo study of the responses of the tumor cells (survival / death) to the different molecules / therapeutic combinations (chemotherapy or targeted therapy) likely to be administered to the patient. This response, translated into a tumor-specific sensitivity profile, can be used by the clinicians to determine the most appropriate therapeutic protocol. By increasing the therapeutic efficacy from the first line and reducing the deleterious side effects associated with multiple drug cycles, the sensitivity test transforms the consensus approach into personalized medicine, providing patients with improved progression free survival (PFS) associated with an improvement in the quality of life. Oncomedics has developed Oncogramme®, a CE-labeled in vitro diagnostic medical device that has already demonstrated the ability to predict chemosensitivity in a recent pilot study of metastatic CRC (prediction with 84% chance of success of tumor sensitivity to chemotherapy, vs. 50% maximum for chemotherapy administered according to the consensus method). The hypothesis that patients treated with a metastatic CRC for which systemic chemotherapy is adapted using Oncogramme® have better response rates, PFS and quality of life than patients treated according to usual practice, with optimization of the costs of care. To our knowledge, this is the only fully standardized test available, where each step and reagents of the procedure are mastered. The reliability of the procedure makes it possible to render a personalized result for each patient in 97% of the cases. In addition, the analysis is specifically centered on tumor cells using a method using fully defined, developed and validated media and reagents for each cancer, including CRC. The method of revealing the effect of the therapies identifies the proportion of dead cells in each condition, whatever their physiological state (proliferation / quiescence), by determining the percentage of living and killed cells, thus ensuring high sensitivity
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
256
Patient is followed within the usual care for stage 4 colorectal cancer, but an Oncogramme test will be made and chemotherapy will be adapted to the results.
CHU d'AMIENS
Amiens, France
Bergonié Institut
Bordeaux, France
Clinique des Cédres
Brive-la-Gaillarde, France
CHU de TOURS
Chambray-lès-Tours, France
Clermont-Ferrand University Hospital
Clermont-Ferrand, France
CHu de la Martinique
Fort-De-France, France
Hospital Center
Guéret, France
Limoges University Hospital
Limoges, France
Nimes University Hospital
Nîmes, France
CHU de POITIERS
Poitiers, France
...and 3 more locations
Occurrence of the progression or death of the patient.
The event studied is the occurrence of the progression or death of the patient during the year following the inclusion in the study. The progression of the patient is determined by the RECIST (Response Evaluation Criteria in Solid Tumors).
Time frame: Year 1
Response to first-line treatment administrated
Percentage of patients in each response category to first-line treatment administered, evaluated by RECIST in each of the two groups.
Time frame: every month, up to 12 months
Overall survival
The event study is the death of the patient during the 6 months and the year following the inclusion.
Time frame: Month 6 and Year 1
Specific survival
The event considered is death due to illness during the 6 months and the year following the inclusion. The attribution of the death to the illness will be made by the adjudication committee.
Time frame: Month 6 and Year 1
Incremental Cost / Efficiency Ratio
Calculation of the Incremental Cost / Efficiency Ratio (ICER) expressed in euros per year of life gained without occurrence of death or progression to 1 year of the adapted chemotherapeutic treatment according to the results of Oncogramme® using EQ5D-5L s
Time frame: Year 1
Incremental Cost / Utility Ratio
Calculation of the Incremental Cost / Utility Ratio (ICUR) expressed in euros per QALY gained at 1 year of the adapted chemotherapeutic treatment according to the results of Oncogramme® using EQ5D-5L scale.
Time frame: Year 1
Quality of life
Compare the quality of life of patients at 3 months, 6 months, 9 months and 1 year between the two groups using the EQ5D-5L questionary score.
Time frame: Month 3, Month 6, Month 9 and Year 1
No adaptation of chemotherapy
If there is no adaptation of the treatment to the results of Oncogramme®, describe the criteria that led to the failure to take into account the results of Oncogramme®
Time frame: every month, up to 12 months
Grade 3 and higher adverse events related to chemotherapy
Describe and compare in both groups the proportion of grade 3 and higher adverse events related to chemotherapy.
Time frame: Year 1
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.