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Trial registered on ANZCTR
Registration number
ACTRN12615000381583
Ethics application status
Approved
Date submitted
13/03/2015
Date registered
27/04/2015
Date last updated
16/12/2020
Date data sharing statement initially provided
11/06/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Circulating tumour DNA (ctDNA) analysis informing adjuvant chemotherapy in Stage II Colon Cancer
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Scientific title
A study to evaluate the use of circulating tumour DNA to guide adjuvant chemotherapy on recurrence-free survival in patients with stage II Colon or rectal cancer.
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Secondary ID [1]
286348
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Nil
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Universal Trial Number (UTN)
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Trial acronym
DYNAMIC
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Patients with the diagnosis of Stage II Colon cancer.
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Patients with the diagnosis of stage II rectal cancer
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Condition category
Condition code
Cancer
294775
294775
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0
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Bowel - Back passage (rectum) or large bowel (colon)
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a randomized, multi-centre, biomarker driven adjuvant treatment study involving the collection of blood samples from subjects with curatively resected Stage II colon and rectal cancer. 450 consecutive eligible subjects will be enrolled at participating centres after informed consent is obtained. Patients will be enrolled within 28 days post surgery. Subjects will be randomized 2:1 to be treated according to the ctDNA results (Arm A, n=300), or per standard clinical criteria at the discretion of the treating clinician (Arm B, n=150). Resected tumour samples will be made available for mutation analyses. Patients must not have undergone pre-operative chemotherapy or radiotherapy.
All patients enrolled will have a blood sample taken at enrollment (week 4) and 3 weeks later (week 7) for initial ctDNA testing.
Patients randomized to Arm A and who have positive ctDNA result will receive adjuvant chemotherapy, patients with negative ctDNA result will not receive chemotherapy.
Patients randomized to Arm B will be treated at their clinicians discretion. The clinician will initially be blinded to their ctDNA result but results will be provided at or after 6 months post-op following a written request from the site investigator.
Patients treated with chemotherapy will receive single agent 5FU-based regimen (including capecitabine) or fluoropyrimidine plus oxaliplatin .
Acceptable fluoropyrimidine based chemotherapy regimens include 3-6 months weeks of:
1. 2 weekly De Gramont (modified)
a. Leucovorin 50mg IV
b. Fluorouracil 400mg/m2 IV
c. Fluorouracil 2400mg/m2 CIV pump over 46 hours
2. Weekly modified QUASAR
a. Leucovorin 50mg IV
b. Fluorouracil 375-450mg/m2 IV (dose as per institutional standard of care)
3. Weekly modified Roswell Park (weekly for 6 weeks followed by 2 week break)
a. Leucovorin 50mg IV
b. Fluorouracil 500mg/m2 IV
4. Capecitabine PO days 1 to 14, Q21 days (dose as per institutional standard of care)
Acceptable Oxaliplatin-based chemotherapy regimens include 3-6 months of:
1. 2 weekly FOLFOX6 (modified)
a. Oxaliplatin 85mg/m2 IV
b. Leucovorin 50mg IV
c. Fluorouracil 400mg/m2 IV
d. Fluorouracil 2400mg/m2 CIV pump over 46 hours
2. 3 weekly XELOX/CAPOX
a. Oxaliplatin 130mg/m2
b. Capecitabine 1000mg/m2 twice a day PO days 1 to 14, Q21 days
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Intervention code [1]
291411
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Early detection / Screening
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Intervention code [2]
291651
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Treatment: Other
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Comparator / control treatment
Patients enrolled in Arm B will be blinded to the ctDNA result and will be treated as per standard clinical criteria at the discretion of the treating clinician.
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Control group
Active
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Outcomes
Primary outcome [1]
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To evaluate whether an adjuvant therapy strategy based on ctDNA results may affect the number of patients treated with chemotherapy and recurrence-free survival.
Recurrence will be assessed through protocol specified follow up regimen, including 3 monthly CEA tests and 6 monthly CT scans.
