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Rectal CancerPhase 2CAO/ARO/AIO-16NCT03561142

Organ Preservation in Locally Advanced Rectal Cancer by Radiochemotherapy Followed by Consolidation Chemotherapy.

A Phase 2 study testing Radiotherapy, Chemotherapy and Deep regional hyperthermia in people with Rectal Cancer and Rectal Neoplasms, run by University Hospital Tuebingen at 4 sites in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

There is a growing body of evidence that surgery and associated morbidities can be omitted without compromising oncological safety in selected patients who have achieved a clinical complete response after radiochemotherapy. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Radiotherapy, Chemotherapy and Deep regional hyperthermia
Could I receive a placebo?
No, everyone receives an active treatment
How many people
94 participants
Where
4 sitesGermany
Study dates
15 Jun 2018to 16 Apr 2024
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Male and female patients with histologically confirmed diagnosis of rectal cancer localized 0 - 12 cm from the anocutaneous line as measured by rigid rectoscopy (i.e. lower and middle third of the rectum)
  • Any MRI staged cT3 tumor or any cT1 cN+ or cT2 cN+ with nodal staging according to "SOP MRI"
  • Staging requirements: High-resolution, thin-sliced (i.e. 3mm) magnetic resonance imaging (MRI) of the pelvis is the mandatory local staging procedure.
  • Cross-sectional imaging of the abdomen and chest to exclude distant metastases.
  • Aged at least 18 years. No upper age limit.
  • WHO/ECOG Performance Status ≤ 1
  • Adequate hematological, hepatic, renal and metabolic function parameters
  • Informed consent of the patient

Who cannot join

  • Lower border of the tumor localised more than 12 cm from the anocutaneous line as measured by rigid rectoscopy
  • cT4 tumors
  • Positive lateral pelvic lymph nodes
  • Distant metastases (to be excluded by CT scan of the thorax and abdomen)
  • Preexisting fecal incontinence for solid stool
  • Preexisting peripheral sensory neuropathy with functional impairment
Show all 26Show fewer
  • Preexisting myelosuppression reflected by a neutrophil count < 2.000/mm^3 and/or platelets < 100.000/mm^3
  • Severe impairment of kidney function with a Creatinin Clearance < 30 ml/min)
  • Prior antineoplastic therapy for rectal cancer
  • Prior radiotherapy of the pelvic region
  • Major surgery within the last 4 weeks prior to inclusion
  • Subject pregnant or breast feeding, or planning to become pregnant within 6 months after the end of treatment.
  • Subject (male or female) is not willing to use highly effective methods of contraception according to the "Clinical trial fertility group"
  • On-treatment participation in an interventional clinical study in the period 30 days prior to inclusion
  • Previous or current drug abuse
  • Other concomitant antineoplastic therapy
  • Serious concurrent diseases, including neurologic or psychiatric disorders (incl. dementia and uncontrolled seizures), active, uncontrolled infections, active, disseminated coagulation disorder, severe liver function disorders
  • WHO/ECOG Performance Status > 1
  • Clinically significant cardiovascular disease (incl. myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) ≤ 6 months before enrolment.
  • Chronic diarrhea (> grade 1 according NCI CTCAE) Prior or concurrent malignancy ≤ 3 years prior to enrolment in study (Exception: non-melanoma skin cancer or cervical carcinoma FIGO stage 0-1), if the patient is continuously disease-free
  • Known allergic reactions on study medication
  • Known dihydropyrimidine dehydrogenase deficiency
  • Medication inhibitors of the dihydropyrimidine dehydrogenase, such as Brivudin, Sorivudin and its analogues.
  • Pernicious anemia or other anemias caused by Vitamin B-12 deficiency.
  • Psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule (these conditions should be discussed with the patient before registration in the trial).
  • Additionally for hyperthermia cardiac pacemakers and metal implants in the proximity of the pelvis constitute a criterion for exclusion.

Trial locations and contacts

4 sites in 1 country.

