Testování pumpové chemoterapie jako doplněk standardní péče chemoterapie versus standardní péče chemoterapie samotná pro pacienty s neresekovatelnými kolorektálními metastázami v játrech: studie PUMP
Randomizovaná studie fáze III systémové terapie s nebo bez jaterní arteriální infuze pro neresekovatelné kolorektální jaterní metastázy: studie PUMP
This phase III trial compares hepatic arterial infusion (HAI) (pump chemotherapy) in addition to standard of care chemotherapy versus standard of care chemotherapy alone in treating patients with colorectal cancer that has spread to the liver (liver metastases) and cannot be removed by surgery (unresectable). HAI uses a catheter to carry a tumor-killing chemotherapy drug called floxuridine directly into the liver. HAI is already approved by the Food and Drug Administration (FDA) for use in metastatic colorectal cancer to the liver, but it is only available at a small number of hospitals, and most of the time it is not used until standard chemotherapy stops working. Standard chemotherapy drugs work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding HAI to standard chemotherapy may be effective in shrinking or stabilizing unresectable colorectal liver metastases.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
- Biologický: Bevacizumab
- Lék: Fluorouracil
- Postup: Magnetic Resonance Imaging
- Lék: Capecitabine
- Biologický: Panitumumab
- Lék: Oxaliplatin
- Lék: Leucovorin
- Biologický: Cetuximab
- Lék: Irinotecan
- Lék: Floxuridine
- Postup: Computed Tomography
- Postup: Implantation
- Postup: Intrahepatic Infusion Procedure
- Postup: Single Photon Emission Computed Tomography
Detailní popis
PRIMARY OBJECTIVE:
I. To determine if patients with persistently unresectable colorectal liver metastases (CRLM) after treatment with first-line chemotherapy have improved overall survival (OS) with hepatic arterial infusion (HAI) and systemic chemotherapy versus systemic chemotherapy alone.
SECONDARY OBJECTIVES:
I. To determine whether there is a direct association between hepatic progression free survival (hPFS) and overall survival (OS) when patients are treated with HAI combined with systemic chemotherapy for unresectable CRLM.
II To determine the impact on progression free survival (overall, hepatic and extrahepatic) for patients with unresectable CRLM treated with HAI in combination with systemic chemotherapy.
III. To determine objective response rate (ORR) in the liver, defined as the proportion of patients achieving complete or partial response by Response Evaluation Criteria is Solid Tumors (RECIST) 1.1.
IV. To determine the rate of conversion to resectable disease, defined as the proportion of patients who successfully convert from unresectable to resectable status and undergo R0/R1 resection/ablation.
V. To determine the rate in which patients are intended to be treated with HAI but are deemed ineligible at the time of planned pump insertion due to detection of occult extrahepatic disease or unsuitable arterial anatomy (Intra-Operative Ineligibility, IOI).
VI. To determine the extent to which patient and disease-specific factors correlate with short- and long-term risk of HAI-specific complications.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients undergo surgery to place the HAI pump within 6 weeks of randomization, followed by single photon emission computed tomography/computed tomography (SPECT/CT) on study. Patients then receive floxuridine via the HAI pump within 12 weeks of randomization on study. Patients also receive one of the following standard chemotherapy regimens per the treating physician within 16 weeks of randomization: FOLFOX (fluorouracil intravenously [IV], oxaliplatin IV, and leucovorin IV), FOLFIRI (fluorouracil IV, irinotecan IV, and leucovorin IV), or OX/IRI (oxaliplatin IV and irinotecan IV) with or without cetuximab IV and/or panitumumab IV on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients may have leucovorin omitted from their regimen per institutional standards. Patients also undergo CT and/or magnetic resonance imaging (MRI) scans throughout the trial.
ARM B: Patients receive one of the following standard chemotherapy regimens per the treating physician within 6 weeks of randomization: FOLFOXIRI (fluorouracil IV, oxaliplatin IV, irinotecan IV, and leucovorin IV), FOLFOX IV, FOLFIRI IV, or OX/IRI IV with or without cetuximab IV, panitumumab IV, and/or bevacizumab IV on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients may receive capecitabine orally (PO) in substitution for fluorouracil at the discretion of the investigator and may have leucovorin omitted from their regimen per institutional standards. Patients also undergo CT and/or MRI scans throughout the trial.