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Assessment method [1]
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Timepoint [1]
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Patients from all Arms will be followed up every 3 months for the first 2 years and then every 6 months for the next 3 years post surgery for recurrence.
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Secondary outcome [1]
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To evaluate whether an adjuvant therapy strategy based on ctDNA results may affect overall survival in patients with stage II colorectal cancer
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Assessment method [1]
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Timepoint [1]
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Patients from all Arms will be followed up every 3 months for the first 2 years and then every 6 months for the next 3 years post surgery for survival.
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Secondary outcome [2]
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To correlate the change of serial ctDNA measurements during treatment with disease recurrence.
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Assessment method [2]
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Timepoint [2]
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Patients in Arm A receiving chemotherapy will have monthly blood tests to measure their ctDNA levels, and be followed up every 3 months for the first 2 years and then every 6 months for the next 3 years post surgery for recurrence.
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Eligibility
Key inclusion criteria
1. Subjects with curatively resected stage II (T3-4, N0M0) colon or rectal cancer.
2. Patients with rectal cancer will be eligible unless they have had pre-operative combined chemotherapy or radiotherapy, or are scheduled for post-operative combined chemotherapy and radiotherapy. All rectal cancer patients included in the trial must have had TME type surgery with negative (R0) resection margins.
3. A representative paraffin embedded tumour sample is avaiable for molecular testing.
4. Fit for adjuvant chemotherapy.
5. ECOG performance status 0-2.
6. Patients that are accessible for follow up.
7. CT C/A/P within 8 weeks demonstrating no metastatic disease.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. History of another primary cancer within the last 3 years, with the exception of non-melanomatous skin cancer and carcinoma in situ of the cervix.
2. Patients with multiple primary colorectal cancers
3. Patients treated with neoadjuvant chemo-radiation.
4. Medical or psychiatric condition or occupational responsibilities that may preclude compliance with the protocol.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation involves contacting the Sponsor Site who holds the randomized allocation table.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomization using a randomisation table created by statistical software.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
It is anticipated that 10% of patients will have detectable ctDNA. The study will need to enrol 450 patients to recruit 30 patients with detectable post op ctDNA into Arm A. This will achieve an 80% power at a=0.1 to demonstrate non-inferiority in Arm A.
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
1/05/2015
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Actual
10/08/2015
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Date of last participant enrolment
Anticipated
1/01/2020
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Actual
25/07/2019
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Date of last data collection
Anticipated
8/08/2024
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Actual
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Sample size
Target
450
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Accrual to date
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Final
459
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,SA,TAS,WA,VIC
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Recruitment hospital [1]
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Royal Melbourne Hospital - City campus - Parkville
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Recruitment hospital [2]
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Western Hospital - Footscray
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Recruitment hospital [3]
6667
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The Alfred - Prahran
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Recruitment hospital [4]
6668
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Austin Health - Austin Hospital - Heidelberg
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Recruitment hospital [5]
6669
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Barwon Health - Geelong Hospital campus - Geelong
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Recruitment hospital [6]
6670
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Bendigo Health Care Group - Bendigo Hospital - Bendigo
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Recruitment hospital [7]
6671
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Border Medical Oncology - Albury
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Recruitment hospital [8]
6672
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Cabrini Hospital - Malvern - Malvern
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Recruitment hospital [9]
6673
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The Canberra Hospital - Garran
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Recruitment hospital [10]
6674
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Box Hill Hospital - Box Hill
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Recruitment hospital [11]
6675
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Fiona Stanley Hospital - Murdoch
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Recruitment hospital [12]
6676
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Flinders Medical Centre - Bedford Park
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Recruitment hospital [13]
6677
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The Chris O’Brien Lifehouse - Camperdown
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Recruitment hospital [14]
6678
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Monash Medical Centre - Clayton campus - Clayton
