Trial Review

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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
Date results information initially provided
4/09/2019
Type of registration
Prospectively registered

Titles & IDs
Public title
Circulating tumour DNA (ctDNA) analysis informing adjuvant chemotherapy in Stage II Colon Cancer
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.
Secondary ID [1] 286348 0
Nil
Universal Trial Number (UTN)
Trial acronym
DYNAMIC
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Patients with the diagnosis of Stage II Colon cancer. 294472 0
Patients with the diagnosis of stage II rectal cancer 294791 0
Condition category
Condition code
Cancer 294775 294775 0 0
Bowel - Back passage (rectum) or large bowel (colon)

Intervention/exposure
Study type
Interventional
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
Intervention code [1] 291411 0
Early detection / Screening
Intervention code [2] 291651 0
Treatment: Other
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.
Control group
Active

Outcomes
Primary outcome [1] 294538 0
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.
Timepoint [1] 294538 0
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.
Secondary outcome [1] 313576 0
To evaluate whether an adjuvant therapy strategy based on ctDNA results may affect overall survival in patients with stage II colorectal cancer
Timepoint [1] 313576 0
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.
Secondary outcome [2] 313696 0
To correlate the change of serial ctDNA measurements during treatment with disease recurrence.
Timepoint [2] 313696 0
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.

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.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
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.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation involves contacting the Sponsor Site who holds the randomized allocation table.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomization using a randomisation table created by statistical software.
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Efficacy
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.

Recruitment
Recruitment status
Active, not recruiting
Date of first participant enrolment
Anticipated
1/05/2015
Actual
10/08/2015
Date of last participant enrolment
Anticipated
1/01/2020
Actual
25/07/2019
Date of last data collection
Anticipated
8/08/2024
Actual
Sample size
Target
450
Accrual to date
Final
459
Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,SA,TAS,WA,VIC
Recruitment hospital [1] 6665 0
Royal Melbourne Hospital - City campus - Parkville
Recruitment hospital [2] 6666 0
Western Hospital - Footscray
Recruitment hospital [3] 6667 0
The Alfred - Prahran
Recruitment hospital [4] 6668 0
Austin Health - Austin Hospital - Heidelberg
Recruitment hospital [5] 6669 0
Barwon Health - Geelong Hospital campus - Geelong
Recruitment hospital [6] 6670 0
Bendigo Health Care Group - Bendigo Hospital - Bendigo
Recruitment hospital [7] 6671 0
Border Medical Oncology - Albury
Recruitment hospital [8] 6672 0
Cabrini Hospital - Malvern - Malvern
Recruitment hospital [9] 6673 0
The Canberra Hospital - Garran
Recruitment hospital [10] 6674 0
Box Hill Hospital - Box Hill
Recruitment hospital [11] 6675 0
Fiona Stanley Hospital - Murdoch
Recruitment hospital [12] 6676 0
Flinders Medical Centre - Bedford Park
Recruitment hospital [13] 6677 0
The Chris O’Brien Lifehouse - Camperdown
Recruitment hospital [14] 6678 0
Monash Medical Centre - Clayton campus - Clayton
Recruitment hospital [15] 6679 0
Nepean Hospital - Kingswood
Recruitment hospital [16] 6680 0
Royal Brisbane & Womens Hospital - Herston
Recruitment hospital [17] 6681 0
Royal Hobart Hospital - Hobart
Recruitment hospital [18] 6682 0
St John of God Hospital Warrnambool - Warrnambool
Recruitment hospital [19] 6683 0
St Vincent's Hospital (Melbourne) Ltd - Fitzroy
Recruitment hospital [20] 8812 0
Calvary Mater Newcastle - Waratah
Recruitment hospital [21] 8813 0
Newcastle Private Hospital - New Lambton Heights
Recruitment hospital [22] 11457 0
The Northern Hospital - Epping
Recruitment postcode(s) [1] 14303 0
2050 - Camperdown
Recruitment postcode(s) [2] 16935 0
2298 - Waratah
Recruitment postcode(s) [3] 16936 0
2305 - New Lambton Heights
Recruitment postcode(s) [4] 14299 0
2605 - Garran
Recruitment postcode(s) [5] 14305 0
2747 - Kingswood
Recruitment postcode(s) [6] 14293 0
3004 - Prahran
Recruitment postcode(s) [7] 14291 0
3050 - Parkville
Recruitment postcode(s) [8] 14309 0
3065 - Fitzroy
Recruitment postcode(s) [9] 23476 0
3076 - Epping
Recruitment postcode(s) [10] 14294 0
3084 - Heidelberg
Recruitment postcode(s) [11] 14300 0
3128 - Box Hill
Recruitment postcode(s) [12] 14298 0
3144 - Malvern
Recruitment postcode(s) [13] 14304 0
3168 - Clayton
Recruitment postcode(s) [14] 14295 0
3220 - Geelong
Recruitment postcode(s) [15] 14308 0
3280 - Warrnambool
Recruitment postcode(s) [16] 14296 0
3550 - Bendigo
Recruitment postcode(s) [17] 14297 0
3690 - Wodonga
Recruitment postcode(s) [18] 14306 0
4029 - Herston
Recruitment postcode(s) [19] 14292 0
5022 - Henley Beach
Recruitment postcode(s) [20] 14302 0
5042 - Bedford Park
Recruitment postcode(s) [21] 14301 0
6150 - Murdoch
Recruitment postcode(s) [22] 14307 0
7000 - Hobart

