Chemoradiation and Consolidation Chemotherapy With or Without Oxaliplatin for Distal Rectal Cancer and Watch and Wait
Status:
Recruiting
Trial end date:
2027-04-01
Target enrollment:
Participant gender:
Summary
Background: Neoadjuvant chemoradiation (nCRT) has been considered the preferred initial
treatment strategy for distal rectal cancer. Advantages of this approach include improved
local control after radical surgery but also the opportunity for organ preserving strategies
(Watch and Wait - WW). Consolidation chemotherapy (cCT) regimens using fluoropyrimidine-based
with or without oxaliplatin following nCRT have demonstrated to increase complete response
and organ preservation rates among these patients. However, the benefit of adding oxaliplatin
to cCt compared to fluoropyrimidine alone regimens in terms of primary tumor response remains
unclear. Since oxaliplatin-treatment may be associated with considerable toxicity, it becomes
imperative to understand the benefit of its incorporation into standard cCT regimens in terms
of primary tumor response. The aim of the present trial is to compare the outcomes of 2
different cCT regimens following nCRT (fluoropyrimidine-alone versus
fluoropyrimidine+oxaliplatin) for patients with distal rectal cancer.
Methods: In this multi-centre study, patients with magnetic resonance-defined distal rectal
tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54Gy)
followed by cCT with fluoropyrimidine alone versus fluoropyrimidine+oxaliplatin. Magnetic
resonance (MR) will be analyzed centrally prior to patient inclusion and randomization.
mrT2-3N0-1 tumor located no more than 1cm above the anorectal ring determined by sagittal
views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks
from radiotherapy (RT) completion. Patients with clinical complete response (clinical,
endoscopic and radiological) will be enrolled in an organ-preservation program (WW). The
primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18
weeks from RT completion.
Discussion: Long-course nCRT with cCT is associated with improved complete response rates and
may be a very attractive alternative to increase the chances for organ-preservation
strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been
investigated in the setting of a randomized trial to compare clinical response rates and the
possibility of organ-preservation. The outcomes of this study may significantly impact
clinical practice of patients with distal rectal cancer interested in organ-preservation.