Erlotinib Hydrochloride in Treating Patients With Stage I-III Colorectal Cancer or Adenoma

A Phase IIa Randomized, Double-Blind Trial of Erlotinib in Inhibiting EGF Receptor Signaling in Aberrant Crypt Foci of the Colon

This randomized phase II trial is studying how well erlotinib hydrochloride works in treating patients with stage I-III colorectal cancer or adenoma. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Erlotinib hydrochloride may also stop tumors from growing or coming back

Study Overview

• Status: Completed
• Conditions: Stage IIA Rectal Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage IIIA Rectal Cancer; Stage IIIB Rectal Cancer; Stage IIIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIB Colon Cancer; Stage IIIC Colon Cancer; Recurrent Colon Cancer; Recurrent Rectal Cancer; Stage I Colon Cancer; Stage I Rectal Cancer; Stage IIA Colon Cancer; Stage IIB Colon Cancer; Stage IIC Colon Cancer; Adenomatous Polyp
• Intervention / Treatment: Other: laboratory biomarker analysis; Drug: erlotinib hydrochloride; Other: placebo

Detailed Description

PRIMARY OBJECTIVES:

I. To test the hypothesis that erlotinib (erlotinib hydrochloride) doses as low as 25 mg will decrease aberrant crypt foci (ACF) phosphorylated extracellular signal-regulated kinases (pERK) levels from baseline (pre) to post erlotinib treatment.

SECONDARY OBJECTIVES:

I. To test the hypothesis that additional epidermal growth factor (EGF) inducible biomarkers will decrease from baseline (pre) to post treatment with erlotinib 25 mg, 50 mg or 100 mg orally (PO) once daily (QD) therapy.

II. To determine the mean decrease from baseline of the ACF: normal mucosa pERK ratio pre and post 8-30 days of erlotinib.

III. To determine erlotinib concentration in plasma and colorectal tissue at 25 mg, 50 mg and 100 mg doses after 8-30 days of therapy.

IV. To determine the incidence of rash, diarrhea and other side effects of low dose erlotinib.

OUTLINE: Patients are randomized to 1 of 3 treatment arms.

ARM I: Patients receive 100 mg of erlotinib hydrochloride PO and two 25 mg of placebo PO QD.

ARM II: Patients receive 50 mg of erlotinib hydrochloride PO and one 100 mg of placebo PO QD.

ARM III: Patients receive 25 mg of erlotinib hydrochloride PO and one 100 mg of placebo and one 25 mg of placebo PO QD.

In all arms, treatment continues for 8-30 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 4 to 9 weeks.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • Long Beach, California, United States, 90822
      • VA Long Beach Healthcare System
    • Orange, California, United States, 92868
      • Chao Family Comprehensive Cancer Center
  • Illinois
    • Chicago, Illinois, United States, 60612
      • University of Illinois at Chicago

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Participants with one or more of the following criteria will be eligible to participate:

  • History of Stage I-III colorectal cancer, not treated in the past 6 months with no anticipated treatment in the next 3 months
  • Adenoma ≥ 1 cm in size
  • 3 or more adenomas (of any size) removed at one colonoscopy within past 6 years
  • Sessile serrated adenoma ≥ 5 mm in size
  • Adenoma (of any size) with villous features (villous, tubulovillous)
  • Adenoma (of any size) with high grade dysplasia
• Participants are eligible for randomization into the treatment phase of the trial if they are found to have ≥ 4 ACFs at either baseline colonoscopy or baseline flexible sigmoidoscopy
• Blood tests at screening which meet the following criteria:
• WBC > 3000/mm^3
• Platelets > 100,000/mm^3
• Hemoglobin > 10g/dl
• Plasma creatinine of < 1.6mg/dl
• Total bilirubin < 1.5 x the upper limit of normal
• Serum ALT < 1.5 x the upper limit of normal
• Serum AST < 1.5 x the upper limit of normal
• ECOG performance status 0-1
• Women of child-bearing potential and men taking study drug must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
• Ability to understand, as well as sign the written informed consent document
• If a woman is of child-bearing potential, she must have a negative pregnancy test prior to study entry; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately

Exclusion Criteria:

• History of Inflammatory Bowel Disease (IBD)
• History of interstitial lung disease or chronic lung disease
• Smoking within the past 3 months
• Increased bleeding risk from rectal biopsy (Patients receiving aspirin or plavix can be enrolled)
• Patients receiving warfarin or coumadin
• Uncontrollable diarrhea of any cause
• Patients, including rectal cancer patients, that have received prior radiation to the rectum or pelvis
• Participants taking a known significant CYP 3A4 inducer or inhibitor; known significant inducers/inhibitors include: amprenavir, aprepitant, atazanavir, carbamazepine, clarithromycin, conivaptan, diltiazem, darunavir/ritonavir, dronedarone, erythromycin, fluconazole, fosamprenavir, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, phenytoin, posaconazole, rifampin, ritonavir, St. John's wort, saquinavir, telithromycin, tipranavir/ritonavir, verapamil, voriconazole
• Women who are pregnant or breast-feeding
• Active keratoconjunctivitis, or corneal surgery in the past three weeks
• Any medical or psychosocial condition that could jeopardize the subject's participation in and compliance to the study
• Participants who are taking any other investigational pharmaceutical agents
• Previous history of sensitivity to erlotinib, Iressa, or Erbitux, such as a rash that is uncontrollable by topical steroids and/or antibiotics