Germany4 sites, 4 recruiting
  • University Hospital Erlangen

    Erlangen

    Oliver Ott, Prof.

    Not yet recruiting
  • University Hospital Frankfurt

    Frankfurt

    Claus Rödel, Prof.

    Not yet recruiting
  • University Hospital Tübingen

    Tübingen

    Cihan Gani, Dr.

    Recruiting
  • University Hospital Würzburg

    Würzburg

    Bülent Polat, Dr.

    Not yet recruiting

Other trials in Germany

About this study

Official title: Organ Preservation in Locally Advanced Rectal Cancer by Radiochemotherapy Followed by Consolidation Chemotherapy. A Prospective Phase II Pilot Trial of the German Rectal Cancer Study Group

There is a growing body of evidence that surgery and associated morbidities can be omitted without compromising oncological safety in selected patients who have achieved a clinical complete response after radiochemotherapy. However with standard neoadjuvant treatment regimens the pathological complete response rate lies in the range between 10%-20%, the number of patients qualifying for non-operative management is even lower since the sensitivity of currently available diagnostic measures for predicting the pathological complete response hardly surpasses 50%-60%.The hereby proposed phase II trial CAO/ARO/AIO-16 aims at finding novel and innovative aspects of rectal cancer treatment. According to recently published data the radiochemotherapy regime in the present study with consolidating chemotherapy and delayed assessment of response has the potential to achieve pathological complete rates of approximately 40%. A standardized re-evaluation after consolidating chemotherapy will select patients who are candidates for organ-preservation. These patients will not undergo radical surgery and will instead be follow-up closely for tumor regrowth.

Being tested
Radiotherapy, Chemotherapy, Deep regional hyperthermia
Medical subject headings
Rectal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RadiotherapyRadiation

    Radiotherapy: 28 x 1.8 Gy (total: 50.4 Gy), 5 fractions per week on day 1- 38

  • ChemotherapyDrug

    Also called all brands of the used drugs are allowed

    chemoradiotherapy is started according to the following schedule: 5-FU: 250 mg/sqm per day, iv, on day 1-14, day 22-35; Oxaliplatin: 50 mg/sqm, day 1, 8, 22, and 29. After a break of two and a half weeks, patients receive three chemotherapy cycles, starting on day 57, 71 and 85, consisting of: Folinic acid: 400 mg/sqm, 2h-iv; Oxaliplatin: 100 mg/sqm, 2h-iv; 5-FU: 2400 mg/sqm, 46h-iv

  • Deep regional hyperthermiaOther

    Deep regional hyperthermia to the pelvis, total time 90 min, target temperature 41-42°C. Twice weekly, up to a total of 10 sessions within d1 and d38.

    Deep regional hyperthermia is offered at the centers in Tübingen and Erlangen.

Study groups in NCT03561142
Study groupRoleWhat they receive
Radiochemotherapy -> chemotherapy.ExperimentalRadiochemotherapy followed by consolidation chemotherapy. Deep regional hyperthermia can additionally be performed at the centers in Tübingen and Erlangen.
Receives: Radiation: Radiotherapy; Drug: Chemotherapy; Other: Deep regional hyperthermia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical complete response rate

    Response to treatment is assessed on day 106 after the start of radiochemotherapy.

    A clinical complete response is defined by standardized findings in rectoscopy, MRI and digital rectal examination

    Measured: Day 106 after the start of treatment

Secondary outcomes (13)
  1. Local regrowth rate

    Measured: 4 years

  2. Safety of the treatment (toxicity assessment according to NCI CTCAE Version 4.0)

    Measured: 4 years

  3. Fecal incontinence according to Wexner-Vaizey Score

    Possible scores range from 0 (perfect continence) to 24 (complete incontinence)

