Combination Chemotherapy and Cetuximab as First-Line Therapy in Treating Patients With Advanced and/or Metastatic Colorectal Cancer
15. september 2021 opdateret af: Cheryl Pugh
A Two-arm Phase II Randomised Trial of Intermittent Chemotherapy Plus Continuous Cetuximab and of Intermittent Chemotherapy Plus Intermittent Cetuximab in First Line Treatment of Patients With K-ras-normal (Wild-type) Metastatic Colorectal Cancer
RATIONALE: Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether giving combination chemotherapy together with intermittent cetuximab is more effective than combination chemotherapy given together with continuous cetuximab in treating colorectal cancer.
PURPOSE: This randomized phase II trial is studying giving combination chemotherapy together with intermittent cetuximab to see how well it works compared to combination chemotherapy given together with continuous cetuximab as first-line therapy in treating patients with advanced or metastatic colorectal cancer.
Studieoversigt
Status
Afsluttet
Betingelser
Detaljeret beskrivelse
OBJECTIVES:
Primary
- To compare the activity, in terms of failure-free survival, of patients with K-ras-normal (wild type) advanced and/or metastatic colorectal cancer treated with intermittent combination chemotherapy comprising oxaliplatin, leucovorin calcium, and fluorouracil (OxMdG) or oxaliplatin and capecitabine (XELOX) and intermittent vs continuous cetuximab as first-line therapy.
- To compare the safety and feasibility of these regimens in these patients.
Secondary
- To compare the safety of cetuximab reintroduction, in terms of frequency of grade 3-4 allergic reactions in these patients.
- To compare improvement in disease control (i.e., complete response plus partial response plus stable disease) at 24 weeks in patients treated with these regimens.
- To compare overall and progression-free survival of patients treated with these regimens.
- To compare response rates at 12, 24, and 36 weeks in patients treated with these regimens.
- To compare toxicity of these regimens in these patients.
OUTLINE: This is a multicenter study. Patients are randomised to 1 of 2 treatment arms.
Arm I (intermittent chemotherapy and intermittent cetuximab): Patients receive 1 of the following combination chemotherapy and cetuximab regimens:
- OxMdG: Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1 and fluorouracil IV continuously over 46 hours on days 1 and 2. Patients also receive cetuximab IV over 1-2 hours on days 1 and 8. Treatment repeats every 14 days for up to 6 courses (12 weeks) in the absence of disease progression or unacceptable toxicity.
- XELOX (for patients with line-related problems): Patients receive oxaliplatin IV over 2 hours on day 1 and oral capecitabine twice daily on days 1-15 (28 doses). Patients also receive cetuximab IV over 1-2 hours on days 1, 8, and 15. Treatment repeats every 21 days for up to 4 courses (12 weeks) in the absence of disease progression or unacceptable toxicity.
After completion of 12 weeks of study therapy, patients with disease progression are removed from study. Patients with stable or responding disease stop treatment with OxMdG or XELOX and cetuximab and undergo clinical evaluation at least every 6 weeks until disease progression or clinical deterioration. Upon evidence of disease progression or clinical deterioration, patients restart treatment with OxMdG or XELOX and cetuximab as before and continue to alternate 12 weeks of treatment with treatment breaks in the absence of disease progression or unacceptable toxicity. Patients with disease progression during study therapy stop treatment and proceed to second-line therapy or best supportive care.
- Arm II (intermittent chemotherapy and continuous cetuximab): Patients receive OxMdG or XELOX and cetuximab for 12 weeks as in arm I. Patients with disease progression after 12 weeks of study therapy are removed from study. Patients with stable or responding disease* after 12 weeks of study therapy stop treatment with OxMdG or XELOX and continue treatment with cetuximab weekly as monotherapy in the absence of disease progression or unacceptable toxicity. Patients undergo clinical evaluation as in arm I. Upon progression, patients restart treatment with OxMdG or XELOX and continue cetuximab, as before, alternating 12 weeks of combined OxMdG or XELOX and cetuximab therapy with cetuximab monotherapy. Patients with disease progression during study therapy stop treatment and proceed to second-line therapy as in arm I.
Previously collected tumor tissue samples are obtained at baseline and analyzed by IHC for EGFR status of tumor.
After completion of study treatment, patients are followed every 12 weeks.