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Erlotinib Hydrochloride (25 mg); Patients receive 25mg of erlotinib hydrochloride PO and one 100 mg of placebo and one 25 mg of placebo PO QD.	Other: laboratory biomarker analysis; Correlative studies; Drug: erlotinib hydrochloride; Given PO; Other Names: OSI-774; erlotinib; CP-358,774; Other: placebo; Given PO; Other Names: PLCB
Experimental: Erlotinib Hydrochloride (50 mg); Patients receive 50 mg of erlotinib hydrochloride PO and one 100 mg of placebo PO QD.	Other: laboratory biomarker analysis; Correlative studies; Drug: erlotinib hydrochloride; Given PO; Other Names: OSI-774; erlotinib; CP-358,774; Other: placebo; Given PO; Other Names: PLCB
Experimental: Erlotinib Hydrochloride (100 mg); Patients receive 100 mg of erlotinib hydrochloride PO and two 25 mg of placebo PO QD.	Other: laboratory biomarker analysis; Correlative studies; Drug: erlotinib hydrochloride; Given PO; Other Names: OSI-774; erlotinib; CP-358,774; Other: placebo; Given PO; Other Names: PLCB

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in ACF pERK Levels	Quantification will be performed by Western blot analysis. Tested using paired t-test with a two-sided significance level of 0.05.	From baseline to post-treatment (up to 30 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in EGF-inducible Markers - pEGFR in Normal Mucosa	pEGFR expression levels were quantified by immunoblotting and calculated as the ratio of the pEGFR signals to reference signals. A log-transformation of pEGFR was utilized in primary analyses. The general linear model was used to estimate and compare the relative change in median pEGFR with adjustment for actin as a normalizing factor. The estimated relative change (post:pre) in the median, corresponding 95% confidence interval, and p-value for testing the null hypothesis of equal medians comparing pre- and post-measurements were reported.	From baseline to post-treatment (up to 30 days)
Change in EGF-inducible Markers - Total EGFR in Normal Mucosa	Total EGFR expression levels were quantified by immunoblotting and calculated as the ratio of the total EGFR signals to reference signals. A log-transformation of total EGFR was utilized in primary analyses. The general linear model was used to estimate and compare the relative change in median total EGFR with adjustment for actin as a normalizing factor. The estimated relative change (post:pre) in the median, corresponding 95% confidence interval, and p-value for testing the null hypothesis of equal medians comparing pre- and post-measurements were reported.	From baseline to post-treatment (up to 30 days)
Change in EGF-inducible Markers - pEGFR in ACF	pEGFR expression levels were quantified by immunoblotting and calculated as the ratio of the pEGFR signals to reference signals. A log-transformation of pEGFR was utilized in primary analyses. The general linear model was used to estimate and compare the relative change in median total EGFR with adjustment for actin as a normalizing factor. The estimated relative change (post:pre) in the median, corresponding 95% confidence interval, and p-value for testing the null hypothesis of equal medians comparing pre- and post-measurements were reported.	From baseline to post-treatment (up to 30 days)
Change in EGF-inducible Markers - Total EGFR in ACF	Total EGFR expression levels were quantified by immunoblotting and calculated as the ratio of the total EGFR signals to reference signals. A log-transformation of total EGFR was utilized in primary analyses. The general linear model was used to estimate and compare the relative change in median total EGFR with adjustment for actin as a normalizing factor. The estimated relative change (post:pre) in the median, corresponding 95% confidence interval, and p-value for testing the null hypothesis of equal medians comparing pre- and post-measurements were reported.	From baseline to post-treatment (up to 30 days)
ACF: Normal Mucosa pERK Ratio	Quantification will be performed by Western blot analysis. Tested using analysis of variance with subsequent pairwise comparisons using the Tukey method to adjust for multiple comparisons.	Up to day 30
Plasma Erlotinib Concentration (ng/mL)	Will be quantified in biopsy samples using appropriate descriptive statistics (means and standard deviations).	Up to day 30
Plasma OSI-420 Concentration (ng/mL)	Will be quantified in biopsy samples using appropriate descriptive statistics (means and standard deviations).	Up to day 30
Normal Mucosa Erlotinib Concentration (ng/mg)	Will be quantified in biopsy samples using appropriate descriptive statistics (means and standard deviations).	Up to day 30
Normal Mucosa OSI-420 Concentration (ng/mg)	Will be quantified in biopsy samples using appropriate descriptive statistics (means and standard deviations).	Up to day 30
Number of Participants Reported at Least 1 Side Effect During the Study	Described for each arm using frequencies. The onset of adverse events is between randomization date and off-study date.	Up to 9 weeks
Number of Participants Reported at Least 1 Rash Side Effect During the Study	Described for each arm using frequencies.	Up to 9 weeks
Number of Participants Reported at Least 1 Diarrhea Side Effect During the Study	Described for each arm using frequencies.	Up to 9 weeks

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Timothy Morgan, Chao Family Comprehensive Cancer Center

Study record dates

Study Major Dates

• Study Start: July 1, 2008
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): September 1, 2013

Study Registration Dates

• First Submitted: September 17, 2008
• First Submitted That Met QC Criteria: September 17, 2008
• First Posted (Estimate): September 18, 2008

Study Record Updates

• Last Update Posted (Estimate): January 6, 2015
• Last Update Submitted That Met QC Criteria: December 22, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Neoplasms, Glandular and Epithelial; Disease Attributes; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Adenoma; Recurrence; Rectal Neoplasms; Colonic Neoplasms; Adenomatous Polyps; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Erlotinib Hydrochloride
• Other Study ID Numbers: NCI-2012-02984; N01CN35160 (U.S. NIH Grant/Contract); UCI06-8-01; CDR0000614277 (Registry Identifier: PDQ (Physician Data Query))