Prospective Translational Study Investigating Molecular Predictors of Resistance and Response to Regorafenib Monotherapy (PROSPECT-R)
2021年4月30日 更新者：Royal Marsden NHS Foundation Trust
A Prospective Translational Study Investigating Molecular Predictors of Resistance and Response to Regorafenib Monotherapy in RAS Mutant Metastatic Colorectal Cancer
This is a single centre prospective biological translational research study involving the collection of tumour tissue, blood samples and clinical data from patients being treated with regorafenib for metastatic Colorectal Cancer (mCRC) at the Royal Marsden Hospital.
Patients will be eligible for the study if they have a histological diagnosis of CRC, are refractory to standard available therapies with palliative intent for mCRC, have received prior treatment with at least one anti-VEGF antibody and chemotherapy drugs including fluorouracil (5FU) or capecitabine, oxaliplatin and irinotecan, and patients have RAS mutant tumours.
調査の概要
詳細な説明
This is an exploratory translational research study to obtain research biopsies of RAS mutant metastatic colorectal cancer (mCRC) tumour tissue prior to commencement of regorafenib multi-tyrosine kinase inhibitor (MKI) treatment targeting vascular endothelial growth factor receptor (VEGFR), tumour microenvironment and oncogenic driver alterations, and again at development of resistance.
Candidate markers of resistance will be identified in tissue biopsies through genetic and other molecular analysis and parallel collection of serial blood specimens will facilitate the identification of resistance markers and the tracking of resistance evolution in circulating nucleic acids.
Early dynamic contrast enhanced MRI (DCE-MRI) along with diffusion weighted (DW)-MRI imaging at the beginning, and on day 15+/-7 post treatment will be performed.
Additionally, dual contrast enhanced CT (DECT) will be performed according to routine clinical evaluation time points before drug administration and at 8 weeks after drug administration.
Disease will be monitored with serial CT scans of the chest abdomen and pelvis (CT-CAP) every eight weeks, until progression.
The aim of the study is to identify novel predictive biomarkers of resistance and response to this targeted therapy in mCRC previously treated with oxaliplatin, fluoropyrimidines and irinotecan, using genetic, epigenetic, transcriptomics, proteomic and live tissue culture methods.
These molecular analyses will be performed on metastatic tumour tissue samples taken firstly before commencement of regorafenib, and secondly on progression of disease, and thirdly from archival primary or metastatic tumour tissue.
There is an additional biopsy at 8 weeks in patients with response or stable disease, as determined by Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 criteria.
研究の種類
観察的
入学 (実際)
49
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Surrey
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Carshalton、Surrey、イギリス、SM2 5PT
- The Royal Marsden NHS Foundation Trust London and Surrey
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年歳以上 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
サンプリング方法
非確率サンプル
調査対象母集団
Patients will be selected from the clinics and multi-disciplinary meetings, so long that they meet all the inclusion criteria and no exclusion criteria.
説明
Inclusion Criteria:
- Patients with RAS mutant (MT) metastatic colorectal cancer (mCRC) who have been at least once treated with available therapies including fluoropyrimidine-based chemotherapy, oxaliplatin, irinotecan and an anti-angiogenic agent, except for patients who have not been treated with oxaliplatin due to previous documented peripheral neuropathy in an adjuvant setting or in those patients where disease has progressed within a short time from receiving adjuvant treatment (<12 months).
- Eligible to receive regorafenib within the context of PROSPECT-R trial at the Royal Marsden Hospital
Exclusion criteria:
A patient who meets any of the exclusion criteria will NOT be eligible for randomization.
A patient must NOT
- have had prior treatment with regorafenib or any other VEGF-targeting kinase inhibitor
- have had previous or concurrent cancer that is distinct in primary site or histology from colorectal cancer within 5 years prior to randomization EXCEPT for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors [Ta (Noninvasive tumor), Tis (Carcinoma in situ) and T1 (Tumor invades lamina propria)].