Funding & Sponsors
Funding source category [1] 290922 0
Government body
Name [1] 290922 0
NHMRC
Country [1] 290922 0
Australia
Primary sponsor type
Other Collaborative groups
Name
Walter and Eliza Hall Institute
Address
1G Royal Pde
Parkville
Vic 3052
Country
Australia
Secondary sponsor category [1] 289608 0
None
Name [1] 289608 0
Address [1] 289608 0
Country [1] 289608 0

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 292527 0
Melbourne Health HREC
Ethics committee address [1] 292527 0
Post Office
Royal Melbourne Hospital
Parkville Victoria 3050
Ethics committee country [1] 292527 0
Australia
Date submitted for ethics approval [1] 292527 0
26/11/2014
Approval date [1] 292527 0
11/02/2015
Ethics approval number [1] 292527 0
HREC/14/MH/355

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.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 55750 0
A/Prof Jeanne Tie
Address 55750 0
Peter MacCallum Cancer Centre
305 Grattan St, Melbourne VIC 3000
Country 55750 0
Australia
Phone 55750 0
+61 3 9345 2707
Fax 55750 0
Email 55750 0
jeanne.tie@petermac.org
Contact person for public queries
Name 55751 0
Mr Matthew Chapman
Address 55751 0
Walter and Eliza Hall Institute
1G Royal Parade
Parkville VIC 3052
Country 55751 0
Australia
Phone 55751 0
+61 3 9345 2828
Fax 55751 0
Email 55751 0
matthew.chapman@mh.org.au
Contact person for scientific queries
Name 55752 0
A/Prof Jeanne Tie
Address 55752 0
Peter MacCallum Cancer Centre
305 Grattan St, Melbourne VIC 3000
Country 55752 0
Australia
Phone 55752 0
+61 3 9345 2707
Fax 55752 0
Email 55752 0
jeanne.tie@petermac.org

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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.


What supporting documents are/will be available?