After completion of treatment, patients follow up every 3 months for 2 years and then every 6 months for an additional 3 years.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 3
Kontakty a umístění
Studijní místa
-
-
Alabama
-
Birmingham, Alabama, Spojené státy, 35233
- Staženo
- University of Alabama at Birmingham Cancer Center
-
-
Arizona
-
Gilbert, Arizona, Spojené státy, 85234
- Nábor
- Banner MD Anderson Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 602-747-9738
-
Vrchní vyšetřovatel:
- Rajesh Ramanathan
-
Phoenix, Arizona, Spojené státy, 85006
- Nábor
- Banner-University Medical Center Phoenix
-
Kontakt:
- Site Public Contact
- E-mail: BannerResearch@bannerhealth.com
-
Vrchní vyšetřovatel:
- Rajesh Ramanathan
-
Sun City, Arizona, Spojené státy, 85351
- Nábor
- Banner Boswell Medical Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 480-440-7458
- E-mail: BMDACCResearch@bannerhealth.com
-
Vrchní vyšetřovatel:
- Rajesh Ramanathan
-
-
Colorado
-
Aurora, Colorado, Spojené státy, 80045
- Nábor
- UCHealth University of Colorado Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 720-848-0650
-
Vrchní vyšetřovatel:
- Alexis D. Leal
-
-
Florida
-
Aventura, Florida, Spojené státy, 33180
- Nábor
- UM Sylvester Comprehensive Cancer Center at Aventura
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 954-461-2180
-
Coral Gables, Florida, Spojené státy, 33146
- Nábor
- UM Sylvester Comprehensive Cancer Center at Coral Gables
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
Deerfield Beach, Florida, Spojené státy, 33442
- Nábor
- UM Sylvester Comprehensive Cancer Center at Deerfield Beach
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
Hollywood, Florida, Spojené státy, 33021
- Nábor
- UM Sylvester Comprehensive Cancer Center at Hollywood
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
Miami, Florida, Spojené státy, 33136
- Nábor
- University of Miami Miller School of Medicine-Sylvester Cancer Center
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
Miami, Florida, Spojené státy, 33176
- Nábor
- UM Sylvester Comprehensive Cancer Center at Kendall
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
Plantation, Florida, Spojené státy, 33324
- Nábor
- UM Sylvester Comprehensive Cancer Center at Plantation
-
Vrchní vyšetřovatel:
- Jashodeep Datta
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 305-243-2647
-
-
Georgia
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Atlanta, Georgia, Spojené státy, 30322
- Nábor
- Emory University Hospital/Winship Cancer Institute
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 404-778-1868
-
Vrchní vyšetřovatel:
- Olumide B. Gbolahan
-
Atlanta, Georgia, Spojené státy, 30342
- Nábor
- Emory Saint Joseph's Hospital
-
Vrchní vyšetřovatel:
- Olumide B. Gbolahan
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 404-851-7115
-
-
Illinois
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Chicago, Illinois, Spojené státy, 60637
- Nábor
- University of Chicago Comprehensive Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 773-702-8222
- E-mail: cancerclinicaltrials@bsd.uchicago.edu
-
Vrchní vyšetřovatel:
- Ryan Merkow
-
Chicago, Illinois, Spojené státy, 60611
- Nábor
- Northwestern University
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 312-695-1301
- E-mail: cancer@northwestern.edu
-
Vrchní vyšetřovatel:
- Shishir K. Maithel
-
Chicago, Illinois, Spojené státy, 60641
- Nábor
- Northwestern Medicine Cancer Center Old Irving Park
-
Vrchní vyšetřovatel:
- Shishir K. Maithel
-
Kontakt:
- Site Public Contact
- E-mail: nctnprogram_rhlccc@northwestern.edu
-
Shiloh, Illinois, Spojené státy, 62269
- Staženo
- Memorial Hospital East
-
-
Indiana
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Carmel, Indiana, Spojené státy, 46032
- Nábor
- IU Health North Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 317-278-5632
- E-mail: iutrials@iu.edu
-
Vrchní vyšetřovatel:
- Anita Turk
-
Indianapolis, Indiana, Spojené státy, 46202
- Nábor
- Indiana University/Melvin and Bren Simon Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 317-278-5632
- E-mail: iutrials@iu.edu
-
Vrchní vyšetřovatel:
- Anita Turk
-
-
Kentucky
-
Lexington, Kentucky, Spojené státy, 40536
- Nábor
- University of Kentucky/Markey Cancer Center
-
Vrchní vyšetřovatel:
- Michael J. Cavnar
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 859-257-3379
-
-
