Maintenance Bevacizumab Only or Bevacizumab Plus Metronomic Chemotherapy in Advanced Colorectal Cancer (MOMA)

December 5, 2017 updated by: Alfredo Falcone, Azienda Ospedaliero, Universitaria Pisana

Phase II Randomized Study of Maintenance Treatment With Bevacizumab or Bevacizumab Plus Metronomic Chemotherapy After First-line Induction FOLFOXIRI Plus Bevacizumab for Metastatic Colorectal Cancer Patients

This study consist of 4-months induction first-line chemotherapy with the G.O.N.O. FOLFOXIRI regimen plus bevacizumab followed by maintenance with bevacizumab or bevacizumab plus metronomic chemotherapy (with capecitabine and cyclophosphamide) in mCRC patients.

The main objective of this study is to preliminarily evaluate the potential effects of the combination of a metronomic chemotherapy with capecitabine and cyclophosphamide to maintenance bevacizumab on pharmacodynamic and clinical parameters among mCRC patients.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

232

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
      • Brescia, Italy, 25124
        • Istituto Ospedaliero Fondazione Poliambulanza Di Brescia
      • Brescia, Italy, 25125
        • Pres.Ospedaliero Spedali Civili Brescia
      • Cremona, Italy, 26100
        • Istituti Ospitalieri di Cremona
      • Cuneo, Italy, 12100
        • Azienda Ospedaliera S. Croce E Carle Di Cuneo
      • Ferrara, Italy, 44100
        • A.O. Universitaria Arcispedale S.Anna Di Ferrara
      • Frosinone, Italy, 03100
        • Ausl Di Frosinone -
      • Genova, Italy, 16128
        • E.O. Ospedali Galliera
      • Legnago, Italy, 37045
        • Ospedale Per Acuti Mater Salutis Di Legnago
      • Lucca, Italy
        • Oncologia AUSL 2 Lucca
      • Milano, Italy, 20132
        • Irccs Fondazione Centro S. Raffaele Del Monte Tabor
      • Napoli, Italy, 80131
        • A.O. Universitaria Federico Ii Di Napoli
      • Padova, Italy, 35128
        • IRCCS Istituto Oncologico Veneto (IOV)
      • Pisa, Italy, 56100
        • Polo Oncologico Area Vasta Nord Ovest
      • Pontedera, Italy, 56100
        • Ausl 5 Di Pisa
      • Prato, Italy, 59100
        • Ospedale Mesericordia E Dolce
      • Reggio Emilia, Italy, 42100
        • Ospedale S. Maria Nuova
      • Roma, Italy
        • Campus Biomedico
      • Roma, Italy, 00186
        • Ospedale San Giovanni Calibita Fatebenefratelli
      • Roma, Italy, 00189
        • Ospedale San Pietro Fatebenefratelli Di Roma
      • Udine, Italy, 33100
        • A.O. Universitaria S. Maria Della Misericordia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Histologically proven diagnosis of colorectal cancer.
  • Not resectable metastatic colorectal cancer not previously treated with chemotherapy for metastatic disease.
  • At least one measurable lesion according to RECIST criteria.
  • Male or female of 18-75 years of age.
  • ECOG PS < 2 if aged < 71 years, ECOG PS = 0 if aged 71-75 years;
  • Life expectancy of at least 12 weeks.
  • Previous adjuvant chemotherapy containing oxaliplatin is allowed if more than 12 months have elapsed between the end of adjuvant therapy and first relapse;
  • Previous adjuvant chemotherapy with fluoropyrimidine monotherapy is allowed if more than 6 months have elapsed between the end of adjuvant and first relapse;
  • Neutrophils 1.5 x 109/L, Platelets 100 x 109/L, Hgb >9 g/dl.
  • Total bilirubin 1.5 time the upper-normal limits (UNL) of the institutional normal values and ASAT (SGOT) and/or ALAT (SGPT) 2.5 x UNL, or 5 x UNL in case of liver metastases, alkaline phosphatase 2.5 x UNL, 5 x UNL in case of liver metastases.
  • Creatinine clearance >50 mL/min or serum creatinine 1.5 x UNL.
  • Urine dipstick of proteinuria <2+. Patients discovered to have 2+ proteinuria on dipstick urinalysis at baseline, should undergo a 24-hour urine collection and must demonstrate <1 g of protein/24 hr.
  • Written informed consent to treatment and translational analyses.

