- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06199232
Targeted Treatment Plus Tislelizumab and HAIC for Advanced CRCLM Failed From Standard Systemic Treatment
Targeted Treatment Based on ctDNA Genotyping Combined With Tislelizumab and HAIC as Salvage Treatment for Advanced Colorectal Cancer Liver Metastasis Failed From Standard Systemic Treatment (SALVLIV Trial)
Study Overview
Status
Intervention / Treatment
Detailed Description
Although surgery has been demonstrated to improve the prognosis of patients with colorectal cancer liver metastasis (CRCLM), only 20% of patients with CRCLM is candidate for surger. Irinotecan-/oxaliplatin-based doublet/triplet chemotherapy regimen combined with targeted therapy (anti vascular endothelial growth factor [VEFG] or anti epidermal growth factor receptor [EGFR]) based on the genotype are recommended as standard first- and second-line treatment for unresectabel metastatic colorectal cancer (mCRC) by NCCN guideline. RAS and BRAF are the important signal members in the EGFR signal pathway, and the mutation of them could induce the persistent activation of the downstream of the MAPK pathway, leading to the differentiation, proliferation, and growth change of the tumor cell. The status of RAS and BRAF V600E mutation will affect the efficacy of anti-EGFR therapy, but not anti-VEGF therapy.
Regorafenib, fruquintinb, and TAS-102 have been recommended as third-line treatment for mCRC, while the survivl benefits from these agents are limited, with the median progression-free survival (PFS) and median OS of 1.9-3.7 months and 6.4-9.3 months, respectively.
The efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) for CRCLM have been demonstrated by multiple trials and recommended by many guidelines worldwide. Fruquintinib, a small molecular tyrosine kinase inhibitor targeting at VEGF 1-3, has been demonstrated to change the tumor microenvironment and enhance the anti-tumor effect of programmed death-1 (PD-1) inhibitor in microsatellite stable (MSS) CRC. Anti-EGFR rechallenge (cetuximab rechallenge) was effective in patients with CRC who interrupted the anti-EGFR therapy while responsed to anti-EGFR therapy in the first-line treatment. In 2021, a phase II trial, which explore the efficacy and safety of cetuximab rechallenge combined with Avelumab for pretreated RAS wide type (WT) mCRC. Our retrospective study (unpublished) showed HAIC combined with fruquintinib and tislelizumab presented greater efficacy for MSS CRCLM.
Thus, the investigators will conduct a prospective trial to explore the efficacy and safety of targeted treatment based on ctDNA genotyping combined with tislelizumab and HAIC as salvage treatment for advanced CRCLM failed from standard systemic treatment, aiming to provide individualized optimized regimen for MSS CRCLM in salvage treatment.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Xiaodong Wang, M.D.
- Phone Number: 0086-18611586227
- Email: xiaodongw75@yahoo.com
Study Locations
-
-
Beijing
-
Beijing, Beijing, China, 100142
- Recruiting
- Peking Univerisity Cancer Hospital
-
Contact:
- Xiaodong Wang, M.D.
- Phone Number: 0086-18611586227
- Email: xiaodongw75@yahoo.com
-
Sub-Investigator:
- Xiaodong Wang, M.D.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18-80 years old.
- Colorectal cancer confirmed by histopatology.
- The metastasis is mainly located in liver.
- Unresectable liver metastasis is confirmed by CT/MRI scan and multidisciplinary.
- Failed from standard first- and second-line systemic treatment.
- At least one measurable lesion according to modified Response Evaluation Criteria in Solid Tumors guidelines (mRECIST).
- Eastern Cooperative Oncology Group (ECOG) performance status <2.
- Child-Pugh A or B (≤ 7).
- Expectant survival time ≥ 3 months.