Michigan
-
Ann Arbor, Michigan, Spojené státy, 48109
- Nábor
- University of Michigan Rogel Cancer Center
-
Vrchní vyšetřovatel:
- Benjamin D. Ferguson
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-865-1125
- E-mail: CancerAnswerLine@med.umich.edu
-
Grand Rapids, Michigan, Spojené státy, 49503
- Nábor
- Corewell Health Grand Rapids Hospitals - Butterworth Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 616-391-1230
- E-mail: crcwm-regulatory@crcwm.org
-
Vrchní vyšetřovatel:
- Kathleen Y. Butler
-
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Minnesota
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Minneapolis, Minnesota, Spojené státy, 55455
- Nábor
- University of Minnesota/Masonic Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 612-624-2620
-
Vrchní vyšetřovatel:
- Ajay Prakash
-
Rochester, Minnesota, Spojené státy, 55905
- Nábor
- Mayo Clinic in Rochester
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 855-776-0015
-
Vrchní vyšetřovatel:
- Cornelius A. Thiels
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Missouri
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City of Saint Peters, Missouri, Spojené státy, 63376
- Staženo
- Siteman Cancer Center at Saint Peters Hospital
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Creve Coeur, Missouri, Spojené státy, 63141
- Staženo
- Siteman Cancer Center at West County Hospital
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St Louis, Missouri, Spojené státy, 63110
- Staženo
- Washington University School of Medicine
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St Louis, Missouri, Spojené státy, 63129
- Staženo
- Siteman Cancer Center-South County
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St Louis, Missouri, Spojené státy, 63136
- Staženo
- Siteman Cancer Center at Christian Hospital
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New Jersey
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Basking Ridge, New Jersey, Spojené státy, 07920
- Nábor
- Memorial Sloan Kettering Basking Ridge
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
Middletown, New Jersey, Spojené státy, 07748
- Nábor
- Memorial Sloan Kettering Monmouth
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
Montvale, New Jersey, Spojené státy, 07645
- Nábor
- Memorial Sloan Kettering Bergen
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
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New York
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Buffalo, New York, Spojené státy, 14263
- Nábor
- Roswell Park Cancer Institute
-
Vrchní vyšetřovatel:
- Anuradha Krishnamurthy
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-767-9355
- E-mail: askroswell@roswellpark.org
-
Commack, New York, Spojené státy, 11725
- Nábor
- Memorial Sloan Kettering Commack
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
East White Plains, New York, Spojené státy, 10604
- Nábor
- Memorial Sloan Kettering Westchester
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
New York, New York, Spojené státy, 10065
- Nábor
- Memorial Sloan Kettering Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
New York, New York, Spojené státy, 10029
- Nábor
- Mount Sinai Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-824-7309
- E-mail: CCTO@mssm.edu
-
Vrchní vyšetřovatel:
- James O. Park
-
Uniondale, New York, Spojené státy, 11553
- Nábor
- Memorial Sloan Kettering Nassau
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 212-639-7592
-
Vrchní vyšetřovatel:
- Andrea Cercek
-
-
North Carolina
-
Durham, North Carolina, Spojené státy, 27710
- Nábor
- Duke University Medical Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 888-275-3853
-
Vrchní vyšetřovatel:
- Hope E. Uronis
-
Raleigh, North Carolina, Spojené státy, 27609
- Nábor
- Duke Cancer Center Raleigh
-
Vrchní vyšetřovatel:
- Hope E. Uronis
-
Kontakt:
- Site Public Contact
- E-mail: NCTNStudyTeam@dm.duke.edu
-
Winston-Salem, North Carolina, Spojené státy, 27157
- Nábor
- Wake Forest University Health Sciences
-
Vrchní vyšetřovatel:
- Perry Shen
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 336-713-6771
-
-
Ohio
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Cleveland, Ohio, Spojené státy, 44106
- Aktivní, ne nábor
- Case Western Reserve University
-
Columbus, Ohio, Spojené státy, 43210
- Nábor
- Ohio State University Comprehensive Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-293-5066
