The ctDNA-RECIST Trial Part One

Trial Title: The ctDNA-RECIST Trial Part One

NCT ID: NCT06562348

Condition: Gastrointestinal Neoplasm

Conditions: Official terms:
Gastrointestinal Neoplasms
Digestive System Neoplasms

Conditions: Keywords:
Circulating Tumor DNA
Liquid Biopsy
Gastrointestinal Neoplasm
Metastatic

Study type: Interventional

Study phase: Phase 2

Overall status: Not yet recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Intervention model description: An open label 1:1 randomized phase II trial

Primary purpose: Other

Masking: None (Open Label)

Intervention:

Intervention type: Other
Intervention name: Standard of care
Description: Patients will be offered palliative systemic treatment according to standard of care. Response evaluation will be performed with the imaging-based RECIST according to standard guidelines. Treatment pauses according to institutional guidelines. Blood samples will be analyzed retrospectively to evaluate ctDNA.
Arm group label: A: Standard of care

Intervention type: Other
Intervention name: ctDNA-RECIST guided palliative systemic treatment
Description: Patients are offered palliative systemic treatment according to standard of care. Response evaluation will be performed using ctDNA-RECIST. ctDNA is measured before start of treatment. If the baseline sample is ctDNA negative the patient is transferred to an observational cohort, and sampling procedures continues as in the standard arm. If the baseline sample is ctDNA positive the patient continues in the ctDNA-RECIST guided arm. Treatment response is evaluated according to ctDNA-RECIST, and further sampling follows a predefined decision schedule.
Arm group label: ctDNA-RECIST guided therapy approach

Summary: A study investigating if analysis of circulating tumor DNA (ctDNA) can guide palliative treatment in patients with gastrointestinal cancer.

Detailed description: Background: Circulating tumor DNA, (ctDNA) has the potential to better monitor treatment efficacy compared to imaging, possibly sparing the patient for ineffective treatment and their associated toxicity an allowing for an early change of the treatment approach. Based on multiple dataset we have defined ctDNA-RECIST - the ctDNA response evaluation criteria. Aim: This phase II randomized trial evaluates the use of ctDNA Response Evaluation Criteria in Solid Tumors (ctDNA-RECIST) versus standard imaging-based RECIST to guide treatment decisions in patients with metastatic gastrointestinal cancers. Design: Patients are randomized 1:1. Patients in Arm A are offered standard treatment with response evaluation according to the RECIST criteria based on imaging, and treatment pauses according to institutional guidelines. In Arm B, treatment response is evaluated based on change in ctDNA between the baseline sample and the evaluation and confirmation sample, according to ctDNA-RECIST: - Progressive disease: An increase of ctDNA above the previous value with no overlap of the two CI's - Stable disease: A value within CI of the previous value. The category also includes samples with both previous and present value being 0 (undetectable). - Partial Response: A decrease below the previous value with no overlap of the two CI'S but the lower CI does not overlap 0. - Complete response: Decreasing value to an undetectable level - Near complete response: A decrease below the previous value with no overlap of the two CI'S and with the lower CI overlapping 0 Complete and near complete response can be combined and classified as maximal response. The study is initiated as a feasibility study (part one)and will continue into the expansion trial after interim analysis.(part two)

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Incurable metastatic gastrointestinal cancer - Indication for first or second-line systemic treatment - Measurable disease according to RECIST v.1.1 - CT of chest and abdomen less than 30 days old at time of treatment initiation - Age at least 18 years - ECOG performance status 0-2 - Clinically eligible systemic palliative treatment at investigators decision. - Adequate bone marrow, liver and renal function allowing systemic chemotherapy - Anticonception for fertile women and for male patients with a fertile partner. Intrauterine device, vasectomy of a female subject's male partner or hormonal contraceptive are acceptable - Written and verbally informed consent Exclusion Criteria: - Incapacity, frailty, disability and comorbidity to a degree that according to the investigator is not compatible with combination chemotherapy - Other concurrent malignant tumor except non-melanoma skin cancer or carcinoma in situ cervicis uteri - Pregnant (positive pregnancy test) or breast-feeding women

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: Aarhus University Hospital

Address:
City: Aarhus
Zip: 8000
Country: Denmark

Contact:
Last name: Karen-Lise G Spindler

Facility:
Name: Department pf Oncology, Vejle Hospital

Address:
City: Vejle
Zip: 7100
Country: Denmark

Start date: September 2024

Completion date: September 1, 2030

Lead sponsor:
Agency: Karen-Lise Garm Spindler
Agency class: Other

Collaborator:
Agency: Vejle Hospital
Agency class: Other

Source: Aarhus University Hospital

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT06562348