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Recruitment hospital [15]
6679
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Nepean Hospital - Kingswood
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Recruitment hospital [16]
6680
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Royal Brisbane & Womens Hospital - Herston
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Recruitment hospital [17]
6681
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Royal Hobart Hospital - Hobart
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Recruitment hospital [18]
6682
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St John of God Hospital Warrnambool - Warrnambool
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Recruitment hospital [19]
6683
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St Vincent's Hospital (Melbourne) Ltd - Fitzroy
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Recruitment hospital [20]
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Calvary Mater Newcastle - Waratah
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Recruitment hospital [21]
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Newcastle Private Hospital - New Lambton Heights
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Recruitment hospital [22]
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The Northern Hospital - Epping
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Recruitment postcode(s) [1]
14303
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2050 - Camperdown
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Recruitment postcode(s) [2]
16935
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2298 - Waratah
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Recruitment postcode(s) [3]
16936
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2305 - New Lambton Heights
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Recruitment postcode(s) [4]
14299
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2605 - Garran
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Recruitment postcode(s) [5]
14305
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2747 - Kingswood
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Recruitment postcode(s) [6]
14293
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3004 - Prahran
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Recruitment postcode(s) [7]
14291
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3050 - Parkville
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Recruitment postcode(s) [8]
14309
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3065 - Fitzroy
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Recruitment postcode(s) [9]
23476
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3076 - Epping
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Recruitment postcode(s) [10]
14294
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3084 - Heidelberg
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Recruitment postcode(s) [11]
14300
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3128 - Box Hill
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Recruitment postcode(s) [12]
14298
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3144 - Malvern
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Recruitment postcode(s) [13]
14304
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3168 - Clayton
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Recruitment postcode(s) [14]
14295
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3220 - Geelong
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Recruitment postcode(s) [15]
14308
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3280 - Warrnambool
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Recruitment postcode(s) [16]
14296
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3550 - Bendigo
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Recruitment postcode(s) [17]
14297
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3690 - Wodonga
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Recruitment postcode(s) [18]
14306
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4029 - Herston
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Recruitment postcode(s) [19]
14292
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5022 - Henley Beach
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Recruitment postcode(s) [20]
14302
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5042 - Bedford Park
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Recruitment postcode(s) [21]
14301
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6150 - Murdoch
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Recruitment postcode(s) [22]
14307
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7000 - Hobart
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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NHMRC
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
290922
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Australia
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Primary sponsor type
Other Collaborative groups
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Name
Walter and Eliza Hall Institute
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Address
1G Royal Pde
Parkville
Vic 3052
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
289608
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Address [1]
289608
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Country [1]
289608
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Melbourne Health HREC
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Ethics committee address [1]
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Post Office Royal Melbourne Hospital Parkville Victoria 3050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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26/11/2014
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Approval date [1]
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11/02/2015
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Ethics approval number [1]
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HREC/14/MH/355
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Summary
Brief summary
