- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05694936
Combining Sodium Valproate With Standard-of-care EGFR (Epidermal Growth Factor Receptor) Monoclonal Antibody Treatment in Patients With Metastatic Colorectal Cancer
A Phase II Randomised Controlled Trial to Determine the Efficacy of Combining the HDAC Inhibitor Sodium Valproate With EGFR Monoclonal Antibody (Panitumumab or Cetuximab) Maintenance in the First-line Treatment of Patients With RAS Wild Type Metastatic Colorectal Cancer (CRC)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The primary objective is to evaluate progression free survival (PFS) in patients with RAS wild type metastatic CRC treated in the first-line with VPA plus panitumumab or cetuximab maintenance, or panitumumab or cetuximab maintenance alone.
The secondary objectives are (i) to evaluate overall survival (OS) and objective response rates (ORRs; RECIST v 1.1) in patients with RAS wild type metastatic CRC treated in the first-line with VPA plus panitumumab or cetuximab maintenance, and panitumumab or cetuximab maintenance alone; and (ii) to evaluate the safety (NCI CTCAE v5.0) of first-line maintenance treatment with VPA plus panitumumab or cetuximab, and panitumumab or cetuximab maintenance alone in patients with RAS wild type metastatic CRC.
The tertiary and exploratory objectives are:
- To evaluate Health-Related Quality of Life (EORTC QLQ-C30 and EQ-5D-5L) in patients with RAS wild type metastatic CRC treated in the first-line with VPA plus panitumumab or cetuximab maintenance, and panitumumab or cetuximab maintenance alone.
Exploratory analyses including, but not limited to:
(i) Determining whether changes in levels of histone acetylation in peripheral blood mononuclear cells (PBMCs) are associated with improved efficacy with VPA plus anti-EGFR monoclonal antibody maintenance treatment; and (ii) determining whether potential resistance-conferring mutations in circulating tumour DNA (ctDNA) are associated with efficacy outcomes in patients treated with anti-EGFR monoclonal antibody maintenance.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Sukanya Sathyamurthie
- Phone Number: +61 2 7208 2719
- Email: sukanya@gicancer.org.au
Study Contact Backup
- Name: Louise Christophersen
- Phone Number: +61 2 7208 2718
- Email: louise@gicancer.org.au
Study Locations
-
-
New South Wales
-
Saint Leonards, New South Wales, Australia, 2065
- Recruiting
- Royal North Shore Hospital
-
Contact:
- Amy Williams
- Email: amy.williams@health.nsw.gov.au
-
-
South Australia
-
Adelaide, South Australia, Australia, 5000
- Recruiting
- Queen Elizabeth Hospital
-
Contact:
- Lynda Sok
- Email: lynda.sok@sa.gov.au
-
Bedford Park, South Australia, Australia, 5042
- Recruiting
- Southern Adelaide Local Health Network Incorporated
-
Contact:
- Alison Richards
- Email: alison.richards@sa.gov.au
-
-
Victoria
-
Ballarat Central, Victoria, Australia, 3350
- Recruiting
- Eben-Marie Garzina
-
Contact:
- Eben-Marie Garzina
- Email: eben-marie.garzina@bhs.org.au
-
Box Hill, Victoria, Australia, 3128
- Recruiting
- Eastern Health
-
Contact:
- Karen Lim
- Email: karen.lim@monash.edu
-
Frankston, Victoria, Australia, 3199
- Recruiting
- Peninsula Health
-
Contact:
- Jade Rice
- Email: jrice@phcn.vic.gov.au
-
Melbourne, Victoria, Australia, 3084
- Recruiting
- Austin Health
-
Contact:
- Kirsten Remen
- Email: kirsten.remen@austin.org.au
-
Contact:
- Donna Haberl
- Email: donna.haberl@austin.org.au
-
Melbourne, Victoria, Australia, 3000
- Recruiting
- Peter Maccallum Cancer Institute
-
Contact:
- John Buen
- Email: PCCTU.MoncB@petermac.org
-
Warrnambool, Victoria, Australia, 3280
- Recruiting
- South West Healthcare
-
Contact:
- Lucy Leonard
- Email: swhct@swh.net.au
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years.
- Histological diagnosis of colorectal cancer.
