A022101 A Pragmatic Randomized Phase III Trial Evaluating Total Ablative Therapy for Patients With Limited Metastatic Colorectal Cancer: Evaluating Radiation, Ablation, and Surgery [ERASur]

Study of Ablative Therapy in Limited Metastatic Colorectal Cancer

Enrolling By Invitation
18 years or above
All
Phase 3
364 participants needed
1 Location

Brief description of study

This phase III trial compares total ablative therapy and usual systemic therapy to usual systemic therapy alone in treating patients with colorectal cancer that has spread to up to 4 body sites (limited metastatic). The usual approach for patients who are not participating in a study is treatment with intravenous (IV) (through a vein) and/or oral medications (systemic therapy) to help stop the cancer sites from getting larger and the spread of the cancer to additional body sites. Ablative means that the intention of the local treatment is to eliminate the cancer at that metastatic site. The ablative local therapy will consist of very focused, intensive radiotherapy called stereotactic ablative radiotherapy (SABR) with or without surgical resection and/or microwave ablation, which is a procedure where a needle is temporarily inserted in the tumor and heat is used to destroy the cancer cells. SABR, surgical resection, and microwave ablation have been tested for safety, but it is not scientifically proven that the addition of these treatments are beneficial for your stage of cancer. The addition of ablative local therapy to all known metastatic sites to the usual approach of systemic therapy could shrink or remove the tumor(s) or prevent the tumor(s) from returning.

Detailed description of study

PRIMARY OBJECTIVE:

I. To evaluate and compare overall survival (OS) (measured from time of randomization) in patients with newly diagnosed oligometastatic colorectal cancer (oCRC) treated with total ablative therapy (TAT) in addition to standard of care (SOC) systemic therapy versus SOC systemic therapy.

SECONDARY OBJECTIVES:

I. To evaluate and compare event-free survival (EFS) (measured from time of randomization) between the two treatment arms.

II. To assess the adverse events (AE) profile within each of the two treatment arms.

III. To evaluate the time to local recurrence (TLR) (measured from completion of TAT) in patients with newly diagnosed oCRC treated with TAT + SOC systemic therapy.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM 1: Patients undergo TAT on study, consisting of SABR with or without surgical resection and/or microwave ablation. Patients also receive SOC chemotherapy on study. Patients also undergo computed tomography (CT) or magnetic resonance imaging (MRI) or positron emission tomography (PET)/CT scans throughout the trial.

ARM 2: Patients receive SOC chemotherapy on study. Patients also undergo Patients also undergo CT or MRI or PET/CT scans throughout the trial.

Eligibility of study

You may be eligible for this study if you meet the following criteria:

  • Conditions: Metastatic Colorectal Adenocarcinoma, Stage IV Colorectal Cancer AJCC v8
  • Age: 18 years or above
  • Gender: All

Inclusion Criteria:

  • PRE-REGISTRATION (STEP 0): Histologically-confirmed metastatic colorectal adenocarcinoma
  • PRE-REGISTRATION (STEP 0): No known microsatellite instable (MSI) tumor
  • PRE-REGISTRATION (STEP 0): No known BRAF V600E mutation
  • PRE-REGISTRATION (STEP 0): Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression. No known peritoneal and/or omental metastases. If radiologic studies suggest the presence of peritoneal disease, a diagnostic laparoscopy is recommended to verify the absence of peritoneal implants
  • PRE-REGISTRATION (STEP 0): Primary tumor is already resected OR primary tumor is surgically amenable to resection, as determined by consultation and documentation with surgeon or documentation of discussion in the institutional multi-disciplinary tumor board where a surgeon confirms resectability. Patients with unresectable primary tumors are not eligible
  • PRE-REGISTRATION (STEP 0): Four (4) or fewer apparent sites of metastatic disease based on review by local medical team of baseline radiographic imaging obtained prior to initiation of systemic therapy.
    • Sites of metastatic disease must be radiographically evident, but pathologic confirmation is not required.
    • Liver-only metastatic disease is NOT permitted. For patients with liver metastases, there must be at least one other site of metastasis in addition to the liver to be eligible for this study.
    • Metastatic lesions must be amenable to any combination of surgical resection, microwave ablation, and/or stereotactic ablative body radiation therapy (SABR). SABR is required for at least one lesion. Therefore, the patient must be seen by a radiation oncologist in consultation to verify eligibility.
    • Single sites include:
      • Each hemiliver (right and left), each lobe of the lungs, each adrenal gland, lymph nodes amenable to a single resection or treatment in a single SABR field, bone metastases amenable to treatment in a single SABR field
  • PRE-REGISTRATION (STEP 0): Patients must have measurable disease per Response

    Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1

  • PRE-REGISTRATION (STEP 0): A maximum of 16 weeks (4 months) of systemic therapy may be administered prior to pre-registration
  • REGISTRATION (STEP 1): Patients must have no overt evidence of disease progression during systemic therapy prior to registration
  • REGISTRATION (STEP 1): Not eligible for hepatic artery infusion pump (HAIP) therapy or benefit of HAIP therapy is undefined
  • REGISTRATION (STEP 1): Patients must have measurable disease per RECIST v1.1
  • REGISTRATION (STEP 1): Patients must be receiving (or have received) first-line systemic therapy for metastatic disease for a minimum of 16 weeks (4 months) and a maximum of 24 weeks (6 months)
  • REGISTRATION (STEP 1): Prior definitive therapy, including adjuvant chemotherapy, must have been completed at least 12 months prior to diagnosis of metastatic disease
  • REGISTRATION (STEP 1): Not pregnant and not nursing, because this study involves an agent or treatment that has known genotoxic, mutagenic, and teratogenic effects.
    • Therefore, for women of childbearing potential only, a negative pregnancy test done =< 14 days prior to registration is required
  • REGISTRATION (STEP 1): Age >= 18 years
  • REGISTRATION (STEP 1): Eastern Cooperative Oncology Group (ECOG) performance status: 0-2
  • REGISTRATION (STEP 1): Absolute neutrophil count (ANC) >= 1,500/mm^3
  • REGISTRATION (STEP 1): Platelet count >= 50,000/mm^3
  • REGISTRATION (STEP 1): Creatinine =< 1.5 x upper limit of normal (ULN) OR calculated (calc.) creatinine clearance >= 30 mL/min
    • Calculated using the Cockcroft-Gault equation
  • REGISTRATION (STEP 1): Total bilirubin =< 1.5 x ULN
  • REGISTRATION (STEP 1): Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase [SGOT]) / alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x ULN
    • In the event of metastatic liver disease, =< 5 x ULN
  • REGISTRATION (STEP 1): Human immunodeficiency virus (HIV)-infected patients on

    effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. Note: HIV testing is not required for eligibility

  • REGISTRATION (STEP 1): No other planned concurrent investigational agents while on study

Exclusion Criteria:

  • N/A

This study investigates the effects of total ablative therapy compared to usual systemic therapy in patients with limited metastatic colorectal cancer. Colorectal cancer can spread to other parts of the body, and this study focuses on cases where it has spread to up to four sites. Ablative therapy aims to eliminate cancer at these sites using focused treatments like stereotactic ablative radiotherapy (SABR), surgical removal, or microwave ablation. These methods are designed to directly target and destroy cancer cells, but their effectiveness in this stage of cancer is still being studied.

Participants in the study will be randomly assigned to one of two groups. One group will receive total ablative therapy along with standard chemotherapy, while the other group will receive only the standard chemotherapy. Throughout the study, participants will undergo various imaging tests such as CT, MRI, or PET/CT scans to monitor the cancer's response to treatment. These procedures will help determine whether the addition of ablative therapy can improve outcomes for patients with limited metastatic colorectal cancer.

  • Who can participate: Adults 18 and older with histologically-confirmed metastatic colorectal adenocarcinoma and up to four sites of metastatic disease, without known microsatellite instability or BRAF V600E mutation, are eligible. Participants must have completed prior definitive therapy at least 12 months before diagnosis of metastatic disease.
  • Study details: Participants will be randomly assigned to receive either total ablative therapy combined with standard chemotherapy or standard chemotherapy alone. Total ablative therapy may include stereotactic ablative radiotherapy, surgical resection, or microwave ablation. A placebo is not used in this study.
Updated on 02 Jul 2026. Study ID: 25-0772
If you need assistance finding a non-cancer clinical research study or if you have any questions, please email psom-ocr@pobox.upenn.edu For Cancer trials contact Penn Medicine's Cancer Trial Navigator at: PMCancerResearch@pennmedicine.upenn.edu or 215-349-8245

Study is selecting its participants from a population, or group of people, decided on by the researchers in advance.

Contact Abramson Cancer Center Navigator