Adequate organ function as follows:
- Hemoglobin ≥ 90 g/L;
- Absolute neutrophil count ≥ 1.5×10^9/L;
- Blood platelet count ≥ 775×10^9/L;
- Alanine aminotransferase (ALT), aspartate aminotransferase (AST) ≤ 5 times of upper limit of normal (ULN);
- Total bilirubin ≤ 2 times of ULN;
- Serum creatinine ≤ 1.5 times of ULN;
- Albumin ≥ 30 g/L.
- Patients sign informed consent.
Exclusion Criteria:
- Extensive extrahepatic metastasis (>25% of tumor burden in liver).
- HER2 (3+) or HER2 amplification.
- MSI-H or dMMR.
- Allergic to contrast media.
- Pregnant or lactational.
- Allergic to oxaliplatin or cetuximab.
- Coinstantaneous a lot of malignant hydrothorax or ascites.
- History of organ transplantation (including bone marrow auto-transplantation and peripheral stem cell transplantation).
- Coinstantaneous infection and need anti-infection therapy.
- Coinstantaneous peripheral nervous system disorder.
- History of obvious mental disorder and central nervous system disorder.
- Concomitant malignancy within 5 years, except for non-melanoma skin cancer and carcinoma in situ of cervix.
- Without legal capacity.
- Impact the study because of medical or ethical reasons.
- Clinically severe gastrointestinal bleeding within 6 months of the start of treatment or any life-threatening bleeding events within 3 months of the start of treatment.
- Uncorrectable coagulation disorder.
- Obvious abnormal in ECG or obvious clinical symptoms of heart disease, like congestive heart failure, coronary heart disease with obvious clinical symptoms, unmanageable arrhythmia and hypertension.
- History of myocardial infarction within 12 months, or Grade III/IV of heart function.
- Severe liver disease (like cirrhosis), renal disease, respiratory disease, unmanageable diabetes or other kinds of systematic disease.
- Any other subjects that the investigator considers ineligible.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment Arm
HAIC combined with targeted therapy and PD-1 inhibitor
|
HAIC regimen: doublet or triplet regimen based on the response and adverse events occurred in the previous standard treatment (depended on the decision of researchers)-oxaliplatin (85 mg/m2, split into d1 and d2, 0-2h,) and 5-fluorouracial (2g/m2, split into d1 and d2, 2-24h)/ oxaliplatin (65 mg/m2, 0-2h, d1), irinotecan (100 mg/m2, 0-2h, d2), and 5-fluorouracial (2g/m2, split in d1 and d2, 2-24h), repeated every 4 weeks; drug-eluting TACE will be performed at 3rd-4th cycles if the lesions in liver is abundant with blood supply. Tislelizumab (a PD-1 inhibitor): 200 mg, intravenous drip for 30-60 minutes before 24h of HAIC, q4w. Cetuximab (Group A, KRAS/NRAK/BRAF/EGFR wide type and interrupt cetuximab more than 3 months): 500 mg/m2, intravenous drip before HAIC, q4w. Fruquintinib (Group B, KRAS/NRAS/BRAF/EGFR mutation type and wide type but treated with cetuximab in last 3 months): 3 mg/d, d3-23, then suspend for 1w.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PFS rate at 6 months
Time Frame: From the date of treatment begining to the date of 6 months after the treatment begining.
|
Proportion of patients with 6- month progression-free survival after treatment begining in all patients.
|
From the date of treatment begining to the date of 6 months after the treatment begining.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with treatment-related adverse events
Time Frame: Through study completion, an average of once per 1 month.
|
Number of patients with AE, treatment-related AE (TRAE), serious adverse event (SAE) assessed by CTCAE v5.0.
|
Through study completion, an average of once per 1 month.