    Measured: 4 years

  4. Quality of life according to EORTC Quality of Life questionnaire - C30

    Measured: 4 years

  5. Quality of life according to EORTC Quality of Life questionnaire - CR29

    Measured: 4 years

  6. Frequency of Low anterior resection syndrome (LARS-scale)

    Measured: 4 years

  7. Surgical morbidity in patients undergoing surgery

    Measured: up to 30 days after surgery

  8. Surgical complications in patients undergoing surgery

    Measured: up to 30 days after surgery

  9. Pathological staging, tumor downstaging (assessed by ypTNM findings in relation to initial cTNM staging), tumor regression grading according to Dworak in patients undergoing surgery

    Measured: Day 123 after the start of treatment

  10. R0 resection rate, rate of circumferential resection margin negativity (> 1mm) in patients undergoing surgery

    Measured: Day 123 after the start of treatment

  11. Rate of sphincter-sparing surgery in patients undergoing surgery

    Measured: Day 123 after the start of treatment

  12. Relapse-free survival (local / distant / overall)

    Measured: 4 years

  13. Overall survival

    Measured: 4 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Jun 2018
  2. Study start15 Jun 2018 (estimated)
  3. Primary completion16 Apr 2020 (estimated)
  4. Study completion16 Apr 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Patients will undergo different treatments based on response achieved after radiochemotherapy. 1. Clinical Complete Response: Omission of surgery and follow-up 2. Near clinical complete response: Reevaluation in three months 3. Poor / no response: Surgery
Masking
None (open label)
Enrolment
94 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03561142
Sponsor's protocol ID
CAOAROAIO16
Acronym
CAO/ARO/AIO-16
Status last verified
Apr 2018
First submitted
19 Apr 2018
Last updated
19 Jun 2018
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Gani C, Bonomo P, Zwirner K, Schroeder C, Menegakis A, Rodel C, Zips D. Organ preservation in rectal cancer - Challenges and future strategies. Clin Transl Radiat Oncol. 2017 Mar 23;3:9-15. doi: 10.1016/j.ctro.2017.02.002. eCollection 2017 Apr.

    PubMed 29658007
  • Schroeder C, Gani C, Lamprecht U, von Weyhern CH, Weinmann M, Bamberg M, Berger B. Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone. Int J Hyperthermia. 2012;28(8):707-14. doi: 10.3109/02656736.2012.722263. Epub 2012 Sep 24.

    PubMed 23006132
  • Rodel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Strobel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. doi: 10.1016/S1470-2045(15)00159-X. Epub 2015 Jul 15.

    PubMed 26189067
  • Diefenhardt M, Fokas E, Kosmala R, Polat B, Germer CT, Schlenska-Lange A, Kuhnt T, Ghadimi M, Rieken S, Wiegering A, Schwarzbach M, Fleischmann M, Grutzmann R, Ott OJ, Martus P, Konigsrainer A, Zips D, Hofheinz RD, Gani C, Rodel C. Organ Preservation and Quality of Life After Total Neoadjuvant Treatment in Rectal Cancer. JAMA Netw Open. 2026 Oct 1;9(10):e2639063. doi: 10.1001/jamanetworkopen.2026.39063.

    PubMed 42879156
  • Gani C, Fokas E, Polat B, Ott OJ, Diefenhardt M, Konigsrainer A, Boke S, Kirschniak A, Bachmann R, Wichmann D, Bitzer M, Clasen S, Grosse U, Hoffmann R, Gotz M, Hofheinz RD, Germer E, Germer CT, Fietkau R, Martus P, Zips D, Rodel C. Organ preservation after total neoadjuvant therapy for locally advanced rectal cancer (CAO/ARO/AIO-16): an open-label, multicentre, single-arm, phase 2 trial. Lancet Gastroenterol Hepatol. 2025 Jun;10(6):562-572. doi: 10.1016/S2468-1253(25)00049-4.

    PubMed 40347958

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Radiotherapy, Chemotherapy and Deep regional hyperthermia in people with Rectal Cancer and Rectal Neoplasms, run by University Hospital Tuebingen at 4 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 26 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 19 Jun 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Cihan Gani, Dr. (+4970712982165, cihan.gani@med.uni-tuebingen.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical complete response rate (time frame: Day 106 after the start of treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03561142, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Jun 2018.

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