- E-mail: Jamesline@osumc.edu
-
Vrchní vyšetřovatel:
- Alex B. Blair
-
Youngstown, Ohio, Spojené státy, 44501
- Nábor
- Saint Elizabeth Youngstown Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 937-528-2900
- E-mail: clinical.trials@daytonncorp.org
-
Vrchní vyšetřovatel:
- Howard M. Gross
-
-
Oregon
-
Portland, Oregon, Spojené státy, 97239
- Nábor
- Oregon Health and Science University
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 503-494-1080
- E-mail: trials@ohsu.edu
-
Vrchní vyšetřovatel:
- Skye C. Mayo
-
-
Pennsylvania
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Allentown, Pennsylvania, Spojené státy, 18103
- Nábor
- Lehigh Valley Hospital-Cedar Crest
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 610-402-9543
- E-mail: Morgan_M.Horton@lvhn.org
-
Vrchní vyšetřovatel:
- Tareq Al baghdadi
-
Erie, Pennsylvania, Spojené státy, 16544
- Nábor
- Saint Vincent Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 814-452-5000
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
Jefferson Hills, Pennsylvania, Spojené státy, 15025
- Nábor
- Jefferson Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 412-359-3043
- E-mail: ddefazio@wpahs.org
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
Monroeville, Pennsylvania, Spojené státy, 15146
- Nábor
- Forbes Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 412-858-7746
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
Philadelphia, Pennsylvania, Spojené státy, 19111
- Nábor
- Fox Chase Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 215-728-4790
-
Vrchní vyšetřovatel:
- Vanessa Wookey
-
Pittsburgh, Pennsylvania, Spojené státy, 15224
- Nábor
- West Penn Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 412-578-5000
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
Pittsburgh, Pennsylvania, Spojené státy, 15212
- Nábor
- Allegheny General Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 877-284-2000
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
Wexford, Pennsylvania, Spojené státy, 15090
- Nábor
- Wexford Health and Wellness Pavilion
-
Kontakt:
- Site Public Contact
- E-mail: Dawnmarie.DeFazio@ahn.org
-
Vrchní vyšetřovatel:
- Patrick L. Wagner
-
-
Tennessee
-
Nashville, Tennessee, Spojené státy, 37232
- Nábor
- Vanderbilt University/Ingram Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-811-8480
-
Vrchní vyšetřovatel:
- Chandrasekhar Padmanabhan
-
-
Texas
-
Dallas, Texas, Spojené státy, 75390
- Nábor
- UT Southwestern/Simmons Cancer Center-Dallas
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 214-648-7097
- E-mail: canceranswerline@UTSouthwestern.edu
-
Vrchní vyšetřovatel:
- Adam C. Yopp
-
Dallas, Texas, Spojené státy, 75235
- Nábor
- Parkland Memorial Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 214-590-5582
- E-mail: canceranswerline@UTSouthwestern.edu
-
Vrchní vyšetřovatel:
- Adam C. Yopp
-
Dallas, Texas, Spojené státy, 75237
- Nábor
- UT Southwestern Simmons Cancer Center - RedBird
-
Vrchní vyšetřovatel:
- Adam C. Yopp
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 214-648-7097
- E-mail: canceranswerline@utsouthwestern.edu
-
Fort Worth, Texas, Spojené státy, 76104
- Nábor
- UT Southwestern/Simmons Cancer Center-Fort Worth
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 214-648-7097
- E-mail: canceranswerline@UTSouthwestern.edu
-
Vrchní vyšetřovatel:
- Adam C. Yopp
-
Richardson, Texas, Spojené státy, 75080
- Nábor
- UT Southwestern Clinical Center at Richardson/Plano
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 972-669-7044
- E-mail: Suzanne.cole@utsouthwestern.edu
-
Vrchní vyšetřovatel:
- Adam C. Yopp
-
-
Wisconsin
-
Madison, Wisconsin, Spojené státy, 53792
- Nábor
- University of Wisconsin Carbone Cancer Center - University Hospital
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-622-8922
- E-mail: clinicaltrials@cancer.wisc.edu
-
Vrchní vyšetřovatel:
- Patrick Varley
-
Madison, Wisconsin, Spojené státy, 53718
- Nábor
- University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
-
Kontakt:
- Site Public Contact
- Telefonní číslo: 800-622-8922
- E-mail: clinicaltrials@cancer.wisc.edu
-
Vrchní vyšetřovatel:
- Patrick Varley
-
-
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
-
Patient must be >= 18 years of age
-
Patient must have confirmed unresectable liver confined metastatic colorectal cancer (CRC).
