Studies
| Study First Submitted Date | 2022-04-05 |
| Study First Posted Date | 2022-05-17 |
| Last Update Posted Date | 2023-05-11 |
| Start Month Year | June 1, 2024 |
| Primary Completion Month Year | June 1, 2028 |
| Verification Month Year | May 2023 |
| Verification Date | 2023-05-31 |
| Last Update Posted Date | 2023-05-11 |
Detailed Descriptions
| Sequence: | 20578090 |
| Description | The addition of stereotactic body radiation therapy (SBRT) to metastases in a limited unresectable metastatic setting might improve progression-free survival (PFS). The success of the addition of local treatments in mCRC patients depends largely on: control of microscopic disease, diagnostic accuracy of macroscopic disease and effective treatment of all detected metastases with limited additional toxicity to surrounding tissues. Until shortly, the use of SBRT was possible to a limited number of locations due to target movement or toxicity to surrounding radiosensitive structures. With the introduction of MRI-guided radiotherapy these limitations have been largely reduced due to the possibility to make a daily new treatment plan based on MRI-visualized anatomy. This allows the use of smaller margins for uncertainty with less healthy tissues in the radiation field. Thereby, a broader application of SBRT to add local control to metastases became possible. This study is an open-label, multicenter, randomized phase II screening trial assessing the impact of SBRT in combination with systemic therapy compared to systemic therapy alone on safety and efficacy in patients with mCRC and ≤10 metastases with no option of local treatment with curative intent and with stable disease or partial response after treatment of CAPOX-B, FOLFOX-B or FOLFOXIRI-B. |
Facilities
| Sequence: | 198659300 | Sequence: | 198659301 | Sequence: | 198659302 | Sequence: | 198659303 |
| Name | Meander Medical Centre | Name | St. Antonius | Name | Diakonessenhuis | Name | UMC Utrecht |
| City | Amersfoort | City | Utrecht | City | Utrecht | City | Utrecht |
| State | Utrecht | ||||||
| Zip | 3813TZ | Zip | 3543AZ | Zip | 3582KE | Zip | 3584CX |
| Country | Netherlands | Country | Netherlands | Country | Netherlands | Country | Netherlands |
Facility Contacts
| Sequence: | 27944290 | Sequence: | 27944291 | Sequence: | 27944292 | Sequence: | 27944293 |
| Facility Id | 198659300 | Facility Id | 198659301 | Facility Id | 198659302 | Facility Id | 198659303 |
| Contact Type | primary | Contact Type | primary | Contact Type | primary | Contact Type | primary |
| Name | Hans-Martin Otten, Dr. | Name | Maartje Los, Dr. | Name | Tanja Oostergo, Dr. | Name | Koen Zwart, Drs. |
| SIRIUS@umcutrecht.nl | |||||||
| Phone | 088-7556084 | ||||||
Browse Interventions
| Sequence: | 95328422 | Sequence: | 95328423 | Sequence: | 95328424 | Sequence: | 95328425 | Sequence: | 95328426 | Sequence: | 95328427 | Sequence: | 95328428 | Sequence: | 95328429 |
| Mesh Term | Bevacizumab | Mesh Term | Antineoplastic Agents, Immunological | Mesh Term | Antineoplastic Agents | Mesh Term | Angiogenesis Inhibitors | Mesh Term | Angiogenesis Modulating Agents | Mesh Term | Growth Substances | Mesh Term | Physiological Effects of Drugs | Mesh Term | Growth Inhibitors |
| Downcase Mesh Term | bevacizumab | Downcase Mesh Term | antineoplastic agents, immunological | Downcase Mesh Term | antineoplastic agents | Downcase Mesh Term | angiogenesis inhibitors | Downcase Mesh Term | angiogenesis modulating agents | Downcase Mesh Term | growth substances | Downcase Mesh Term | physiological effects of drugs | Downcase Mesh Term | growth inhibitors |
| Mesh Type | mesh-list | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor |
Conditions
| Sequence: | 51800522 | Sequence: | 51800523 |
| Name | Metastatic Colorectal Cancer | Name | Oligometastatic Disease |
| Downcase Name | metastatic colorectal cancer | Downcase Name | oligometastatic disease |
Id Information
| Sequence: | 39863840 |
| Id Source | org_study_id |
| Id Value | NL76444.041.21 |
Countries
| Sequence: | 42261312 |
| Name | Netherlands |
| Removed | False |
Design Groups
| Sequence: | 55220353 | Sequence: | 55220354 |
| Group Type | Active Comparator | Group Type | Experimental |