- Metastatic colorectal cancer that is being treated with non-curative intent. This may be because the disease is anatomically not resectable, resection is contra-indicated for any reason, or the patient refuses resection.
- Measurable disease as assessed by CT scan (by RECIST 1.1).
- Evidence of RAS wild type status (KRAS exons 2, 3 and 4 and NRAS exons 2, 3, and 4) as assessed by the investigators' choice of testing laboratory.
- ECOG performance status 0, 1.
- Suitable, as deemed by the investigator, for maintenance treatment with panitumumab or cetuximab alone or in combination with oral sodium valproate.
- Completed four months of first-line induction treatment with fluoropyrimidine-based chemotherapy (which may be intravenous or oral, in which case 15 weeks of treatment is required; and either alone or in combination with oxaliplatin or irinotecan) and anti-EGFR monoclonal antibody (panitumumab or cetuximab) without progressive disease.
- Prior palliative radiotherapy is allowed, provided that (i) no concurrent chemotherapy was administered, (ii) at least 2 weeks after completion of therapy has elapsed before enrolment, and (iii) any toxicities have resolved or are Grade 1. Prior fluoropyrimidine chemotherapy given concurrent with radiation as neoadjuvant treatment for rectal cancer is allowed.
- Adequate hepatic function with serum total bilirubin < x1.5 upper limit of normal range and ALT or AST < x3 upper limit of normal range.
- Adequate bone marrow function with platelets ≥ 80 X 109/L; neutrophils ≥ 1.5 X 109/L; haemoglobin ≥ 8g/dL.
- Adequate renal function, with calculated creatinine clearance ≥ 50 mL/min.
- Any abnormalities in magnesium are not > Grade 2. Any abnormalities in total calcium are not > Grade 1. Total calcium should be corrected for albumin level as per the institution's usual calculation method. Serum potassium levels should be above 4.0 mmol/L.
- Archival formalin-fixed paraffin embedded (FFPE) tumour tissue is available for storage and use by the central laboratory.
- Life expectancy of at least 12 weeks.
- Women and partners of women of childbearing potential must agree to use adequate contraception uninterrupted for the duration of receiving VPA, cetuximab and panitumumab, and for an additional 2 months after the last dose of cetuximab and 6 months after the last dose of panitumumab. Adequate contraceptive measures are barrier methods (condoms, diaphragm); oral, injectable, or implant birth control; or abstinence.
- Willing and able to comply with all study requirements, including treatment, timing and/or nature of required assessments.
- Written informed consent including consent for donation of tumour tissue for biomarker studies and collection of peripheral blood for research.
Exclusion Criteria:
- BRAFV600E mutant CRC.
- CRC with HER2 IHC score of 3+. Note that IHC evaluation for HER2 amplification is required for determining eligibility. HER2 testing using ISH is not required.
- Prior chemotherapy before first-line induction chemotherapy. Exceptions are adjuvant chemotherapy which was given in association with (i) complete resection of primary colon or rectal cancer provided there is no clinical, radiological or biochemical evidence of relapse for at least 6 months after completion of adjuvant treatment, and/or (ii) complete resection of limited colorectal metastases to liver and/or lung provided there is no clinical, radiological or biochemical evidence of relapse for at least 6 months after completion of adjuvant treatment.
- History of life-threatening hypersensitivity reactions to panitumumab or cetuximab, or any product excipients of panitumumab or cetuximab.
- Known hypersensitivity to sodium valproate.
- Any other contraindication/s to sodium valproate including mitochondrial disorders and urea cycle disorders.
- Pre-existing acute or chronic hepatic dysfunction or family history of severe hepatitis
- Patients with systemic lupus erythematosus are eligible, however the investigator should discuss the potential risk of immune disorders with the participant, which have been noted only exceptionally during the use of VPA.
- Patients with long QT syndrome, or QTc interval duration > 480 msec, or use of concomitant medications that significantly prolong the QTc interval.
- Prior or current treatment with HDAC inhibitor or compounds with HDAC inhibitor-like activity, including hydroxamic acid (e.g vorinostat/zolinza, panobinostat/farydak. Belinostat/beleodaq), benzamide (tucidinostat/epidaza/chidamide), cyclic tetrapeptide (Romidepsin/Istodax) or carboxylic acid (e.g sodium valproate, phenylbutyrate) based HDAC inhibitors.
