A Phase I/II Study of XELOXIRI and Bevacizumab as First-line Treatment in Metastatic Colorectal Cancer

A Phase I/II Study of Irinotecan, Oxaliplatin, Capecitabine (XELOXIRI) and Bevacizumab as a First-line Therapy for Patients With Metastatic Colorectal Cancer

The phase I/II study was designed to evaluate if the regimen of Irinotecan, Oxaliplatin, Capecitabine (XELOXIRI) and Bevacizumab is a superior first-line option for patients with metastatic colorectal cancer(mCRC) in terms of safety and efficacy.

Study Overview

• Status: Unknown
• Conditions: Colorectal Cancer; Metastatic Cancer; Colorectal Adenocarcinoma
• Intervention / Treatment: Drug: XELOXIRI/Bevacizumab

Detailed Description

Recent studies have shown that the triplet-drug regimen FOLFOXIRI (irinotecan/oxaliplatin/fluorouracil) can further improves survival benefit for patients with metastatic colorectal cancer(mCRC) compared to standard two-drug regimens in first-line therapy, especially when combined with bevacizumab. However, the increased toxicities of FOLFOXIRI limited its usage. Capecitabine demonstrates a superior efficacy and safety than fluorouracil, so we designed this trial to evaluate if the XELOXIRI plus bevacizumab can be a better alternative to FOLFOXIRI plus bevacizumab. The phase I study is to determine the safety and the recommended phase II dose (RP2D) of XELOXIRI plus Bevacizumab. In the phase II study, we aim to determine the efficacy of the regimen as first-line therapy for mCRC and explore potential molecular biomarkers (genomes, circulating tumor cell) for toxicity forecasting or efficacy monitoring.

• Study Type: Interventional
• Enrollment (Anticipated): 106
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: M.D; Phone Number: 13681015148 13681015148; Email: lyang69@sina.com

Study Locations

• China
  • Beijing, China
    • Recruiting
    • National Center/Cancer Hospital, China Academy of Medical Science and Peking Union Medical College
  • Beijing, China
    • Recruiting
    • National Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients with histologically confirmed metastatic colorectal adenocarcinoma;
• Age 18-80 years old;
• Eastern Cooperation Oncology Group (ECOG) performance score(<2);
• At least one measurable lesion for disease assessment according to RECIST version 1.1;
• Able to take oral medications;
• Previous fluoropyrimidine-based adjuvant or neoadjuvant chemotherapy was allowed only when it ended ≥ 6 months before study enrollment;
• No previous therapy for mCRC;
• Adequate organ functions as assessed by the following laboratory requirements: Leukocytes≥3.0x109/L, absolute neutrophil count≥1.5x109/L, platelet count≥100x109/L, hemoglobin≥9g/dL; serum bilirubin≤1.5x the upper limit of normal(ULN);Alanine aminotransferase(ALT) and aspartate aminotransferase(AST)≤3x ULN; serum creatinine≤1.5x ULN; calculated creatinine clearance or 24 hour creatinine clearance ≥60ml/min.
• An expected survival of at least 3 months;
• Willingly provide written informed consent to study procedures.

Exclusion Criteria:

