Panitumumab and RAS, Diagnostically-useful Gene Mutation for mCRC (PARADIGM)
A Phase III, Randomized, Controlled Study of mFOLFOX6 + Bevacizumab Combination Therapy Versus mFOLFOX6 + Panitumumab Combination Therapy in Chemotherapy-naive Patients With KRAS/NRAS Wild-type, Incurable/Unresectable, Advanced/Recurrent Colorectal Cancer
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The purpose of this study is to verify the efficacy of mFOLFOX6 + panitumumab combination therapy and mFOLFOX6 + bevacizumab combination therapy in first-line treatment of chemotherapy-naive patients with KRAS/NRAS wild-type, incurable/unresectable, advanced/recurrent colorectal cancer.
This study will enroll a total of approximately 800 participants (400 per group).
Participants will be randomized to either the mFOLFOX6 + panitumumab arm (Group P) or mFOLFOX6 + bevacizumab arm (Group B) at 1:1 ratio at the time of registration.
Group P and Group B treatment regimen shown below should be administered once every two weeks, following dose, schedule and route of administration.
Group P; mFOLFOX6 + panitumumab combination therapy, once every two weeks OXA: 85 mg/m2/day 1 l-LV: 200 mg/m2/day 1 5-FU iv: 400 mg/m2/day 1 5-FU civ: 2400 mg/m2/day 1-3 panitumumab: 6 mg/kg
Group B; mFOLFOX6 + bevacizumab combination therapy, once every two weeks OXA: 85 mg/m2/day 1 l-LV: 200 mg/m2/day 1 5-FU iv: 400 mg/m2/day 1 5-FU civ: 2400 mg/m2/day 1-3 bevacizumab: 5 mg/kg
This trial is conducted by multicenter and is scheduled for 12 months as whole administration period.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
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Akita, Japan
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Aomori, Japan
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Chiba, Japan
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Fukui, Japan
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Fukuoka, Japan
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Gifu, Japan
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Ibaraki, Japan
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Kagoshima, Japan
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Kochi, Japan
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Kumamoto, Japan
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Kyoto, Japan
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Miyazaki, Japan
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Nagano, Japan
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Nagasaki, Japan
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Niigata, Japan
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Okayama, Japan
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Okinawa, Japan
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Osaka, Japan
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Saga, Japan
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Saitama, Japan
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Shizuoka, Japan
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Tokushima, Japan
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Toyama, Japan
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Yamagata, Japan
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Aichi
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Ichinomiya, Aichi, Japan
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Komaki, Aichi, Japan
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Konan, Aichi, Japan
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Nagakute, Aichi, Japan
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Nagoya, Aichi, Japan
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Okazaki, Aichi, Japan
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Toyoake, Aichi, Japan
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Toyohashi, Aichi, Japan
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Toyokawa, Aichi, Japan
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Toyota, Aichi, Japan
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Yatomi, Aichi, Japan
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Akita
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Daisen, Akita, Japan
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Aomori
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Hirosaki, Aomori, Japan
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Misawa, Aomori, Japan
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Chiba
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Kashiwa, Chiba, Japan
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Yachiyo, Chiba, Japan
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Ehime
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Matsuyama, Ehime, Japan
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Toon, Ehime, Japan
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Fukui
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Tsuruga, Fukui, Japan
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Yoshida, Fukui, Japan
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Fukuoka
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Kitakyushu, Fukuoka, Japan
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Koga, Fukuoka, Japan
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Kurume, Fukuoka, Japan
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Omuta, Fukuoka, Japan
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Onga, Fukuoka, Japan
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Fukushima
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Aizuwakamatsu, Fukushima, Japan
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Iwaki, Fukushima, Japan
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Koriyama, Fukushima, Japan
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Shirakawa, Fukushima, Japan
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Gifu
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Hashima, Gifu, Japan
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Kakamigahara, Gifu, Japan
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Minokamo, Gifu, Japan
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Ogaki, Gifu, Japan
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Okazai, Gifu, Japan
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Gunma
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Maebashi, Gunma, Japan
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Ota, Gunma, Japan
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Hiroshima
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Fukuyama, Hiroshima, Japan
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Hokkaido
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Hakodate, Hokkaido, Japan
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Kitami, Hokkaido, Japan
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Kushiro, Hokkaido, Japan
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Obihiro, Hokkaido, Japan
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Otaru, Hokkaido, Japan
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Sapporo, Hokkaido, Japan
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Hyogo
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Akashi, Hyogo, Japan
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Amagasaki, Hyogo, Japan
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Himeji, Hyogo, Japan
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Kobe, Hyogo, Japan
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Nishinomiya, Hyogo, Japan
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Ibaraki
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Hitachi, Ibaraki, Japan
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Kasama, Ibaraki, Japan
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Ryugasaki, Ibaraki, Japan