- Active treatment with sodium valproate for non-oncological conditions.
- Active epilepsy or convulsive conditions that require continuous use of anticonvulsants.
- History of interstitial lung disease or pulmonary fibrosis.
- Leptomeningeal disease as the only manifestation of malignancy.
Untreated/active CNS metastases (i.e., progressing, requiring ongoing corticosteroids or anticonvulsants for symptom control).
Patients with CNS metastases are eligible if they have previously been successfully treated with surgery and/or radiotherapy at least 8 weeks prior to cycle 1 day 1, have ceased taking all corticosteroids and/or anticonvulsants for at least 4 weeks and if imaging within 4 weeks of cycle 1 day 1 excludes any progression.
Invasive malignant disease, other than CRC, diagnosed within 2 years of randomisation.
Patients with non-melanotic skin cancer, carcinoma in situ of the uterine cervix, or any other cancer which was treated with curative intent > 2 years prior to randomisation and without evidence of relapse, are eligible.
- Active infection requiring systemic therapy and/or other concurrent uncontrolled medical conditions.
- Positive pregnancy test prior to the initiation of the study medications.
- History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate.
- Medical, psychiatric conditions or any other reason that, as assessed by the investigator, may compromise the patient's ability to give informed consent or to comply with the protocol-specified treatments and assessments.
Study Plan
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: Experimental arm (n=60)
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks, with sodium valproate oral continuously in a twice daily dose (target daily dose of 20 mg/kg/d at Cycle 1 Day 13, then dose adjusted to maintain serum VPA levels within the target range of 50-100 μg/mL)
|
Sodium valproate oral continuously in a twice daily dose (Initial dose of 600mg/d up-titrated to target daily dose of 20 mg/kg/d at Cycle 1 Day 13, then dose adjusted to maintain serum VPA levels within the target range of 50-100 μg/mL); Refer to arm description.
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks; Refer to arm description.
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks; Refer to arm description.
|
Active Comparator: Control arm (n=30)
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks
|
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks; Refer to arm description.
Panitumumab 6 mg/kg IV every 2 weeks or cetuximab 500 mg/m2 IV every 2 weeks; Refer to arm description.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression free survival
Time Frame: 12 Months from randomisation
|
Progression free survival (PFS) will be defined as the interval from date of registration or randomisation to the date of first evidence of disease progression (measured by RECIST v1.1 criteria) or death whichever occurs first, in each treatment arm.
|
12 Months from randomisation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall Survival
Time Frame: 12 Months from randomisation
|
Overall survival (OS) will be defined as the interval from date of registration or randomisation to date of death from any cause.
|
12 Months from randomisation
|
Objective response rates (ORRs)
Time Frame: 12 Months from randomisation
|
ORRs will be calculated as the proportion of participants in each arm who are assessed as having a complete or partial response measured by RECIST v1.1.
|
12 Months from randomisation
|
Quantification of the incidence of treatment-emergent adverse events according to CTCAE V5.0
Time Frame: 12 Months from randomisation
|
Safety of each treatment arm will be assessed by evaluating the number and severity (grade) of adverse events reported according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0).
|
12 Months from randomisation
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Health-related quality of life (EORTC QLQ-C30)
Time Frame: 12 Months from randomisation
|
Health-Related Quality of Life (HRQoL) will be determined by the global and subscale scores outlined in the EORTC user manual and scoring guidelines.
Scores are from 0-100, with higher scores indicating better quality of life.
|
12 Months from randomisation
|
Health-related quality of life (EQ-5D-5L)
Time Frame: 12 Months from radomisation
|
The EQ-5D-5L will be used to derive utility scores suitable for quality adjusted survival analyses.
