Preoperative Chemosensitivity Testing to Predict Treatment Benefit in Adjuvant Stage III Colon Cancer (PePiTA)

• Examine the predictive value of PET-assessed tumour FDG uptake response after one course of preoperative chemotherapy on the outcome of adjuvant therapy, measured by 3-year DFS. [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: No ]
  

• Examine the predictive value of PET-assessed tumour FDG uptake changes after one course of preoperative chemotherapy on OS [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: No ]
  
• Evaluate the best cut-off value for relative delta SUV in assessment of preoperative chemotherapy response by FDG-PET/CT imaging. [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: No ]
  
• Analyze the cost-effectiveness of preoperative chemo-sensitivity testing [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: No ]
  
• Assess the predictive value of circulating tumour cells on disease-free survival [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: No ]
  
• Assess the predictive value of SNPs on toxicity- and drug target-related genes on DFS [ Time Frame: Within 3 years after completion of adjuvant chemotherapy ] [ Designated as safety issue: Yes ]
  
• Create a frozen tumour bank for future studies [ Time Frame: Within 2 years from the beginning of study ] [ Designated as safety issue: No ]
  

Patients with histological confirmed colon adenocarcinoma compatible with clinical stage II or III are eligible for study screening. Receipt of a signed informed consent and study inclusion should be done within 15 days after histological diagnosis. A usual workup for preoperative staging of colon cancer must be done not more than 1 month before study inclusion and include CEA assessment, positive histological sample for colon adenocarcinoma and chest and abdominal CT scan. After receipt of the written consent, the patient undergoes baseline PET/CT scan and donates blood samples for CTC and SNP analyses. Delay between baseline examinations and histological diagnosis must not exceed 21 days. The baseline examinations should be done within 1 week before beginning of the first course of FOLFOX chemotherapy. Thirteen to 15 days after chemotherapy, the PET/CT and blood sampling for CTC analysis are repeated. Standard surgery follows after 15 days but no more than 30 days from Day 1 of preoperative chemotherapy. Two frozen tissue cores are obtained during surgery and sent immediately in dry ice shipping to the central Tumour Bank (Jules Bordet Institute) or stored locally at -80°C to be sent in batches to the central tumour bank. Thereafter, the patient receives standard care, according to tumour pathological stage. In fully eligible patients, FOLFOX chemotherapy should be started not more than 45 days after surgery. In stage III patients otherwise ineligible, recommendation is to start FOLFOX chemotherapy within 45 days after surgery although such patients will not be included in the primary analysis. Treatment in case of stage II or stage IV colon cancer is left at investigator's discretion. Eleven courses of adjuvant FOLFOX are foreseen, in order to match the usual recommendation coming from the Mosaic Trial.

Follow-up procedures after completion of adjuvant treatment will follow standard European clinical recommendations for stage II and III patients. Clinical follow-up data will be obtained for all patients, including those with stage II disease, with a minimum follow-up time of three years.