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Schraa SJ, van Rooijen KL, van der Kruijssen DEW, Rubio Alarcón C, Phallen J, Sausen M, Simmons J, Coupé VMH, van Grevenstein WMU, Elias S, Verkooijen HM, Laclé MM, Bosch LJW, van den Broek D, Meijer GA, Velculescu VE, Fijneman RJA, Vink GR, Koopman M. Circulating tumor DNA guided adjuvant chemotherapy in stage II colon cancer (MEDOCC-CrEATE): study protocol for a trial within a cohort study. BMC Cancer 2020; 20:790. [PMID: 32819390 PMCID: PMC7441668 DOI: 10.1186/s12885-020-07252-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Accurate detection of patients with minimal residual disease (MRD) after surgery for stage II colon cancer (CC) remains an urgent unmet clinical need to improve selection of patients who might benefit form adjuvant chemotherapy (ACT). Presence of circulating tumor DNA (ctDNA) is indicative for MRD and has high predictive value for recurrent disease. The MEDOCC-CrEATE trial investigates how many stage II CC patients with detectable ctDNA after surgery will accept ACT and whether ACT reduces the risk of recurrence in these patients. METHODS/DESIGN MEDOCC-CrEATE follows the 'trial within cohorts' (TwiCs) design. Patients with colorectal cancer (CRC) are included in the Prospective Dutch ColoRectal Cancer cohort (PLCRC) and give informed consent for collection of clinical data, tissue and blood samples, and consent for future randomization. MEDOCC-CrEATE is a subcohort within PLCRC consisting of 1320 stage II CC patients without indication for ACT according to current guidelines, who are randomized 1:1 into an experimental and a control arm. In the experimental arm, post-surgery blood samples and tissue are analyzed for tissue-informed detection of plasma ctDNA, using the PGDx elio™ platform. Patients with detectable ctDNA will be offered ACT consisting of 8 cycles of capecitabine plus oxaliplatin while patients without detectable ctDNA and patients in the control group will standard follow-up according to guideline. The primary endpoint is the proportion of patients receiving ACT when ctDNA is detectable after resection. The main secondary outcome is 2-year recurrence rate (RR), but also includes 5-year RR, disease free survival, overall survival, time to recurrence, quality of life and cost-effectiveness. Data will be analyzed by intention to treat. DISCUSSION The MEDOCC-CrEATE trial will provide insight into the willingness of stage II CC patients to be treated with ACT guided by ctDNA biomarker testing and whether ACT will prevent recurrences in a high-risk population. Use of the TwiCs design provides the opportunity to randomize patients before ctDNA measurement, avoiding ethical dilemmas of ctDNA status disclosure in the control group. TRIAL REGISTRATION Netherlands Trial Register: NL6281/NTR6455 . Registered 18 May 2017, https://www.trialregister.nl/trial/6281.
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Affiliation(s)
- S J Schraa
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - K L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - D E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - C Rubio Alarcón
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - M Sausen
- Personal Genome Diagnostics, Baltimore, MD, 21224, USA
| | - J Simmons
- Personal Genome Diagnostics, Baltimore, MD, 21224, USA
| | - V M H Coupé
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - W M U van Grevenstein
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H M Verkooijen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M M Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L J W Bosch
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - D van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - G A Meijer
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - V E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - R J A Fijneman
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - G R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Schraa SJ, Frerichs KA, Agterof MJ, Hunting JCB, Los M, de Jong PC. Relative dose intensity as a proxy measure of quality and prognosis in adjuvant chemotherapy for breast cancer in daily clinical practice. Eur J Cancer 2017; 79:152-157. [PMID: 28494406 DOI: 10.1016/j.ejca.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
AIM Adjuvant chemotherapy treatment of women with breast cancer is frequently complicated by toxic side-effects, resulting in dose reduction and delay. In Dutch guidelines, a relative dose intensity (RDI) of at least 85% is recommended for optimal treatment. The aim was to investigate predictors of low RDI and its effect on prognosis. METHODS All patients treated in the St. Antonius Hospital with adjuvant chemotherapy for breast cancer between 2008 and 2013 were included (N = 605). RDI was calculated for each single chemotherapeutic agent and for chemotherapy regimens in total. Incidence and causes of RDI <85% were studied, as well as the effect of RDI on prognosis. RESULTS About 10% of 605 patients had RDIs <85%. Predictive factors included age, episodes of febrile neutropenia and grade III or IV hypersensitivity reaction to taxanes. Other adverse events, such as peripheral neuropathy, did not affect RDI. The incidence of febrile neutropenia in the 5-fluorouracil, epirubicin, cyclofosfamide, docetaxel (FEC-D) protocol was 24% and therefore was above the threshold set by the European Organisation for Research and Treatment of Cancer for primary granulocyte colony-stimulating factor (G-CSF) prophylaxis. No relationship between RDI and (disease-free) survival was found with a median follow-up of 38 months. Apart from the stage of disease, obesity is a predictor of poor outcome. CONCLUSIONS RDI <85% is predicted by patients' age, febrile neutropenia and hypersensitivity reactions to taxanes. The incidence of febrile neutropenia in FEC-D treatment indicates primary prophylaxis with G-CSF following docetaxel treatment. No relationship was found between RDI and (disease-free) survival, but longer follow-up is needed.
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Affiliation(s)
- S J Schraa
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K A Frerichs
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Agterof
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C B Hunting
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P C de Jong
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
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