| Title | Systemic maintenance therapy | Title | Systemic maintenance therapy in combination with stereotactic body radiation therapy (SBRT) |
Interventions
| Sequence: | 52122593 | Sequence: | 52122594 |
| Intervention Type | Radiation | Intervention Type | Drug |
| Name | Stereotactic body radiation therapy (SBRT) | Name | Maintenance therapy (CAP-B or 5-FU/LV plus bevacizumab.) |
| Description | Patients will receive a single fraction of 15 Gy to each of the macroscopic tumor sites including the primary tumor if still in situ. All lesions are treated. The treatment will be delivered in an image-guided way, either on a conventional linear accelerator (LINAC) or a MR-LINAC, whichever has the best targeting according to the treating radiation oncologist. | Description | CAP + bevacizumab (following CAPOX-B) Bevacizumab 7.5mg/kg i.v. on day 1 and 1250 mg/m2 of capecitabine, orally twice daily on days 1-14 if age is <70 years and 1000 mg/m2 of capecitabine, orally twice daily on days 1-14 if age is higher than 70 years. CAP + bevacizumab is repeated every three weeks. 5-FU/LV + bevacizumab (following FOLFOX-B) Bevacizumab 5.0mg/kg i.v. together with leucovorin 400 mg/m2 i.v. bolus 5FU 400 mg/m2 all on day 1. Followed by continuous infusion of 5-fluorouracil 2400 mg/m2 in 46 hours. 5-FU + bevacizumab is repeated every two weeks. 5-FU/LV + bevacizumab (following FOLFOXIRI-B) Bevacizumab 5.0mg/kg i.v. together with leucovorin 400 mg/m2 i.v. all on day 1. Followed by continuous infusion of 5-fluorouracil 3200 mg/m2 in 46 hours. 5-FU + bevacizumab is repeated every two weeks. When S1 is used a replacement for fluoropyrimidine therapy it is administered in a dose of 30mg/m2 twice daily on days 1-14. S1 is repeated every three weeks. |
Keywords
| Sequence: | 79260625 | Sequence: | 79260626 | Sequence: | 79260627 | Sequence: | 79260628 |
| Name | Metastatic colorectal cancer | Name | Image guided radiation | Name | MR guided therapy | Name | Oligometastatic / polymetastatic cancer |
| Downcase Name | metastatic colorectal cancer | Downcase Name | image guided radiation | Downcase Name | mr guided therapy | Downcase Name | oligometastatic / polymetastatic cancer |
Design Outcomes
| Sequence: | 176182147 | Sequence: | 176182148 | Sequence: | 176182149 | Sequence: | 176182150 | Sequence: | 176182151 | Sequence: | 176182152 | Sequence: | 176182153 | Sequence: | 176182154 | Sequence: | 176182155 | Sequence: | 176182156 | Sequence: | 176182157 | Sequence: | 176182158 |
| Outcome Type | primary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary | Outcome Type | secondary |
| Measure | Progression-free survival | Measure | Accrual rate as assessed by the number of patients included in the study compared to the expected accrual rate. | Measure | Treatment success rate | Measure | Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 | Measure | Overall survival | Measure | Comparing changes on health-related quality of life based on summary score of Quality of Life Questionnaire-Core30 (QLQ-C30) from baseline and 3-monthly timepoints. | Measure | Comparing changes on health-related quality of life based on summary score of Quality of Life Questionnaire-Core29 (QLQ-C29) from baseline and 3-monthly timepoints. | Measure | Comparing changes from health-related quality of life based on summary score of Multidimensional Fatigue Inventory (MFI-20) from baseline and 3-monthly timepoints. | Measure | Pattern of reccurence according to RECIST 1.1: New metastatic lesions, progression of existing lesions or a combination. | Measure | Time to treatment failure | Measure | Tumor response | Measure | Depth of response |
| Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Up to 72 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months | Time Frame | Through study completion, an average of 24 months |