TypeCitationLinkEmailOther DetailsAttachment
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
SourceTitleYear of PublicationDOI
EmbaseCirculating tumor DNA-defined minimal residual disease in solid tumors: Opportunities to accelerate the development of adjuvant therapies.2018https://dx.doi.org/10.1200/JCO.2018.78.9032
EmbaseCirculating tumor DNA guided adjuvant chemotherapy in stage II colon cancer (MEDOCC-CrEATE): Study protocol for a trial within a cohort study.2020https://dx.doi.org/10.1186/s12885-020-07252-y
EmbaseDesigning circulating tumor DNA-based interventional clinical trials in oncology.2019https://dx.doi.org/10.1186/s13073-019-0634-x
EmbaseCirculating tumour DNA in early stage colorectal cancer: Can blood tell all?.2019https://dx.doi.org/10.21037/atm.2019.09.55
EmbaseTumor DNA as a cancer biomarker through the lens of colorectal neoplasia A C.2020https://dx.doi.org/10.1158/1055-9965.EPI-20-0549
EmbaseCirculating tumor DNA and liquid biopsy in oncology.2020https://dx.doi.org/10.1038/s43018-020-0043-5
EmbasectDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper.2020https://dx.doi.org/10.1038/s41571-020-0392-0
EmbaseLiquid biopsy: From discovery to clinical application.2021https://dx.doi.org/10.1158/2159-8290.CD-20-1311
EmbaseCtdna and adjuvant therapy for colorectal cancer: Time to re-invent our treatment paradigm.2021https://dx.doi.org/10.3390/cancers13020346
EmbaseThe Application of Circulating Tumor DNA in the Screening, Surveillance, and Treatment Monitoring of Colorectal Cancer.2021https://dx.doi.org/10.1245/s10434-020-09002-7
EmbaseLiquid biopsy to detect minimal residual disease: Methodology and impact.2021https://dx.doi.org/10.3390/cancers13215364
EmbaseAdvantages and challenges of using ctdna ngs to assess the presence of minimal residual disease (Mrd) in solid tumors.2021https://dx.doi.org/10.3390/cancers13225698
EmbaseThe use of liquid biopsy in early breast cancer: Clinical evidence and future perspectives.2021https://dx.doi.org/10.20517/2394-4722.2020.93
EmbaseCirculating Tumor DNA in Precision Oncology and Its Applications in Colorectal Cancer.2022https://dx.doi.org/10.3390/ijms23084441
EmbaseCirculating Tumor DNA: An Emerging Tool in Gastrointestinal Cancers.2022https://dx.doi.org/10.1200/EDBK_349143
EmbaseOngoing and evolving clinical trials enhancing future colorectal cancer treatment strategies.2022https://dx.doi.org/10.1080/13543784.2022.2040016
EmbaseImpact of Circulating Tumor DNA-Based Detection of Molecular Residual Disease on the Conduct and Design of Clinical Trials for Solid Tumors.2022https://dx.doi.org/10.1200/PO.21.00181
EmbaseAdjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update.2022https://dx.doi.org/10.1200/JCO.21.02538
EmbaseUse of Circulating Tumour DNA to Assess Minimal Residual Disease in Gastrointestinal Cancers.2022
EmbaseLiquid biopsies to monitor and direct cancer treatment in colorectal cancer.2022https://dx.doi.org/10.1038/s41416-022-01769-8
EmbaseCirculating Tumor DNA Analysis Guiding Adjuvant Therapy in Stage II Colon Cancer.2022https://dx.doi.org/10.1056/NEJMoa2200075
EmbaseThe Future of ctDNA-Defined Minimal Residual Disease: Personalizing Adjuvant Therapy in Colorectal Cancer.2022https://dx.doi.org/10.1016/j.clcc.2022.03.004
EmbasePractical recommendations for using ctDNA in clinical decision making.2023https://dx.doi.org/10.1038/s41586-023-06225-y
EmbaseCirculating Tumor DNA: Towards More Individualized Treatment for Patients with Resectable Colorectal Cancer.2023https://dx.doi.org/10.1007/s12029-022-00888-y
EmbasectDNA to Guide Treatment of Colorectal Cancer: Ready for Standard of Care?.2023https://dx.doi.org/10.1007/s11864-022-01048-x
EmbaseOpportunities on the horizon for the management of early colon cancer.2023https://dx.doi.org/10.1016/j.critrevonc.2023.103918
Dimensions AICirculating Tumor DNA Analyses as Markers of Recurrence Risk and Benefit of Adjuvant Therapy for Stage III Colon Cancer2019https://doi.org/10.1001/jamaoncol.2019.3616
Dimensions AIRegulatory implications of ctDNA in immuno-oncology for solid tumors2023https://doi.org/10.1136/jitc-2022-005344
Dimensions AICirculating Tumour DNA to Guide Treatment of Gastrointestinal Malignancies2020https://doi.org/10.1159/000509657
Dimensions AIPostoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer2021https://doi.org/10.1186/s13045-021-01089-z
Dimensions AIPrognostic significance of postsurgery circulating tumor DNA in nonmetastatic colorectal cancer: Individual patient pooled analysis of three cohort studies2020https://doi.org/10.1002/ijc.33312
Dimensions AILiquid Biopsy to Identify Actionable Genomic Alterations2018https://doi.org/10.1200/edbk_199765
Dimensions AICirculating Tumor DNA Analysis in Colorectal Cancer: From Dream to Reality2019https://doi.org/10.1200/po.18.00397
Dimensions AIClinical Applications of Minimal Residual Disease Assessments by Tumor-Informed and Tumor-Uninformed Circulating Tumor DNA in Colorectal Cancer2021https://doi.org/10.3390/cancers13184547
Dimensions AIAnalysis of Plasma Cell-Free DNA by Ultradeep Sequencing in Patients With Stages I to III Colorectal Cancer2019https://doi.org/10.1001/jamaoncol.2019.0528
Dimensions AI„Liquid biopsy“ in der gastrointestinalen Onkologie: Hype oder bald Realität?2022https://doi.org/10.1007/s41971-022-00129-w
N.B. These documents automatically identified may not have been verified by the study sponsor.