-
Patient must not have radiographically or clinically evident extrahepatic disease (including but not limited to radiographically positive periportal lymph nodes).
- NOTE: Patients found to have positive periportal nodes at the time of HAI placement can remain on study.
-
Patient may have calcified pulmonary nodules, and/or =< 5 indeterminate and stable (for a minimum of 3 months on chemotherapy) pulmonary nodules each measuring =< 6 mm in maximal axial dimension.
-
Patient's primary tumor may be in place
-
-
Patient must have received previous first-line chemotherapy that meets one of the following three criteria: a) have received at least 6 but no more than 12 cycles of first-line cytotoxic chemotherapy (where 1 cycle = 14 days) OR b) have received at least 4 but no more than 8 cycles of first-line cytotoxic chemotherapy (where 1 cycle = 21 days) OR c) have developed new colorectal liver metastases (CRLM) within 12 months of completing adjuvant systemic therapy for stage II-III colorectal cancer.
- NOTE: First-line chemotherapy may have included any of the following regimens as listed in the National Comprehensive Cancer Network (NCCN) Guidelines: leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX) (or equivalent), leucovorin calcium (calcium folinate), 5-fluorouracil, and irinotecan (FOLFIRI) (or equivalent), leucovorin calcium (calcium folinate), 5-fluorouracil, oxaliplatin, and irinotecan (FOLFOXIRI), each with or without any of the following: bevacizumab, cetuximab, or panitumumab
-
Patient must have measurable disease
-
Patients who have disease progression, in the judgement of the treating multidisciplinary team, are not eligible.
- This requirement does not apply to patients who developed new colorectal liver metastases within 12 months of completing adjuvant systemic therapy for stage II-III colorectal cancer
-
Patient must meet the following criteria for technical unresectability:
- A margin-negative resection requires resection of three hepatic veins, both portal veins, or the retrohepatic vena cava OR a resection that leaves less than two adequately perfused and drained segments.
- NOTE: Institutional multidisciplinary review is required to confirm unresectability and rule out radiographically positive extrahepatic disease.
- NOTE: Patients who are deemed technically resectable but simultaneous biologically unresectable are not eligible.
-
Patient must undergo multiphase imaging of the chest, abdomen, and pelvis inclusive of CT and/or MRI angiography to confirm acceptable hepatic arterial anatomy for HAI and to rule out extrahepatic disease within 28 days prior to randomization.
- NOTE: If the patient had remote liver-arterial phase imaging greater than 4 weeks from randomization, then only a single phase (portal venous) intravenous contrasted staging CT and/or MRI of the chest/abdomen/pelvis is required.
-
Patient must have an Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1 and be clinically fit to undergo surgery as determined by the pre-operative evaluation.
-
Patient must not have a liver tumor burden exceeding 70% of total liver volume.
-
Patient must not have had prior radiation to the liver (prior radiation therapy to the pelvis is acceptable if completed at least 2 weeks prior to randomization).
-
Patient must not have had prior trans-arterial bland embolization, chemoembolization (TACE) or radioembolization (TARE).
-
Patient must not have had prior treatment with HAI/floxuridine (FUDR)
-
Patient must not have microsatellite instability-high (MSI-H) colorectal cancer.
-
Patient must not have CRLM that could be resected with 2-stage hepatectomy, including associating liver partition and portal vein ligation (ALPPS).
-
Patient must not have an active infection, serious or non-healing active wound, ulcer, or bone fracture.
-
Patient must not have any serious medical problems which would preclude receiving the protocol treatment or would interfere with the cooperation with the requirements of this trial.
-
Patient must not have cirrhosis and/or clinical or radiographic evidence of portal hypertension
-
Patient must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used.
- All patients of childbearing potential must have a blood test or urine study within 14 days prior to randomization to rule out pregnancy.
- A patient of childbearing potential is defined as anyone, regardless of whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
-
Patient must not expect to conceive or father children by using accepted and effective method(s) of contraception or by abstaining from sexual intercourse for the duration of their participation in the study.