|
PFS
Time Frame: From date of treatment beginning until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months
|
The time from treatment initiation to the first documented disease progression or death due to any cause, whichever occurs firstly
|
From date of treatment beginning until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months
|
OS
Time Frame: From date of treatment beginning until the date of death from any cause, assessed up to 100 months
|
The time from treatment initiation to death due to any cause
|
From date of treatment beginning until the date of death from any cause, assessed up to 100 months
|
intrahepatic PFS
Time Frame: From date of treatment beginning until the date of first documented progression in liver or date of death from any cause, whichever came first, assessed up to 100 months
|
The time from treatment initiation to the first documented disease progression in liver or death due to any cause, whichever occurs firstly
|
From date of treatment beginning until the date of first documented progression in liver or date of death from any cause, whichever came first, assessed up to 100 months
|
ORR
Time Frame: Evaluation of tumor burden based on mRECIST criteria through study completion, an average of once per 3 months.
|
The proportion of participants in the analysis population who have complete response (CR) or partial response (PR) determined by investigators using mRECIST criteria at any time during the study.
|
Evaluation of tumor burden based on mRECIST criteria through study completion, an average of once per 3 months.
|
DCR
Time Frame: Evaluation of tumor burden based on mRECIST criteria through study completion, an average of once per 3 months.
|
The proportion of participants in the analysis population who have complete response (CR), partial response (PR), or stable disease (SD) determined by investigators using mRECIST criteria at any time during the study.
|
Evaluation of tumor burden based on mRECIST criteria through study completion, an average of once per 3 months.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Xiaodong Wang, M.D., Peking University Cancer Hospital & Institute
Publications and helpful links
General Publications
- Li J, Qin S, Xu R, Yau TC, Ma B, Pan H, Xu J, Bai Y, Chi Y, Wang L, Yeh KH, Bi F, Cheng Y, Le AT, Lin JK, Liu T, Ma D, Kappeler C, Kalmus J, Kim TW; CONCUR Investigators. Regorafenib plus best supportive care versus placebo plus best supportive care in Asian patients with previously treated metastatic colorectal cancer (CONCUR): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2015 Jun;16(6):619-29. doi: 10.1016/S1470-2045(15)70156-7. Epub 2015 May 13.
- Li J, Qin S, Xu RH, Shen L, Xu J, Bai Y, Yang L, Deng Y, Chen ZD, Zhong H, Pan H, Guo W, Shu Y, Yuan Y, Zhou J, Xu N, Liu T, Ma D, Wu C, Cheng Y, Chen D, Li W, Sun S, Yu Z, Cao P, Chen H, Wang J, Wang S, Wang H, Fan S, Hua Y, Su W. Effect of Fruquintinib vs Placebo on Overall Survival in Patients With Previously Treated Metastatic Colorectal Cancer: The FRESCO Randomized Clinical Trial. JAMA. 2018 Jun 26;319(24):2486-2496. doi: 10.1001/jama.2018.7855.
- Hackl C, Neumann P, Gerken M, Loss M, Klinkhammer-Schalke M, Schlitt HJ. Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma. BMC Cancer. 2014 Nov 4;14:810. doi: 10.1186/1471-2407-14-810.
- Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, Alexander DD, Choti MA, Poston G. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283-301. doi: 10.2147/CLEP.S34285. Epub 2012 Nov 7.
- Cho M, Gong J, Fakih M. The state of regional therapy in the management of metastatic colorectal cancer to the liver. Expert Rev Anticancer Ther. 2016;16(2):229-45. doi: 10.1586/14737140.2016.1129277. Epub 2016 Jan 13.
- Wang Y, Wei B, Gao J, Cai X, Xu L, Zhong H, Wang B, Sun Y, Guo W, Xu Q, Gu Y. Combination of Fruquintinib and Anti-PD-1 for the Treatment of Colorectal Cancer. J Immunol. 2020 Nov 15;205(10):2905-2915. doi: 10.4049/jimmunol.2000463. Epub 2020 Oct 7.