Peer Reviewed and Funded or Endorsed by Cancer Research UK.
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
169
Fase
- Fase 2
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
-
Nicosia, Cypern
- Bank Of Cyprus Oncology Centre
-
-
-
-
-
Bath, Det Forenede Kongerige
- Royal United Hospital
-
Bournemouth, Det Forenede Kongerige
- Royal Bournemouth Hospital
-
Cambridge, Det Forenede Kongerige
- Addenbrookes Hospital
-
Dartford, Det Forenede Kongerige
- Darent Valley Hospital
-
Hereford, Det Forenede Kongerige
- Hereford County Hospital
-
London, Det Forenede Kongerige
- Charing Cross Hospital
-
London, Det Forenede Kongerige
- Guys and St Thomas' Hospitals
-
Poole, Det Forenede Kongerige
- Dorset Cancer Centre, Poole Hospital
-
Sheffield, Det Forenede Kongerige, S10 2SJ
- Weston Park
-
Southport, Det Forenede Kongerige
- Southport and Ormskirk
-
St Helens, Det Forenede Kongerige
- St Helens and Whiston hospitals
-
Warrington, Det Forenede Kongerige
- Warrington and Halton Hospitals
-
Worcester, Det Forenede Kongerige
- Worcestershire Royal Hospital
-
-
England
-
Bradford, England, Det Forenede Kongerige, BD9 6RJ
- Bradford Royal Infirmary
-
Cheltenham, England, Det Forenede Kongerige, GL53 7AN
- Gloucestershire Oncology Centre at Cheltenham General Hospital
-
Colchester, England, Det Forenede Kongerige, C03 3NB
- Essex County Hospital
-
Dorchester, England, Det Forenede Kongerige, DT1 2JY
- Dorset County Hospital
-
Guildford, England, Det Forenede Kongerige, GU2 7XX
- St. Luke's Cancer Centre at Royal Surrey County Hospital
-
London, England, Det Forenede Kongerige, W12 OHS
- Hammersmith Hospital
-
London, England, Det Forenede Kongerige, W2 1NY
- St. Mary's Hospital
-
Oxford, England, Det Forenede Kongerige, OX3 7LJ
- Churchill Hospital
-
Peterborough, England, Det Forenede Kongerige, PE3 6DA
- Peterborough Hospitals Trust
-
Stoke-On-Trent, England, Det Forenede Kongerige, ST4 7LN
- University Hospital of North Staffordshire
-
-
Wales
-
Swansea, Wales, Det Forenede Kongerige, SA2 8QA
- Singleton Hospital
-
-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år til 100 år (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
DISEASE CHARACTERISTICS:
Diagnosis of colorectal adenocarcinoma, defined by 1 of the following:
- Prior or current histologically confirmed primary adenocarcinoma of colon or rectum with clinical or radiological evidence of advanced and/or metastatic disease
- Histologically and cytologically confirmed metastatic adenocarcinoma with clinical and/or radiological evidence of colorectal primary tumor
- Unidimensionally measurable disease by RECIST criteria
Inoperable metastatic or locoregional disease
Potentially resectable liver metastases allowed provided the following criteria are met:
- Fewer than 4 unilobar liver metastases, each < 4 cm in size and without major vascular involvement
- No combination chemotherapy allowed prior to the planned resection of operable liver metastases
- No confirmed K-ras mutation of tumor after screening
- No brain metastases
PATIENT CHARACTERISTICS:
- WHO performance status 0-2
- Must be considered fit to undergo combination chemotherapy
- ANC ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Serum bilirubin ≤ 1.25 times upper limit of normal (ULN)
- Alkaline phosphatase ≤ 5 times ULN
- AST or ALT ≤ 2.5 times ULN
- Creatinine clearance ≥ 50mL/min OR glomerular filtration rate ≥ 50 mL/min
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No severe uncontrolled concurrent medical illness (including poorly controlled angina or myocardial infarction within the past 12 weeks) likely to interfere with protocol treatments
- No psychiatric or neurological condition that would preclude study compliance with oral medication or giving informed consent
- No partial or complete bowel obstruction
- No preexisting neuropathy > grade 1
- No prior or current malignant disease which, in the judgement of the treating investigator, is likely to interfere with COIN-B treatment or assessment of response
- No patients with known hypersensitivity reactions to any of the components of the study treatments