This study will determine the effect of the use of circulating tumour DNA (ctDNA) to guide adjuvant chemotherapy on recurrence-free survival in stage II colon or rectal cancer patients Who is it for? You may be eligible to join this study if you are aged 18 years or above, and have been diagnosed with Stage II colon or rectal cancer and have had your cancer curatively resected. Study details Participants in this study are randomly allocated (by chance) to one of two groups. Participants in one group will have blood samples taken and analysed for circulating tumour DNA (ctDNA) and be treated according to the ctDNA results. Those with positive ctDNA results will receive standard 5FU-based adjuvant chemotherapy (either single agent or combined with oxaliplatin), while those with negative ctDNA will not receive adjuvant chemotherapy. Participants in the other group will have a blood sample taken, but the ctDNA result will not be disclosed. Patients in this group will be treated according to standard clinical criteria at the discretion of the treating physician. Participants who had positive ctDNA results and are being treated with adjuvant chemotherapy will have monthly blood samples taken during treatment to track ctDNA levels. All participants will be followed up 3 monthly for 2 years, then 6 monthly for 3 years through their hospital for a total of five years for disease recurrence and survival.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Jeanne Tie
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Address
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Peter MacCallum Cancer Centre
305 Grattan St, Melbourne VIC 3000
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Country
55750
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Australia
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Phone
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+61 3 9345 2707
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Fax
55750
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Email
55750
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jeanne.tie@petermac.org
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Contact person for public queries
Name
55751
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Matthew Chapman
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Address
55751
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Walter and Eliza Hall Institute
1G Royal Parade
Parkville VIC 3052
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Country
55751
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Australia
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Phone
55751
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+61 3 9345 2828
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Fax
55751
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Email
55751
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matthew.chapman@mh.org.au
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Contact person for scientific queries
Name
55752
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Jeanne Tie
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Address
55752
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Peter MacCallum Cancer Centre
305 Grattan St, Melbourne VIC 3000
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Country
55752
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Australia
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Phone
55752
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+61 3 9345 2707
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Fax
55752
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Email
55752
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jeanne.tie@petermac.org
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
IPD may be collected at a site level. However, IPD will not be made available to the Sponsor. The data that is collected by the Sponsor will not be re-identifiable at the Sponser level. There are safeguards in place to minimise the risk of a privacy breach. They include analysing the data on an aggregated level and access to the data in a controlled environment with only authorised study personnel. Finally, enabling the availability of IPDs will not help meet the primary and secondary objectives of the study which are dependent on the results from the study population rather than on an individual basis.
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
2291
Informed consent form
368173-(Uploaded-07-06-2019-12-11-27)-Study-related document.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Circulating tumor DNA-defined minimal residual disease in solid tumors: Opportunities to accelerate the development of adjuvant therapies.
2018
https://dx.doi.org/10.1200/JCO.2018.78.9032
Dimensions AI
Liquid Biopsy to Identify Actionable Genomic Alterations
2018
https://doi.org/10.1200/edbk_199765
Embase
Circulating tumour DNA in early stage colorectal cancer: Can blood tell all?.
2019
https://dx.doi.org/10.21037/atm.2019.09.55
Embase
Designing circulating tumor DNA-based interventional clinical trials in oncology.
2019
https://dx.doi.org/10.1186/s13073-019-0634-x
Dimensions AI
Analysis of Plasma Cell-Free DNA by Ultradeep Sequencing in Patients With Stages I to III Colorectal Cancer
2019
https://doi.org/10.1001/jamaoncol.2019.0528
Dimensions AI
Circulating Tumor DNA Analyses as Markers of Recurrence Risk and Benefit of Adjuvant Therapy for Stage III Colon Cancer
2019
https://doi.org/10.1001/jamaoncol.2019.3616
Dimensions AI
Circulating Tumor DNA Analysis in Colorectal Cancer: From Dream to Reality
2019
https://doi.org/10.1200/po.18.00397
Embase
Circulating tumor DNA and liquid biopsy in oncology.
2020
https://dx.doi.org/10.1038/s43018-020-0043-5
Embase
Circulating tumor DNA guided adjuvant chemotherapy in stage II colon cancer (MEDOCC-CrEATE): Study protocol for a trial within a cohort study.
2020
https://dx.doi.org/10.1186/s12885-020-07252-y
Embase
ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper.
2020
https://dx.doi.org/10.1038/s41571-020-0392-0
Embase
Tumor DNA as a cancer biomarker through the lens of colorectal neoplasia A C.
2020
https://dx.doi.org/10.1158/1055-9965.EPI-20-0549
Dimensions AI
Circulating Tumour DNA to Guide Treatment of Gastrointestinal Malignancies
2020
https://doi.org/10.1159/000509657
Dimensions AI
Prognostic significance of postsurgery circulating tumor DNA in nonmetastatic colorectal cancer: Individual patient pooled analysis of three cohort studies
2020
https://doi.org/10.1002/ijc.33312
Embase
Advantages and challenges of using ctdna ngs to assess the presence of minimal residual disease (Mrd) in solid tumors.