Exclusion Criteria:

  • Radiotherapy to any site within 4 weeks before the study.
  • Previous treatment with bevacizumab
  • Untreated brain metastases or spinal cord compression or primary brain tumours.
  • History or evidence upon physical examination of CNS disease unless adequately treated.
  • Symptomatic peripheral neuropathy > 2 grade NCIC-CTG criteria;
  • Serious, non-healing wound, ulcer, or bone fracture.
  • Evidence of bleeding diathesis or coagulopathy.
  • Uncontrolled hypertension.
  • Clinically significant (i.e. active) cardiovascular disease for example cerebrovascular accidents (≤6 months), myocardial infarction (≤6 months), unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure, serious cardiac arrhythmia requiring medication.
  • Current or recent (within 10 days prior to study treatment start) ongoing treatment with anticoagulants for therapeutic purposes.
  • Chronic, daily treatment with high-dose aspirin (>325 mg/day).
  • Treatment with any investigational drug within 30 days prior to enrollment.
  • Other co-existing malignancies or malignancies diagnosed within the last 5 years with the exception of basal and squamous cell carcinoma or cervical cancer in situ.
  • Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study treatment start, or anticipation of the need for major surgical procedure during the course of the study.
  • Lack of physical integrity of the upper gastrointestinal tract, malabsorption syndrome, or inability to take oral medication.
  • Pregnant or lactating women. Women of childbearing potential with either a positive or no pregnancy test at baseline. Postmenopausal women must have been amenorrheic for at least 12 months to be considered of non-childbearing potential. Sexually active males and females (of childbearing potential) unwilling to practice contraception during the study (barrier contraceptive measure or oral contraception).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Maintenance:BEVACIZUMAB
Induction: FOLFOXIRI; Manteinance: Bevacizumab
Drug: Maintenance:BEVACIZUMAB

Patients will be randomly assigned to receive induction chemotherapy with the G.O.N.O. FOLFOXIRI regimen plus bevacizumab:

  • BEVACIZUMAB 5 mg/kg over 30 minutes, day 1
  • IRINOTECAN 165 mg/sqm IV over 1-h, day 1
  • OXALIPLATIN 85 mg/sqm IV over 2-h, day 1
  • L-LEUCOVORIN 200 mg/sqm IV over 2-h, day 1
  • 5-FLUOROURACIL 3200 mg/sqm IV 48-h continuous infusion, starting on day 1

with cycles repeated every 2 weeks for 4 months (8 cycles), followed after 2 weeks by (if no progression occurs):

- BEVACIZUMAB 7.5 mg/kg over 30 minutes, day 1 (every three weeks)
Experimental: Maintenance:BEVACIZUMAB+CAPECITABINE+CYCLOPHOSPHAMIDE
Induction: FOLFOXIRI; Maintenance:BEVACIZUMAB+CAPECITABINE+CYCLOPHOSPHAMIDE(Metronomic Chemotherapy)
Drug: Maintenance:BEVACIZUMAB+CAPECITABINE+CYCLOPHOSPHAMIDE

Patients will be randomly assigned to receive induction chemotherapy with the G.O.N.O. FOLFOXIRI regimen plus bevacizumab:

  • BEVACIZUMAB 5 mg/kg over 30 minutes, day 1
  • IRINOTECAN 165 mg/sqm IV over 1-h, day 1
  • OXALIPLATIN 85 mg/sqm IV over 2-h, day 1
  • L-LEUCOVORIN 200 mg/sqm IV over 2-h, day 1
  • 5-FLUOROURACIL 3200 mg/sqm IV 48-h continuous infusion, starting on day 1

with cycles repeated every 2 weeks for 4 months (8 cycles), followed after 2 weeks by (if no progression occurs):