- Li Q, Cheng X, Zhou C, Tang Y, Li F, Zhang B, Huang T, Wang J, Tu S. Fruquintinib Enhances the Antitumor Immune Responses of Anti-Programmed Death Receptor-1 in Colorectal Cancer. Front Oncol. 2022 Mar 17;12:841977. doi: 10.3389/fonc.2022.841977. eCollection 2022.
- Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, Humblet Y, Bouche O, Mineur L, Barone C, Adenis A, Tabernero J, Yoshino T, Lenz HJ, Goldberg RM, Sargent DJ, Cihon F, Cupit L, Wagner A, Laurent D; CORRECT Study Group. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013 Jan 26;381(9863):303-12. doi: 10.1016/S0140-6736(12)61900-X. Epub 2012 Nov 22.
- Mayer RJ, Van Cutsem E, Falcone A, Yoshino T, Garcia-Carbonero R, Mizunuma N, Yamazaki K, Shimada Y, Tabernero J, Komatsu Y, Sobrero A, Boucher E, Peeters M, Tran B, Lenz HJ, Zaniboni A, Hochster H, Cleary JM, Prenen H, Benedetti F, Mizuguchi H, Makris L, Ito M, Ohtsu A; RECOURSE Study Group. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015 May 14;372(20):1909-19. doi: 10.1056/NEJMoa1414325.
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 (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PekingUCHI
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 Liver Metastasis Colon Cancer
-
Memorial Sloan Kettering Cancer CenterRecruitingColorectal Cancer | Colon Cancer | Liver Metastasis Colon Cancer | Adenocarcinoma of the Rectum | Colon Cancer Liver Metastasis | Adenocarcinoma of the ColonUnited States
-
McGill University Health Centre/Research Institute...RecruitingLiver Dysfunction | Liver Metastasis Colon Cancer | Liver RegenerationCanada
-
Lawson Health Research InstituteBayerRecruiting
-
AllVascularRecruitingLiver Metastasis Colon CancerAustralia
-
University of ManchesterManchester University NHS Foundation Trust; The Christie NHS Foundation Trust; Perspect... and other collaboratorsUnknownCancer | Colorectal Cancer | Liver Metastasis Colon Cancer | Cancer MetastaticUnited Kingdom
-
First Affiliated Hospital, Sun Yat-Sen UniversityNot yet recruitingLiver Metastasis Colon CancerChina
-
University of LeedsNational Cancer Institute (NCI); Massachusetts General Hospital; Massachusetts... and other collaboratorsRecruitingColon Cancer Liver MetastasisUnited Kingdom
-
Western University, CanadaNot yet recruitingNAFLD | Liver Metastasis Colon Cancer | Liver Steatoses
-
International Group of Endovascular OncologyCompletedObservational Study on Second Line Treatment of Liver Metastases With DEBIRI and Cetuximab (TACETUX)Colon Cancer Liver MetastasisItaly
-
PerspectumActive, not recruitingLiver Cancer | Liver Metastasis Colon CancerUnited Kingdom
Clinical Trials on HAIC+targeted therapy+PD-1 inhibitor
-
Shanghai Chest HospitalRecruitingNon Small Cell Lung CancerChina
-
Sun Yat-sen UniversityRecruitingHepatocellular CarcinomaChina
-
Peking University Cancer Hospital & InstituteInnovent Biologics (Suzhou) Co. Ltd.CompletedLiver Metastases | Esophageal Squamous Cell Carcinoma | Hepatic Arterial Infusion ChemotherapyChina
-
Canadian Cancer Trials GroupMelanoma and Skin Cancer Trials LimitedRecruitingUnresectable/Metastatic MelanomaCanada, Australia
-
Wen LiRecruitingUnresectable Hepatocellular CarcinomaChina
-
Adanate, IncRecruiting
-
Istari Oncology, Inc.Active, not recruiting
-
Sun Yat-sen UniversityRecruitingHepatocellular CarcinomaChina
-
Second Affiliated Hospital, School of Medicine,...Recruiting
-
Dong WangNot yet recruiting