2021
https://dx.doi.org/10.3390/cancers13225698
Embase
Ctdna and adjuvant therapy for colorectal cancer: Time to re-invent our treatment paradigm.
2021
https://dx.doi.org/10.3390/cancers13020346
Embase
Liquid biopsy to detect minimal residual disease: Methodology and impact.
2021
https://dx.doi.org/10.3390/cancers13215364
Embase
Liquid biopsy: From discovery to clinical application.
2021
https://dx.doi.org/10.1158/2159-8290.CD-20-1311
Embase
The Application of Circulating Tumor DNA in the Screening, Surveillance, and Treatment Monitoring of Colorectal Cancer.
2021
https://dx.doi.org/10.1245/s10434-020-09002-7
Embase
The use of liquid biopsy in early breast cancer: Clinical evidence and future perspectives.
2021
https://dx.doi.org/10.20517/2394-4722.2020.93
Dimensions AI
Clinical Applications of Minimal Residual Disease Assessments by Tumor-Informed and Tumor-Uninformed Circulating Tumor DNA in Colorectal Cancer
2021
https://doi.org/10.3390/cancers13184547
Dimensions AI
Postoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer
2021
https://doi.org/10.1186/s13045-021-01089-z
Embase
Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update.
2022
https://dx.doi.org/10.1200/JCO.21.02538
Embase
Circulating Tumor DNA Analysis Guiding Adjuvant Therapy in Stage II Colon Cancer.
2022
https://dx.doi.org/10.1056/NEJMoa2200075
Embase
Circulating Tumor DNA in Precision Oncology and Its Applications in Colorectal Cancer.
2022
https://dx.doi.org/10.3390/ijms23084441
Embase
Circulating Tumor DNA: An Emerging Tool in Gastrointestinal Cancers.
2022
https://dx.doi.org/10.1200/EDBK_349143
Embase
Impact of Circulating Tumor DNA-Based Detection of Molecular Residual Disease on the Conduct and Design of Clinical Trials for Solid Tumors.
2022
https://dx.doi.org/10.1200/PO.21.00181
Embase
Liquid biopsies to monitor and direct cancer treatment in colorectal cancer.
2022
https://dx.doi.org/10.1038/s41416-022-01769-8
Embase
Ongoing and evolving clinical trials enhancing future colorectal cancer treatment strategies.
2022
https://dx.doi.org/10.1080/13543784.2022.2040016
Embase
The Future of ctDNA-Defined Minimal Residual Disease: Personalizing Adjuvant Therapy in Colorectal Cancer.
2022
https://dx.doi.org/10.1016/j.clcc.2022.03.004
Embase
Use of Circulating Tumour DNA to Assess Minimal Residual Disease in Gastrointestinal Cancers.
2022
Dimensions AI
„Liquid biopsy“ in der gastrointestinalen Onkologie: Hype oder bald Realität?
2022
https://doi.org/10.1007/s41971-022-00129-w
Embase
Circulating Tumor DNA: Towards More Individualized Treatment for Patients with Resectable Colorectal Cancer.
2023
https://dx.doi.org/10.1007/s12029-022-00888-y
Embase
ctDNA to Guide Treatment of Colorectal Cancer: Ready for Standard of Care?.
2023
https://dx.doi.org/10.1007/s11864-022-01048-x
Embase
Opportunities on the horizon for the management of early colon cancer.
2023
https://dx.doi.org/10.1016/j.critrevonc.2023.103918
Embase
Practical recommendations for using ctDNA in clinical decision making.
2023
https://dx.doi.org/10.1038/s41586-023-06225-y
Dimensions AI
Regulatory implications of ctDNA in immuno-oncology for solid tumors
2023
https://doi.org/10.1136/jitc-2022-005344
N.B. These documents automatically identified may not have been verified by the study sponsor.
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