• Patients with dysphagia, active peptic ulcer, intestinal obstruction, active gastrointestinal bleeding, peptic perforation, malabsorption syndrome or uncontrolled intestinal inflammatory diseases;
• With a history of extensive enterotomy or pelvic radiation therapy; Suffering from grade 2 or higher symptomatic peripheral neuropathy according to National Cancer Institute Common Toxicity (NCI-CTC) criteria;
• Uncontrolled central nervous system metastasis, disseminated intravascular coagulation or active infection;
• With concurrent cancer distinct from colorectal adenocarcinoma except cured skin basal cell carcinoma and cervical carcinoma in situ;
• Undergone a major operation, open biopsy or major traumatic injury within 28 days before study enrollment or have potential to receive major operation during the trial;
• Received central venous access device within 2 days before study enrollment;
• Any kind of concurrent cardiac disease with clinical meanings, such as cardiovascular accident, myocardial infarction, thromboembolism or hemorrhage within 6 months before enrollment, congestive heart failure ≤New York Heart Association (NYHA) class 2 or uncontrolled hypertension.
• With positive urine protein and 24-hour urinary protein content>1g;
• Have a tendency of bleeding or clotting;
• With nasty open wounds, ulcers or fractures;
• Current or recent treatment of anticoagulants, antiplatelet agent or nonsteroidal anti-inflammatory drugs, while aspirin of daily dose less than 325mg is allowed.
• With any illness or medical conditions that may jeopardize the patient's compliance or interfere the analyses or judgements of study results;
• Pregnancy or lactation at the time of study entry;
• With fertility but refuse to contraception.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: XELOXIRI/Bevacizumab; drugs: Irinotecan, Oxaliplatin, Capecitabine, Bevacizumab bevacizumab 5mg/kg on day1, irinotecan 150mg/m2 or 165mg/m2 on day1, oxaliplatin 85mg/m2 on day1 and capecitabine 1000mg/m2 twice a day on day1-7, administered every 2 week for 12 cycles, after 12 cycles, administer bevacizumab 5mg/kg on day 1 and capecitabine 1000mg/m2 twice a day on day1-7 as maintenance therapy.

Drug: XELOXIRI/Bevacizumab; bevacizumab 5mg/kg on day1, irinotecan 150mg/m2 or 165mg/m2 on day1, oxaliplatin 85mg/m2 on day1 and capecitabine 1000mg/m2 twice a day on day1-7 repeated every 2 week for 12 cycles, after 12 cycles, bevacizumab 5mg/kg on day 1 and capecitabine 1000mg/m2 twice a day on day1-7 as maintenance therapy repeated every 2 week; Other Names: Irinotecan, Oxaliplatin, Capecitabine, Bevacizumab

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
recommended phase 2 dose (RP2D)	RP2D is determined according to DLT and MTD in the phase 1 study	up to 1 year
dose-limited toxicity (DLT)	dose limited toxicities are evaluated in the phase I study according to CTCAE v5.0 and reviewed through the phase I study completion	up to 1 year
maximum tolerated dose (MTD)	MTD is determined according to the DLT in the phase I study	up to 1 year
objective response rate (ORR)	ORR is defined as the proportion of patients achieving complete response or partial response	up to 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse events (AEs)	Adverse events assessments are computed and categorized according to the Common Toxicity Criteria of the National Cancer Institute, version 5.0	though study completion, an average of 2 years
progression-free survival (PFS)	PFS is defined as the time from randomization to the earliest evidence of disease progression (per RECIST v1.1), or death from any cause	though study completion, an average of 2 years
overall survival (OS)	OS is defined as the time from randomized to death from any cause or to last contact	up to 5 years
disease control rate (DCR)	DCR is defined as the proportion of patients achieving complete response, partial response or having stable disease	up to 2 years
duration of response (DOR)	DOR is defined as the length from the first response occured to disease progression	though study completion, an average of 2 years
time to response (TTR)	TTR is defined as the length from randomization to the first response occured.	up to 2 years
the surgical resection rate of patients with liver-only metastases	the percentage of patients with liver-only metastases undergoing surgical resections during the trial therapy	up to 2 years

Collaborators and Investigators

• Sponsor: Cancer Institute and Hospital, Chinese Academy of Medical Sciences
• Investigators: Principal Investigator: Lin Yang, Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Study record dates

Study Major Dates

• Study Start (Actual): April 26, 2020
• Primary Completion (Anticipated): December 1, 2020
• Study Completion (Anticipated): September 1, 2022

Study Registration Dates

• First Submitted: May 3, 2020
• First Submitted That Met QC Criteria: May 5, 2020
• First Posted (Actual): May 8, 2020

Study Record Updates

• Last Update Posted (Actual): May 8, 2020
• Last Update Submitted That Met QC Criteria: May 5, 2020
• Last Verified: May 1, 2020

More Information

Terms related to this study

• Keywords: bevacizumab; metastatic colorectal cancer; metastatic colorectal adenocarcinoma; XELOXIRI
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Adenocarcinoma; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Topoisomerase Inhibitors; Antineoplastic Agents, Immunological; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Topoisomerase I Inhibitors; Capecitabine; Oxaliplatin; Bevacizumab; Irinotecan
• Other Study ID Numbers: NCC2271

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No