- Patients that are participating in another clinical trial involving an investigational medicinal product, unless it is more than 14 days after they have ceased the investigational medicinal product
- Patients that are participating in another research study involving tumour tissue biopsies planned to take place during the time that the patient is participating in this study
- Have had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to initiation of study treatment
- If female and of childbearing potential, be engaged in breast feeding
- Be unable to swallow oral tablets (crushing of study treatment tablets is not allowed)
- Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 month before the start of study medication (except for adequately treated catheter-related venous thrombosis occurring more than one month before the start of study medication)
- Interstitial lung disease with ongoing signs and symptoms at the time of informed consent.
- Ongoing infection > Grade 2 NCI Common Toxicity Criterial for Adverse Effects (CTCAE).
- Uncontrolled hypertension (Systolic blood pressure > 140 mmHg or diastolic pressure > 90 mmHg) despite optimal medical management
- Have congestive heart failure classified as New York Heart Association Class 2 or higher
- Have had unstable angina (angina symptoms at rest) or new-onset angina < 3 months prior to screening
- Have had a myocardial infarction < 6 months prior to initiation of study treatment
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
|---|---|
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Regorafenib
160 mg orally (po) od for 3 weeks of every 4-week cycle All patients will be required to have pre-treatment dynamic contrast enhance computed tomography (DECT) scan pre-treatment and at 8 weeks. Suitable patients will also be required to have dynamic contrast enhanced magnetic resonance imaging (DEC-MRI) and diffusion weighted (DW)-MRI, pre-treatment and at 2 weeks. All patients will also be required to have an Ultrasound (USS) or CT-guided biopsy of suitable metastatic lesion. |
Patients meeting all of the inclusion criteria and none of the exclusion criteria will receive regorafenib 160 mg orally (po) od for 3 weeks of every 4-week cycle.
Each cycle will comprise 3 weeks of treatment followed by 1 week without treatment, hereafter described as "3 weeks on/1 week off".
Each 160-mg dose will include four regorafenib 40-mg tablets.
他の名前：
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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disease control rate (DCR), measured in months
時間枠：12 months
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DCR will be defined as complete response (CR)/partial response (PR)/ stable disease (SD) using RECIST v1.1.
Chi2 or Fisher's exact tests will be employed to explore whether there is an association between low or high mutations and DCR.
Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs).
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12 months
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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progression free survival (PFS), measured in months
時間枠：12 months
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PFS will be measured from start of treatment to date of progression or death from any cause.Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs).
The PFS will be estimated using the Kaplan-Meier method and survival curves will be generated for each group.
The log-rank test will be used to compare the survival curves and a Cox proportional hazards model will be fitted to obtain hazard ratios (HRs) and 95% CIs.
The proportional hazards assumption will be tested with the use of Schoenfeld residuals
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12 months
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overall survival (OS), measured in months
時間枠：12 months
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OS will be defined as time from start of treatment to death of any cause.
Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs).
The OS will be estimated using the Kaplan-Meier method and survival curves will be generated for each group.
The log-rank test will be used to compare the survival curves and a Cox proportional hazards model will be fitted to obtain hazard ratios (HRs) and 95% CIs.
The proportional hazards assumption will be tested with the use of Schoenfeld residuals
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12 months
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Median values of volume transfer constant (Ktrans) and enhancing fraction (EF) and their product KEF (product of summarised median values of Ktrans x EF/100) will be compared at baseline and on day 15
時間枠：15 days
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Dynamic contrast enhance magnetic resonance imaging (DCE-MRI) will be performed pre-treatment and at day 15.
KEF changes of more than 70% between the two time points will be considered significant and patients will be thus stratified in two groups, i.e.
A) drop in KEF of >70% and B) less than 70% drop in KEF.
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15 days
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協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
協力者
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2015年1月1日
一次修了 (実際)
2017年1月1日
研究の完了 (実際)
2017年7月1日
試験登録日
最初に提出
2015年1月6日
QC基準を満たした最初の提出物
2017年1月4日
最初の投稿 (見積もり)
2017年1月5日
学習記録の更新
投稿された最後の更新 (実際)
2021年5月3日
QC基準を満たした最後の更新が送信されました
2021年4月30日
最終確認日
2017年1月1日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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