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Tsuchiura, Ibaraki, Japan
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Tsukuba, Ibaraki, Japan
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Ishikawa
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Hakusan, Ishikawa, Japan
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Kaga, Ishikawa, Japan
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Kahoku, Ishikawa, Japan
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Kanazawa, Ishikawa, Japan
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Nanao, Ishikawa, Japan
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Iwate
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Morioka, Iwate, Japan
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Kagawa
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Kida, Kagawa, Japan
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Marugame, Kagawa, Japan
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Takamatsu, Kagawa, Japan
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Kanagawa
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Fujisawa, Kanagawa, Japan
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Hiratsuka, Kanagawa, Japan
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Isehara, Kanagawa, Japan
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Kamakura, Kanagawa, Japan
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Kanazawa, Kanagawa, Japan
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Sagamihara, Kanagawa, Japan
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Yokohama, Kanagawa, Japan
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Yokosuka, Kanagawa, Japan
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Kochi
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Nankoku, Kochi, Japan
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Mie
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Matsuzaka, Mie, Japan
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Tsu, Mie, Japan
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Yokkaichi, Mie, Japan
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Miyagi
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Ishinomaki, Miyagi, Japan
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Natori, Miyagi, Japan
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Osaki, Miyagi, Japan
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Sendai, Miyagi, Japan
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Shibata, Miyagi, Japan
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Nagano
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Matsumoto, Nagano, Japan
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Saku, Nagano, Japan
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Nagasaki
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Omura, Nagasaki, Japan
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Sasebo, Nagasaki, Japan
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Nara
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Ikoma, Nara, Japan
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Tenri, Nara, Japan
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Yamatotakada, Nara, Japan
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Oita
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Yufu, Oita, Japan
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Okayama
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Kurashiki, Okayama, Japan
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Okinawa
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Naha, Okinawa, Japan
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Tomigusuku, Okinawa, Japan
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Urasoe, Okinawa, Japan
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Osaka
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Hirakata, Osaka, Japan
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Kawachinagano, Osaka, Japan
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Moriguchi, Osaka, Japan
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Neyagawa, Osaka, Japan
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Osakasayama, Osaka, Japan
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Suita, Osaka, Japan
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Saitama
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Kawagoe, Saitama, Japan
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Kitaadachi, Saitama, Japan
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Koshigaya, Saitama, Japan
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Shiga
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Moriyama, Shiga, Japan
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Otsu, Shiga, Japan
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Shimane
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Izumi, Shimane, Japan
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Izumo, Shimane, Japan
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Shizuoka
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Hamamatsu, Shizuoka, Japan
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Izunokuni, Shizuoka, Japan
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Sunto, Shizuoka, Japan
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Tochigi
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Shimotsuga, Tochigi, Japan
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Shimotsuke, Tochigi, Japan
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Utsunomiya, Tochigi, Japan
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Tokushima
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Komatsushima, Tokushima, Japan
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Tokyo
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Bunkyo-ku, Tokyo, Japan
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Chiyoda-ku, Tokyo, Japan
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Chuo-ku, Tokyo, Japan
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Itabashi-ku, Tokyo, Japan
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Koto-ku, Tokyo, Japan
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Machida, Tokyo, Japan
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Meguro-ku, Tokyo, Japan
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Minato-ku, Tokyo, Japan
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Musashino, Tokyo, Japan
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Ota-ku, Tokyo, Japan
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Shinagawa-ku, Tokyo, Japan
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Shinjuku-ku, Tokyo, Japan
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Tottori
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Yonago, Tottori, Japan
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Toyama
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Kurobe, Toyama, Japan
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Takaoka, Toyama, Japan
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Yamagata
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Sakata, Yamagata, Japan
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Tsuruoka, Yamagata, Japan
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Yamaguchi
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Iwakuni, Yamaguchi, Japan
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Ube, Yamaguchi, Japan
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Yamanashi
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Kofu, Yamanashi, Japan
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Investigator and subinvestigator judge a candidate is understand clinical trial and comply this protocol.
Investigator is those who participate in conducting a study and oversight the study duties at a site.
- Patients who have given written consent to take part in the study after detailed explanation of the study prior to enrollment
- Aged ≥20 to <80 years at the time of informed consent
- Patients with unresectable adenocarcinoma originating in the large intestine (excluding carcinoma of the appendix and anal canal cancer)
- Patients with lesion(s) that can be evaluated. It is not essential to be evaluated the tumor according to the RECIST ver. 1.1.
- Patients who have not received chemotherapy for colorectal cancer. Patients who experience relapse more than 24 weeks (168 days) after the final dose of perioperative adjuvant chemotherapy with fluoropyrimidine agents may be enrolled. Patients who have received perioperative adjuvant chemotherapy including oxaliplatin are excluded.
Patients classified as KRAS/NRAS wild-type by KRAS/NRAS testing. KRAS/NRAS test will be performed using the in vitro diagnostic listed in the National Health Insurance.
Patients with no mutation in any of the codons shown below are considered wild type. It is not considered wild type if either of the codons are not evaluable or not tested.
KRAS: EXON2 (codon 12, 13), EXON3 (codon 59, 61), EXON4 (codon 117, 146) NRAS:EXON2 (codon 12, 13), EXON3 (codon 59, 61), EXON4 (codon 117, 146)
Patients who satisfy the following criteria for the major organ function in tests performed within 14 days prior to enrollment
- Neutrophil count ≥ 1.5×10^3/µL
- Platelet count ≥ 1.0×10^4/µL
- Hemoglobin ≥ 9.0 g/dL
- Total bilirubin ≤ 2.0 mg/dL
- AST ≤ 100 IU/L (≤ 200 IU/L if liver metastases are present)
- ALT ≤ 100 IU/L (≤ 200 IU/L if liver metastases are present)
- Serum creatinine ≤ 1.5 mg/dL
- PT-INR < 1.5 (< 3.0 for patients treated with oral warfarin)
Satisfies at least one of these conditions
- Urine protein (dip stick method) ≤ 1+
- UPC (urine protein creatinine) ratio ≤ 1.0
- Urinary protein ≤ 1000 mg/ 24hours
- ECOG performance status (PS) of 0 or 1
- Life expectancy of ≥ 3 months (90 days) after enrollment
Exclusion Criteria:
- Radiotherapy received within 4 weeks (28 days) prior to enrollment. Treatments aimed at relieving pain for bone metastases are excluded.
- Known brain metastasis or strongly suspected of brain metastasis
- Synchronous cancers or metachronous cancers with a disease-free period of ≤ 5 years (excluding colorectal cancer) excluding mucosal cancers cured or be possibly cured by regional resection (esophageal, stomach, and cervical cancer, non-melanoma skin cancer, bladder cancer, etc.).
- Body cavity fluid that requires treatment (pleural effusion, ascites, pericardial effusion, etc.)
- Patients who do not want to use contraception to prevent pregnancy, and women who are pregnant or breast-feeding, or test positive for pregnancy
- Nonhealing surgical wound (excluding implanted venous reservoirs)
- Active hemorrhage requiring blood transfusion
- Disease requiring systemic steroids for treatment (excluding topical steroids)
- The patient who has placed colonic stent
- Intestinal resection within 4 weeks prior to enrollment or colostomy within 2 weeks prior to enrollmentt
- History or obvious and extensive CT findings of interstitial pulmonary disease (interstitial pneumonia, pulmonary fibrosis, etc.)
- Patients with unstable angina, myocardial infarction, cerebral hemorrhage, arterial thromboembolism such as cerebral infarction, or have history of these desease less than 24 weeks (168 days) before registration (except for lacunar infarction asymptomatic)
- Serious drug hypersensitivity
- Local or systemic active infection requiring treatment, or fever indicating infection
- NYHA class II or higher heart failure or serious heart disease
- Intestinal paralysis, gastrointestinal obstruction, or uncontrollable diarrhoea (incapacitating symptoms despite adequate treatment)
- Poorly controlled hypertension
- Poorly controlled diabetes mellitus
- Active hepatitis B
- Known HIV infection
- Peripheral neuropathy of ≥ Grade 2 by CTCAE (Japanese edition JCOG version 4.03)
- Other patients judged by the investigator or subinvestigator to be ineligible for enrollment in the study (e.g. Patients who might agree to participate under compulsion).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Group P; mFOLFOX6 + panitumumab combination therapy
OXA: 85 mg/m2/day 1 l-LV: 200 mg/m2/day 1 5-FU iv: 400 mg/m2/day 1 5-FU civ: 2400 mg/m2/day 1-3 panitumumab: 6 mg/kg mFOLFOX6 + panitumumab combination therapy, once every two weeks.
|
oxaliplatin (OXA), levofolinate calcium (l-LV), panitumumab: intra-venous infusion 5-FU: bolus and continuous intra-venous infusion
|
|
Active Comparator: Group B; mFOLFOX6 + bevacizumab combination therapy
OXA: 85 mg/m2/day 1 l-LV: 200 mg/m2/day 1 5-FU iv: 400 mg/m2/day 1 5-FU civ: 2400 mg/m2/day 1-3 bevacizumab: 5 mg/kg/ mFOLFOX6 + bevacizumab combination therapy, once every two weeks.
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oxaliplatin (OXA), levofolinate calcium (l-LV), bevacizumab: intra-venous infusion 5-FU: bolus and continuous intra-venous infusion
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
OS in Participants With Left-sided Tumors
Time Frame: Up to approximately 60 months
|
OS was measured as the time from the date of randomization to the date of death due to any cause.
The left-sided tumors were defined as primary tumors occupying a left-sided site include the descending colon, sigmoid colon, and rectum.
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Up to approximately 60 months
|
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Overall Survival (OS) in All Participants
Time Frame: Up to approximately 60 months
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OS was measured as the time from the date of randomization to the date of death due to any cause.
|
Up to approximately 60 months
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Progression-Free Survival (PFS) in Participants With Left-sided Tumors
Time Frame: Up to approximately 60 months
|
PFS was defined as the time from the date of randomization to the earlier of Progressive Disease (PD) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 or death due to any cause.
The left-sided tumors were defined as primary tumors occupying a left-sided site include the descending colon, sigmoid colon, and rectum.
|
Up to approximately 60 months
|
|
Progression-Free Survival (PFS) in All Participants
Time Frame: Up to approximately 60 months
|
PFS was defined as the time from the date of randomization to the earlier of Progressive Disease (PD) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 or death due to any cause.
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Up to approximately 60 months
|
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Response Rate (RR) in All Participants
Time Frame: Up to approximately 60 months
|
RR was defined as number of participants who achieve Complete Response (CR) and Partial Response (PR) as the best overall response per RECIST version 1.1.The best overall response was CR, followed by PR, stable disease (SD), progressive disease (PD), and not evaluable (NE).
CR: disappearance of all target lesions.
Any pathological lymph nodes must have reduction in short axis to <10 mm.
PR: at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters as the best overall response after randomization., SD: neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
PD: at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study).
|
Up to approximately 60 months
|
|
Duration of Response (DOR)
Time Frame: Up to approximately 60 months
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DOR means that the period from the day when either CR or PR is first confirmed until the day of documented PD or the day of death due to all causes, whichever occurs earlier.
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Up to approximately 60 months
|
|
Number of Participants Treated With Curative Surgical Resection After Chemotherapy
Time Frame: Up to approximately 60 months
|
Curative surgical resection was defined as complete resection.
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Up to approximately 60 months
|
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Number of Participants With Treatment-emergent Adverse Events (TEAE)
Time Frame: Up to approximately 60 months
|
Adverse event (AE) was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which did not necessarily have a causal relationship with this treatment.
A TEAE was defined as an adverse event with an onset that occurred in the treatment period after receiving the protocol treatment.
|
Up to approximately 60 months
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Director: Study Director, Takeda
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms
- Neoplasms by Site
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Colonic Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Colorectal Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Protective Agents
- Antineoplastic Agents, Immunological
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Micronutrients
- Vitamins
- Bone Density Conservation Agents
- Calcium-Regulating Hormones and Agents
- Antidotes
- Vitamin B Complex
- Fluorouracil
- Oxaliplatin
- Bevacizumab
- Leucovorin
- Calcium
- Levoleucovorin
- Calcium, Dietary
- Panitumumab
Other Study ID Numbers
Other Study ID Numbers
- Panitumumab-3001
- U1111-1164-9167 (Other Identifier: WHO)
- JapicCTI-142731 (Registry Identifier: JapicCTI)
- jRCTs031180246 (Registry Identifier: Japan Registry of Clinical Trials)
- UMIN000016776 (Registry Identifier: UMIN Clinical Trials Registry)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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