  • BEVACIZUMAB 7.5 mg/kg over 30 minutes, day 1 (every three weeks),
  • CAPECITABINE 500 mg/tid orally, continuously,
  • CYCLOPHOSPHAMIDE 50 mg/day orally, continuously.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
progression-free survival (PFS)
Time Frame: up to 4 years
PFS is defined as the time from randomization to first documentation of objective disease progression or death due to any cause, whichever occurs first.PFS will be censored on the date of the last evaluable on study tumor assessment documenting absence of progressive disease for patients who are alive,on study and progression free at the time of the analysis.Alive patients having no tumor assessments after baseline will have time to event endpoint censored on the date of randomization.Disease status will be evaluated according to RECIST 1.1 criteria.
up to 4 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Best overall response rate (ORR)
Time Frame: up to 4 years
It is defined as the percentage of patients,relative to the total of enrolled subjects,achieving a complete or partial response, according to RECIST 1.1 criteria,during the induction and the maintenance phases of treatment.The determination of clinical response will be based on investigator reported measurements that will be subsequently confirmed by a central review.Responses will be evaluated every 8 weeks.Patients who do not have an on-study assessment will be included in the analysis as non responders.
up to 4 years
Duration of response
Time Frame: up to 4 years
it is defined as the time from the date when measurement criteria are met for CR or PR until first documentation of objective disease progression
up to 4 years
Resection rate
Time Frame: up to 4 years

it is defined as the percentage of patients, relative to the total of enrolled subjects, undergoing secondary R0 resection of metastases during treatment or after its completion.

Secondary R0 surgery is defined as microscopically margin-free complete surgical removal of all residual disease, allowed by tumoral shrinkage and/or disappearance of one or more lesions.
up to 4 years
Time to strategy failure (TSF)
Time Frame: up to 4 years

it is defined as the time from the day of randomization to one of the followings:

  1. progression during FOLFOXIRI + bevacizumab or during a modified FOLFOXIRI + bevacizumab regimen; OR
  2. progression and decision to not administer FOLFOXIRI + bevacizumab or a modified FOLFOXIRI + bevacizumab regimen; OR
  3. introduction of a new agent not included in the study treatment according to randomization arm; OR
  4. death; whichever occurs first.For patients still on-treatment at the time of analysis, the time to strategy failure will be censored on the last date the patients were known to be alive.
up to 4 years
Time to 2nd progressive disease
Time Frame: up to 4 years

it is defined as the time from randomization to second documentation of objective disease progression or death due to any cause, whichever occurs first.

Time to 2nd progressive disease will be censored on the date of the last evaluable on-study tumor assessment documenting absence of progressive disease for patients who are alive, on study and second progression-free at the time of the analysis. Alive patients having no tumor assessments after baseline will have time to event endpoint censored on the date of randomization.
up to 4 years
Overall survival (OS)
Time Frame: up to 4 years
it is defined as the time from randomization to the date of death due to any cause. For patients still alive at the time of analysis, the OS time will be censored on the last date the patients were known to be alive.
up to 4 years
Toxicity rate
Time Frame: up to 4 years
it is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing a specific adverse event, according to National Cancer Institute Common Toxicity Criteria (version 4.0), during the induction and the maintenance phases of treatment.
up to 4 years
Overall toxicity rate
Time Frame: up to 4 years
it is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing any adverse event, according to National Cancer Institute Common Toxicity Criteria (version 4.0), during the induction and the maintenance phases of treatment.
up to 4 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Azienda Ospedaliero, Universitaria Pisana

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2012

Primary Completion (Actual)

March 1, 2017

Study Completion (Actual)

September 1, 2017

Study Registration Dates

First Submitted

October 20, 2014

First Submitted That Met QC Criteria

October 21, 2014

First Posted (Estimate)

October 22, 2014

Study Record Updates

Last Update Posted (Actual)

December 7, 2017

Last Update Submitted That Met QC Criteria

December 5, 2017

Last Verified

December 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MOMA261111
  • 2011-006332-23 (EudraCT Number)

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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