The scale has five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression), each of which are scored at one of five levels ranging from no problems to extreme problems.
|
12 Months from radomisation
|
Quantification of histone acetylation levels in peripheral blood mononuclear cells (PBMCs)
Time Frame: 12 Months from radomisation
|
Exploratory analysis detecting changes in levels of histone acetylation in PBMCs during treatment
|
12 Months from radomisation
|
Quantification of total circulating tumour DNA (ctDNA)
Time Frame: 12 Months from radomisation
|
Exploratory analysis detecting the levels of ctDNA during treatment
|
12 Months from radomisation
|
Collaborators and Investigators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
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
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Enzyme Inhibitors
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Tranquilizing Agents
- Psychotropic Drugs
- GABA Agents
- Anticonvulsants
- Antimanic Agents
- Valproic Acid
- Panitumumab
- Cetuximab
Other Study ID Numbers
- VADER
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Metastatic Colorectal Cancer
-
Mayo ClinicCompletedMetastatic Colorectal Adenocarcinoma | Metastatic Colon Adenocarcinoma | Metastatic Colorectal Carcinoma | Metastatic Rectal Adenocarcinoma | Stage IV Colorectal Cancer AJCC v8 | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Metastatic... and other conditionsUnited States
-
Hutchison Medipharma LimitedActive, not recruitingMetastatic Colorectal Cancer | Metastatic Colon CancerUnited States, Spain, Japan, Australia, Austria, Belgium, Czechia, Estonia, France, Germany, Hungary, Italy, Poland, United Kingdom
-
Emory UniversityBristol-Myers Squibb; National Cancer Institute (NCI); National Institutes of...Active, not recruitingColorectal Cancer Metastatic | Colorectal Adenocarcinoma | Stage IV Colorectal Cancer | Stage IVA Colorectal Cancer | Stage IVB Colorectal Cancer | Refractory Colorectal Carcinoma | Metastatic Microsatellite Stable Colorectal Carcinoma | Stage IVC Colorectal CancerUnited States
-
Array Biopharma, now a wholly owned subsidiary...CompletedMetastatic Colorectal Cancer | Advanced Solid Tumors | Advanced or Metastatic Biliary CancerUnited States
-
Zhejiang Cancer HospitalNot yet recruitingMetastatic Colorectal Cancer | Metastatic Colorectal Adenocarcinoma | CRCChina
-
AmgenCompletedCancer | Metastatic Colorectal Cancer | Colorectal Cancer | Rectal Cancer | Metastatic Cancer | Colon Cancer
-
Academic and Community Cancer Research UnitedNational Cancer Institute (NCI)Active, not recruitingMetastatic Pancreatic Adenocarcinoma | Stage IV Pancreatic Cancer AJCC v6 and v7 | Stage IV Colorectal Cancer AJCC v7 | Stage IVA Colorectal Cancer AJCC v7 | Stage IVB Colorectal Cancer AJCC v7 | Metastatic Gastroesophageal Junction Adenocarcinoma | Metastatic Colorectal Carcinoma | Metastatic Malignant... and other conditionsUnited States
-
Dana-Farber Cancer InstituteAmerican Cancer Society, Inc.Not yet recruitingMetastatic Colorectal Cancer | Colorectal Cancer | Metastatic Colon CancerUnited States
-
Symphogen A/STerminatedCarcinoma | Metastatic Colorectal Cancer | Colorectal Cancer MetastaticUnited States, Spain, Germany, Italy
-
AmgenCompletedCancer | Metastatic Colorectal Cancer | Colorectal Cancer | Rectal Cancer | Metastatic Cancer | Colon Cancer | Oncology
Clinical Trials on Sodium Valproate
-
University of BirminghamActive, not recruitingWolfram SyndromeFrance, United Kingdom, Poland, Spain
-
Xijing HospitalUnknownTraumatic Brain InjuryChina
-
All India Institute of Medical Sciences, New DelhiUnknownChronic Lymphocytic LeukemiaIndia
-
University of VirginiaTerminatedGlioblastomaUnited States
-
Postgraduate Institute of Dental Sciences RohtakUnknownAlveolar Bone LossIndia
-
Ewha Womans UniversityWithdrawnBipolar DepressionKorea, Republic of
-
National Institute on Alcohol Abuse and Alcoholism...University of PittsburghCompleted
-
University of North Carolina, Chapel HillRecruitingStroke | Brain Ischemia | Brain Injuries, Traumatic | Heart Arrest | Intracranial Hemorrhages | Brain Hypoxia | Coma | Hypoxia-Ischemia, Brain | Persistent Vegetative State | Brain Injuries, AcuteUnited States
-
Boston Children's HospitalUniversity of LouisvilleWithdrawn
-
Ewha Womans University Mokdong HospitalWithdrawnDepression, BipolarKorea, Republic of