| Description | Defined as time from randomization to progression of disease or death, whichever occurs first. Progression of disease is based on tumor response as observed on radiographic imaging according to the RECIST 1.1 criteria. | Description | We expect to include 93 patients in 24 months. The expected accrual rate in this study is, therefore, around 4 patients per month. Information for the accrual rate is used from the total accrual rate, the accrual rate in each study center and screening failures. | Description | Dose intensity of SBRT based on the number of patients that receive more than 90% of the planned dose on all lesions in 95% of the planned target volume (PTV). | Description | This will be based on the number of patients with SBRT related toxicity, defined as newly developed grade 2 toxicity of specific interest and grade 3-4 toxicity since randomization according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0) | Description | Defined as time from randomization to death of any cause. | Description | EORTC QLQ-C30 is a 30-item questionnaire to assess the overall quality of life in cancer patients. Most questions used 4-point scale (1 'Not at All' to 4 'Very Much'); 2 questions used 7-point scale (1 'Very Poor' to 7 'Excellent'). Scores are averaged, and transformed to 0-100 scale; higher score is better level of functioning. | Description | EORTC QLQ-C30 is a 29-item questionnaire to assess the overall quality of life in cancer patients. All questions used 4-point scale (1 'Not at All' to 4 'Very Much'). Scores are averaged, and transformed to 0-100 scale; higher score is better level of functioning. | Description | MFI is a validated 20-item, self-reported instrument designed to measure fatigue in the following dimensions: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. The respondent is asked to mark an 'X' in 1 of 5 boxes arranged linearly where 1 is 'Yes, that is true' and 5 is 'No, that is not true.' Each subscale consists of 4 items, 2 indicative for fatigue and 2 contraindicative. For the indicative questions, a high score indicates a high fatigue level and low scores indicate a low fatigue levels. Conversely, for the contraindicative questions a high score indicates a low fatigue level and a low score indicates a high fatigue level. Overall, respondents are rated on a scale of 0 (no fatigue) to 7 (high fatigue). | Description | New metastatic lesions, progression of existing lesions or a combination of both new metastatic lesions and progression of existing lesions based on radiographic imaging according to RECIST 1.1 | Description | Defined as the time of randomization to failure of treatment. If radiologically visible metastatic lesions before systemic therapy are no longer visible at randomization (vanishing lesions) and recurrence of vanishing lesions occurs in patients in the experimental arm without progression of other lesions, this is not yet determined as failure of treatment; additional local therapy is highly encouraged on these lesions (to the discretion of the local investigator). When progression of existing lesions or new lesions occur, it will be determined as failure of treatment. | Description | Based on radiographic imaging according to the RECIST 1.1 criteria. | Description | Based on radiographic imaging |
Browse Conditions
| Sequence: | 191993844 | Sequence: | 191993845 | Sequence: | 191993846 | Sequence: | 191993847 | Sequence: | 191993848 | Sequence: | 191993849 | Sequence: | 191993850 | Sequence: | 191993851 | Sequence: | 191993852 | Sequence: | 191993853 | Sequence: | 191993854 |
| Mesh Term | Colorectal Neoplasms | Mesh Term | Intestinal Neoplasms | Mesh Term | Gastrointestinal Neoplasms | Mesh Term | Digestive System Neoplasms | Mesh Term | Neoplasms by Site | Mesh Term | Neoplasms | Mesh Term | Digestive System Diseases | Mesh Term | Gastrointestinal Diseases | Mesh Term | Colonic Diseases | Mesh Term | Intestinal Diseases | Mesh Term | Rectal Diseases |
| Downcase Mesh Term | colorectal neoplasms | Downcase Mesh Term | intestinal neoplasms | Downcase Mesh Term | gastrointestinal neoplasms | Downcase Mesh Term | digestive system neoplasms | Downcase Mesh Term | neoplasms by site | Downcase Mesh Term | neoplasms | Downcase Mesh Term | digestive system diseases | Downcase Mesh Term | gastrointestinal diseases | Downcase Mesh Term | colonic diseases | Downcase Mesh Term | intestinal diseases | Downcase Mesh Term | rectal diseases |
