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A randomized controlled trial comparing laparoscopic surgery with open surgery in palliative resection of primary tumor in incurable Stage IV colorectal cancer (JCOG1107)

ABSTRACT: Interventions: A: Open primary tumor resection followed by chemotherapy (mFOLFOX6 or CapeOX plus bevacizumab; mFOLFOX6: bevacizumab 5 mg/kg IV on day 1, l-leucovorin 200 mg/m2 and oxaliplatin 85 mg/m2 as a 2-hour IV on day 1, 5-FU 400 mg/m2 IV bolus on day 1 followed by 2,400 mg/m2 IV over 46 hours, repeated every 2 weeks; CapeOX: bevacizumab 7.5 mg/kg IV and oxaliplatin 130 mg/m2 as a 2-hour IV on day 1 and Capecitabine 1000 mg/m2 per day orally from day 1 to day 14, repeated every 2 weeks) B: Laparoscopic primary tumor resection followed by the same chemotherapy as arm A (mFOLFOX6 or CapeOX plus bevacizumab) Primary outcome(s): Progression-free survival Study Design: Parallel Randomized

DISEASE(S): Unresectable Stage Iv Colorectal Cancer And A Synchronous Symptomatic Primary Tumor

PROVIDER: 2625109 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: Alternating oxaliplatin and irinotecan doublet treatment schedules. Arm A:Clinician’s choice doublet chemotherapy (standard chemotherapy) Arm B: Alternating schedule of 2 cycles of oxaliplatin doublet chemotherapy and 2 cycles of irinotecan doublet chemotherapy, i.e. mFOLFOX6-FOLFIRI or CAPOX-CAPIRI In both arms, initial combination chemotherapy will be given for 4-6 months as per standard of care, followed by maintenance fluoropyrimidine chemotherapy until disease progression, unmanageable toxicity or patient or treating clinician’s request. Biologic therapy (bevacizumab or an EGFR inhibitor) will be given according to clinician’s choice; however, as per guidelines, EGFRI use will be restricted to patients with left-sided RAS wild-type tumours. 1) Intervention drug - Doublet chemotherapy (mFOLFOX6, FOLFIRI, CAPOIX or CAPIRI) mFOLFOX6 Frequency: every 2 weeks Oxaliplatin 85 mg/m2 IV day 1 Leucovorin 50 mg IV day 1 Fluorouracil (5FU) 400 mg/m2 IV day 1 Fluorouracil (5FU) infusion 2,400 mg/m2 over 46 hours day 1-2 FOLFIRI Frequency: every 2 weeks Irinotecan 180 mg/m2 IV day 1 (150 mg/m2 if > 70 y.o.) Leucovorin 50 mg IV day 1 Fluorouracil (5FU) 400 mg/m2 IV day 1 Fluorouracil (5FU) infusion 2,400 mg/m2 over 46 hours day 1-2 CAPOX Frequency: every 3 weeks Oxaliplatin 130 mg/m2 IV day 1 Capecitabine 850-1000 mg/m2 orally BD days 1-14 CAPIRI Frequency: every 3 weeks Irinotecan 240 mg/m2 IV day 1 Capecitabine 850-1000 mg/m2 orally BD days 1-14 New drug schedules have been created for the hospital staff to keep track of the alternating cycles. Whether a participant receives mFOLFOX6-FOLFIRI or CAPOX-CAPIRI is decided by the treating practitioner, based on their usual treatment practice. When a patient is on the interventional treatment e.g. CAPOX-CAPIRI, the different treatments are staggered every 3 weeks. For FOLFOX-FOLFIRI, the the different treatments are stag Primary outcome(s): To examine the feasibility of a multi-centre prospective registry-based randomised clinical trial evaluating alternating oxaliplatin and irinotecan doublet schedules vs. continuous doublet chemotherapy during initial treatment of metastatic colorectal cancer. The primary feasibility endpoint will be evaluated by recruitment rate, defined as the proportion of eligible mCRC patients who enrol onto this study. [Eligible participants will be recruited over 1.5 years. All participants will be followed until death or study completion. ] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Open (masking not used);Assignment: Parallel;Type of endpoint: Safety/efficacy

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A randomized controlled trial comparing laparoscopic surgery with open surgery in palliative resection of primary tumor in incurable Stage IV colorectal cancer (JCOG1107)

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