-
Leukocytes >= 3,000/mcL (obtained =< 28 days prior to protocol randomization)
-
Absolute neutrophil count (ANC) >= 1,500/mcL (obtained =< 28 days prior to protocol randomization)
-
Platelets >= 100,000/mcL (obtained =< 28 days prior to protocol randomization)
-
Total Bilirubin =< 1.5 mg/dL (obtained =< 28 days prior to protocol randomization)
-
Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT)(serum glutamic pyruvic transaminase [SGPT]) =< 3.0 x institutional upper limit of normal (ULN) (obtained =< 28 days prior to protocol randomization)
-
Creatinine =< 1.5 x institutional ULN OR creatinine clearance >= 50 mL/min calculated by the Cockcroft-Gault method (obtained =< 28 days prior to protocol randomization)
-
Calcium >= institutional lower limit of normal (LLN)
-
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
-
Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of randomization are eligible for this trial. Testing for HIV is not required for entry onto the study
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: Arm A (HAI, floxuridine, standard chemotherapy)
Patients undergo surgery to place the HAI pump within 6 weeks of randomization, followed by single SPECT/CT on study. Patients then receive floxuridine via the HAI pump within 12 weeks of randomization on study. Patients also receive one of the following standard chemotherapy regimens per the treating physician within 16 weeks of randomization: FOLFOX IV, FOLFIRI IV, or OX/IRI IV with or without cetuximab IV and/or panitumumab IV on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients may have leucovorin omitted from their regimen per institutional standards. Patients also undergo CT and/or MRI scans throughout the trial. |
Given IV
Ostatní jména:
Undergo MRI
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV Given via HAI pump
Ostatní jména:
Undergo SPECT/CT and/or CT
Ostatní jména:
Undergo surgery to place the HAI pump Undergo HAI
Ostatní jména:
Undergo SPECT/CT
Ostatní jména:
|
|
Aktivní komparátor: Arm B (standard chemotherapy)
Patients receive one of the following standard chemotherapy regimens per the treating physician within 6 weeks of randomization: FOLFOXIRI IV, FOLFOX IV, FOLFIRI IV, or OX/IRI IV with or without cetuximab IV, panitumumab IV, and/or bevacizumab IV on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients may receive capecitabine PO in substitution for fluorouracil at the discretion of the investigator and may have leucovorin omitted from their regimen per institutional standards. Patients also undergo CT and/or MRI scans throughout the trial. |
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Undergo MRI
Ostatní jména:
Given PO
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV
Ostatní jména:
Given IV Undergo SPECT/CT and/or CT
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Overall survival (OS)
Časové okno: From randomization to death from any cause, assessed up to 5 years
|
Patients still living will be censored at the date last known alive. OS will be evaluated using the Kaplan-Meier method, and arms will be compared via a stratified log rank test. |
From randomization to death from any cause, assessed up to 5 years
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Progression free survival (PFS)
Časové okno: From randomization to first observed disease progression at any site, or death from any cause, assessed up to 5 years
|
Patients still living without disease progression will be censored at the date of last disease assessment. Disease progression will be based on findings from surveillance cross-sectional imaging of the chest/abdomen/pelvis every 3 months after randomization, defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Will be analyzed similarly to OS, but with and without stratification for sensitivity. |
From randomization to first observed disease progression at any site, or death from any cause, assessed up to 5 years
|
|
Hepatic PFS
Časové okno: From randomization to first observed disease progression in the liver, or death from any cause, assessed up to 5 years
|
Patients still living without hepatic disease progression will be censored at the date of last disease assessment. Hepatic disease progression will be based on findings from surveillance cross-sectional imaging of the chest/abdomen/pelvis every 3 months after randomization, defined by RECIST 1.1. |
From randomization to first observed disease progression in the liver, or death from any cause, assessed up to 5 years
|
|
Extrahepatic-PFS
Časové okno: From randomization to first observed disease progression outside of the liver, or death from any cause, assessed up to 5 years
|
Patients still living without extrahepatic disease progression will be censored at the date of last disease assessment. Extrahepatic disease progression will be based on findings from surveillance cross-sectional imaging of the chest/abdomen/pelvis every 3 months after randomization, defined by RECIST 1.1. |
From randomization to first observed disease progression outside of the liver, or death from any cause, assessed up to 5 years
|
|
Objective response rate
Časové okno: Up to 5 years
|
Will assess hepatic disease burden specifically. Defined as the proportion of patients achieving complete or partial response by RECIST 1.1. Response will be based on surveillance cross-sectional imaging of the chest/abdomen/pelvis every 3 months (+/- 2 weeks) from randomization. Arms will be compared via a Pearson chi-square test. All rates will be reported with exact binomial 95% confidence intervals. |
Up to 5 years
|
|
Rate of conversion to resectable disease
Časové okno: Up to 5 years
|
Defined as the proportion of patients who successfully convert from unresectable to resectable status and undergo R0/R1 resection/ablation. All rates will be reported with exact binomial 95% confidence intervals. |
Up to 5 years
|
|
Intra-operative ineligibility rate
Časové okno: Up to 5 years
|
Defined as the proportion of patients intended to receive hepatic arterial infusion that do not undergo pump implantation due to intraoperative detection of occult extrahepatic disease or unsuitable hepatic arterial anatomy. All rates will be reported with exact binomial 95% confidence intervals. |
Up to 5 years
|
|
Incidence of adverse events
Časové okno: Up to 5 years
|
Defined according to the Common Terminology Criteria for Adverse Events. |
Up to 5 years
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Michael Lidsky, ECOG-ACRIN Cancer Research Group
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
- Novotvary podle místa
- Novotvary
- Střevní nemoci
- Gastrointestinální novotvary
- Novotvary trávicího systému
- Nemoci trávicího systému
- Gastrointestinální onemocnění
- Střevní novotvary
- Rektální onemocnění
- Onemocnění tlustého střeva
- Kolorektální novotvary
- Aminokyseliny, peptidy a proteiny
- Proteiny
- Sloučeniny síry
- Organické chemikálie
- Heterocyklické sloučeniny, 1 kruh
- Heterocyklické sloučeniny
- Heterocyklické sloučeniny, 2-prsten
- Heterocyklické sloučeniny, fúzované kroužek
- Farmaceutické přípravky
- Vyšetřovací techniky
- Formy dávkování
- Nukleové kyseliny, nukleotidy a nukleosidy
- Fyzické jevy
- Camptothecin
- Alkaloidy
- Enzymy a koenzymy
- Protilátky, monoklonální, humanizované
- Protilátky, monoklonální
- Protilátky
- Imunoglobuliny
- Imunoproteiny
- Krevní proteiny
- Sérové globuliny
- Globuliny
- Anorganické chemikálie
- Koordinační komplexy
- Deoxycytidin
- Cytidin
- Pyrimidinové nukleosidy
- Pyrimidiny
- Techniky chemie, analytické
- Analýza spektra
- Nukleosidy
- Formyltetrahydrofoláty
- Tetrahydrofoláty
- Kyselina listová
- Pteriny
- Pteridiny
- Uracil
- Pyrimidinony
- Koenzymy
- Izotypy imunoglobulinu
- Sulfidy
- Anionty
- Ionty
- Elektrolyty
- Sirovodík
- Elektromagnetické jevy
- Magnetické jevy
- Deoxyribonukleosidy
- Elektromagnetické záření
- Záření
- Záření, ionizující
- Elementární částice
- Světlo
- Optické jevy
- Záření, neionizující
- Deoxyuridin
- Uridin
- Přípravy zpožděné akce
- Kapecitabin
- Oxaliplatina
- Bevacizumab
- Irinotekan
- Panitumumab
- Cetuximab
- Fluorouracil
- Leukovorin
- Imunoglobulin G
- Floxuridin
- Magnetická rezonanční spektroskopie
- Disulfidy
- Rentgenové paprsky
- Fotony
- Dehydroftorafur
- (225) AC-DOTA-C (RGDYK)
- 5-fluoro-2'-deoxyuridin
- Drogové implantáty
Další identifikační čísla studie
Další identifikační čísla studie
- EA2222
- U10CA180820 (Grant/smlouva NIH USA)
- EA2222 (Jiný identifikátor: CTEP)
- NCI-2023-02357 (Identifikátor registru: CTRP (Clinical Trial Reporting Program))
- EA2222 (Jiný identifikátor: ECOG-ACRIN Cancer Research Group)
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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