| Mesh Type | mesh-list | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor | Mesh Type | mesh-ancestor |
Sponsors
| Sequence: | 47973855 |
| Agency Class | OTHER |
| Lead Or Collaborator | lead |
| Name | UMC Utrecht |
Overall Officials
| Sequence: | 29066606 | Sequence: | 29066607 | Sequence: | 29066608 |
| Role | Principal Investigator | Role | Principal Investigator | Role | Principal Investigator |
| Name | Guus Bol, Dr. | Name | Martijn Intven, Dr. | Name | Miriam Koopman, Prof. Dr. |
| Affiliation | UMC Utrecht | Affiliation | UMC Utrecht | Affiliation | UMC Utrecht |
Central Contacts
| Sequence: | 11933636 | Sequence: | 11933637 |
| Contact Type | primary | Contact Type | backup |
| Name | Koen Zwart, Drs. | Name | Guus Bol, Dr. |
| Phone | 088-7556084 | ||
| SIRIUS@Umcutrecht.nl | G.M.Bol-2@umcutrecht.nl | ||
| Role | Contact | Role | Contact |
Design Group Interventions
| Sequence: | 67700794 | Sequence: | 67700795 | Sequence: | 67700796 |
| Design Group Id | 55220354 | Design Group Id | 55220353 | Design Group Id | 55220354 |
| Intervention Id | 52122593 | Intervention Id | 52122594 | Intervention Id | 52122594 |
Eligibilities
| Sequence: | 30547765 |
| Gender | All |
| Minimum Age | 18 Years |
| Maximum Age | N/A |
| Healthy Volunteers | No |
| Criteria | Inclusion Criteria: Registered in the prospective Dutch colorectal cancer cohort (PLCRC) Intention at start of palliative systemic therapy to receive six maximum tolerated dose (MTD) cycles of CAPOX-B or eight MTD cycles of FOLFOX-B or FOLFOXIRI-B. Ten or less metastases as determined by the university medical center Utrecht (UMCU) central review Stable disease or partial response after initial chemotherapy according to RECIST 1.1 criteria. Expected adequacy of follow-up World Health organization (WHO) performance status 0-1 Life expectancy >12 weeks Adequate organ functions at start of initial therapy, as determined by normal bone marrow function (Hb≥6.0 mmol/L, absolute neutrophil count ≥1.5 x 10^9/L, platelets ≥100 x 10^9/L), renal function (serum creatinine ≤ 1.5x upper limit of normal (ULN) and creatinine clearance, Cockcroft formula, ≥30 ml/min) and liver function (serum bilirubin ≤ 2 x ULN, serum transaminases ≤ 3 x ULN without presence of liver metastases or ≤ 5x ULN with presence of liver metastases) Written informed consent (SIRIUS) Exclusion Criteria: Less than three cycles of CAPOX-B or four cycles of FOLFOX-B or FOLFOXIRI-B (dose reductions allowed). More than six cycles of CAPOX-B or eight cycles of FOLFOX-B of FOLFOXIRI-B. Possible treatment with curative intent according to local tumor board Substantial overlap with a previously treated radiation volume. Previous radiotherapy is allowed as long as the composite plan meets dose constraints herein. Not amenable for radiotherapy (e.g. peritonitis carcinomatosa) Previous systemic treatment for metastatic disease; prior adjuvant treatment for stage II/III colorectal cancer when given >6 months before the start of initial systemic treatment is allowed. Serious comorbidity or any other condition preventing the safe administration of treatment (including both systemic treatment and radiation) Pregnant or lactating women Other malignancy interfering with prognosis Any concomitant experimental treatment. Contra-indication MR-LINAC (pacemaker or implantable cardioverter-defibrillator) Microsatellite instability or deficient mismatch repair tumor |
| Adult | True |
| Child | False |
| Older Adult | True |
Calculated Values
| Sequence: | 254215472 |
| Number Of Facilities | 4 |
| Registered In Calendar Year | 2022 |
| Were Results Reported | False |
| Has Us Facility | False |
| Has Single Facility | False |
| Minimum Age Num | 18 |
| Minimum Age Unit | Years |
| Number Of Primary Outcomes To Measure | 1 |
| Number Of Secondary Outcomes To Measure | 11 |
Designs
| Sequence: | 30296148 |
| Allocation | Randomized |
| Intervention Model | Parallel Assignment |
| Observational Model | |
| Primary Purpose | Treatment |
| Time Perspective | |
| Masking | None (Open Label) |
Responsible Parties
| Sequence: | 28674706 |
| Responsible Party Type | Principal Investigator |
| Name | Guus Bol |
| Title | Principal investigator |
| Affiliation | UMC Utrecht |