- No proven dihydropyrimidine dehydrogenase deficiency (DPD) or personal or family history of DPD
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior systemic palliative chemotherapy for metastatic disease
- No prior oxaliplatin
- More than 1 month since prior adjuvant chemotherapy comprising fluorouracil (with or without leucovorin calcium), capecitabine, or irinotecan hydrochloride
- More than 1 month since prior chemoradiotherapy comprising fluorouracil (with or without leucovorin calcium) or capecitabine for rectal cancer
- No ongoing requirement for contraindicated concurrent medication
- No concurrent enrollment in any type of study other than observational studies
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Aktiv komparator: D
Intermittent chemotherapy plus intermittent cetuximab treatment comprising 12 weeks of chemotherapy plus cetuximab followed by a period off all therapy, with reintroduction of the same chemotherapy and cetuximab regimen for a further 12 weeks after initial progression off treatment
|
|
|
Eksperimentel: E
Intermittent chemotherapy plus continuous cetuximab treatment comprising 12 weeks of chemotherapy plus cetuximab followed by a period of withdrawal of the chemotherapy, but continued weekly cetuximab monotherapy (maintenance cetuximab), with reintroduction of the same chemotherapy regimen to the cetuximab for a further 12 weeks after initial progression off chemotherapy treatment
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Failure-free survival at 10 months
Tidsramme: 10 months
|
10 months
|
Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Safety of cetuximab reintroduction, in terms of risk of grade 3-4 allergic reactions
Tidsramme: 12, 24 and 36 weeks
|
12, 24 and 36 weeks
|
|
Proportion of patients achieving disease control (complete response plus partial response plus stable disease) at 24 weeks
Tidsramme: 24 weeks
|
24 weeks
|
|
Overall survival
Tidsramme: at 12, 24 and 36 weeks
|
at 12, 24 and 36 weeks
|
|
Progression-free survival
Tidsramme: at 12, 24 and 36 weeks
|
at 12, 24 and 36 weeks
|
|
Response rates
Tidsramme: at 12, 24 and 36 weeks
|
at 12, 24 and 36 weeks
|
|
Toxicity of each treatment regimen by NCI CTCAE v3.0
Tidsramme: at 12, 24 and 36 weeks
|
at 12, 24 and 36 weeks
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Efterforskere
- Ledende efterforsker: Harpreet S. Wasan, Hammersmith Hospitals NHS Trust
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Hjælpsomme links
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. juli 2007
Primær færdiggørelse (Faktiske)
1. juni 2010
Studieafslutning (Faktiske)
1. september 2015
Datoer for studieregistrering
Først indsendt
19. marts 2008
Først indsendt, der opfyldte QC-kriterier
19. marts 2008
Først opslået (Skøn)
20. marts 2008
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
22. september 2021
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
15. september 2021
Sidst verificeret
1. september 2021
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Sygdomme i fordøjelsessystemet
- Neoplasmer
- Neoplasmer efter sted
- Gastrointestinale neoplasmer
- Neoplasmer i fordøjelsessystemet
- Gastrointestinale sygdomme
- Tyktarmssygdomme
- Tarmsygdomme
- Intestinale neoplasmer
- Endetarmssygdomme
- Kolorektale neoplasmer
- Lægemidlers fysiologiske virkninger
- Molekylære mekanismer for farmakologisk virkning
- Antimetabolitter, Antineoplastisk
- Antimetabolitter
- Antineoplastiske midler
- Immunsuppressive midler
- Immunologiske faktorer
- Beskyttelsesagenter
- Antineoplastiske midler, immunologiske
- Mikronæringsstoffer
- Vitaminer
- Calciumregulerende hormoner og midler
- Modgift
- Vitamin B kompleks
- Fluorouracil
- Capecitabin
- Oxaliplatin
- Leucovorin
- Kalk
- Levoleucovorin
- Cetuximab
Andre undersøgelses-id-numre
- CDR0000589635
- MRC-CTU-COIN-B/CR11
- EUDRACT:2006-003049-17
- ISRCTN38375681
- EU-20828
- MERCK-MRC-CTU-COIN-B/CR11
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
JA
IPD-planbeskrivelse
Publication
Studiedata/dokumenter
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .