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Irinotecan Hydrochloride With FOLFIRI and Cetuximab as First-Line Therapy in Treating Patients With RAS Wild-Type Colorectal Cancer

8 december 2016 uppdaterad av: University of Chicago

A UGT1A1 Genotype-Guided Dosing Study of Irinotecan Administered in Combination With 5-Fluorouracil/Leucovorin (FOLFIRI) and Cetuximab as First-Line Therapy in RAS Wild-Type Metastatic Colorectal Cancer Patients

This phase I trial studies the side effects and the best dose of irinotecan hydrochloride, based on a genetic test, when given in combination with fluorouracil, leucovorin calcium, and cetuximab as first-line therapy in treating patients with an abnormal gene called RAS wild-type that has spread to other parts of the body (metastatic). Patients may also have a gene called uridine diphosphate glucuronosyltransferase (UGT1A1) that may interfere with the way irinotecan hydrochloride is absorbed by the body and may not be able to tolerate it. Determining the presence of this gene may help determine the best dose of irinotecan hydrochloride when given with fluorouracil and leucovorin calcium (FOLFIRI). Combination chemotherapy, such as FOLFIRI, works 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. Cetuximab may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving FOLFIRI together with cetuximab may be a better treatment for patients with colorectal cancer.

Studieöversikt

Status

Indragen

Betingelser

Intervention / Behandling

Detaljerad beskrivning

PRIMARY OBJECTIVES:

I. To define the maximum tolerated dose (MTD), the dose limiting toxicity (DLT) and the phase II recommended dosage of irinotecan (irinotecan hydrochloride) administered in the FOLFIRI regimen plus cetuximab in metastatic colorectal cancer (mCRC) patients with *1/*1 and *1/*28 uridine diphosphate glucuronosyltransferase (UGT1A1) genotype treated as first line chemotherapy.

SECONDARY OBJECTIVE:

To estimate the response rate, progression-free survival (PFS) and metastasectomy (with curative intent) rate in the overall patient population (both genotype cohorts).

OTHER OBJECTIVES:

I. To evaluate the variability of irinotecan pharmacokinetics, in combination with cetuximab, in patients with *1/*1 and *1/*28 genotype and the effect of the pharmacokinetic profile on toxicity and response rate.

II. To evaluate the pharmacokinetic profile of irinotecan and its major metabolites in the absence and the presence of cetuximab administration, in order to define the effect of the chimeric monoclonal antibody on irinotecan pharmacokinetics.

OUTLINE: This is a dose-escalation study of irinotecan hydrochloride in patients with UGT1A1.

Patients receive irinotecan hydrochloride intravenously (IV) over 1-2 hours, fluorouracil IV continuously over 46 hours, and leucovorin calcium IV on days 1 and 15. Patients also receive cetuximab IV over 2 hours on days 3 and 15 of course 1 and days 1 and 15 of all subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Studietyp

Interventionell

Fas

  • Fas 1

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Italien
      • Aviano, Italien, 33081
        • Centro Di Riferimento Oncologico

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Histologically or cytologically confirmed diagnosis of mCRC
  • RAS wild-type status (by a Clinical Laboratory Improvement Amendments [CLIA] certified assay that includes all known mutations in Kirsten rat sarcoma viral oncogene homolog [KRAS], Harvey rat sarcoma viral oncogene homolog [HRAS], and neuroblastoma RAS viral (v-ras) oncogene homolog [NRAS])
  • No prior chemotherapy for metastatic disease
  • Able to understand and provide written informed consent
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  • Life expectancy > 3 months
  • Measurable or evaluable disease defined by Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) criteria, i.e. lesions that can be accurately measured in at least one dimension with the longest diameter >= 20 mm using conventional techniques or >= 10 mm using spiral computed tomography (CT) scan
  • Absolute neutrophil count (ANC) > l500/ul
  • Hemoglobin > 9g/dL
  • Platelets > 100,000/ul
  • Total bilirubin =< 1.5 times upper limit of normal
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times upper limit of normal
  • Alkaline phosphatase < 2.5 times the upper limit of normal, unless bone metastasis is present in the absence of liver metastasis
  • Creatinine < 1.5 mg/dL
  • Patients genotyped for UGT1A1*28 polymorphism with *1/*1 or *1/*28 genotype
  • Men and women of childbearing potential must agree to use adequate contraception (double barrier birth control) for the duration of study therapy
  • Negative serum or urine beta-human chorionic gonadotropin (hCG) pregnancy test at screening for patients of childbearing potential

Exclusion Criteria:

  • Patients with both variant alleles (*28/*28)
  • Patients with any polymorphism in UGT1A1 other than *1 or *28 (e.g, *6)
  • Uncontrolled or severe cardiovascular disease, including myocardial infarct or unstable angina within 6 months prior to study treatment, New York Heart Association (NYHA) class II or greater congestive heart failure, serious arrhythmias requiring medication for treatment, clinically significant pericardial disease or cardiac amyloidosis
  • Patients with specific contraindications to the use of anti-EGFR therapy such as pulmonary fibrosis, interstitial pneumonia history
  • Unresolved diarrhea and bowel obstruction
  • Active bleeding
  • Documented cerebral metastasis
  • Serious active infectious disease
  • Pregnancy
  • Radiotherapy or major surgery within 4 weeks
  • Psychiatric illness or social situations that would limit compliance with study requirements
  • Presence of previous or concomitant neoplasm with exclusion of in situ cervical cancer
  • Patients taking substrates, inhibitors and inducers of CYP3A4 should be encouraged to switch to alternative drugs whenever possible, given the potential for drug-drug interactions with irinotecan

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: N/A
  • Interventionsmodell: Enskild gruppuppgift
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Treatment (FOLFIRI and cetuximab)
Patients receive irinotecan hydrochloride IV over 1-2 hours, fluorouracil IV continuously over 46 hours, and leucovorin calcium IV on days 1 and 15. Patients also receive cetuximab IV over 2 hours on days 3 and 15 of course 1 and days 1 and 15 of all subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Läkemedel: Fluorouracil
Givet IV
Andra namn:
  • 5-FU
  • 5-Fluorouracil
Läkemedel: Leucovorin Kalcium
Givet IV
Andra namn:
  • Wellcovorin
  • Kalcifolin
Biologisk: Cetuximab
Givet IV
Andra namn:
  • Erbitux
  • Chimär anti-EGFR monoklonal antikropp
  • Chimerisk MoAb C225
Läkemedel: Irinotekanhydroklorid
Givet IV
Andra namn:
  • Camptosar
  • Camptothecin 11

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Maximum Tolerated Dose (MTD)
Tidsram: 28 days
The MTD recommended for phase II studies will be defined as the dose level immediately below the one at which 1 out of 3 patients or 1 out of 6 patients experienced DLT. Therefore at the MTD, 1/3 out of at least 10 patients experienced DLT. No intra-patient dose escalation is allowed. There will be two genotype cohorts of patients: one for each genotype. The cumulative hematological and non-hematological toxicities as well as the number of dose reductions and a delay in starting the next cycle of treatment will be used as secondary indicators to differentiate the two genotype cohorts of patients. Patients can continue receiving the same dose of irinotecan in the absence of major toxicity if before retreatment they fully recover from any non-hematological toxicity, absolute neutrophil count is 1500 microliters and platelet count is 100,000 microliters. Chemotherapy is discontinued on evidence of disease progression by RECIST version 1.1.
28 days

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Response rate
Tidsram: Every 2 cycles (every 8 weeks), from the beginning of the study until disease progression or death, which ever comes first (up to on average 60 months)
Response rate is the number of patients with a partial response (by RECIST version 1.1) divided by the total number of patients.
Every 2 cycles (every 8 weeks), from the beginning of the study until disease progression or death, which ever comes first (up to on average 60 months)
Progression-free survival (PFS)
Tidsram: From beginning of the study until disease progression or death, which every comes first (up to on average 60 months)
PFS is the time (in days) between study enrollment and disease progression (by RECIST version 1.1) or death, whichever comes first.
From beginning of the study until disease progression or death, which every comes first (up to on average 60 months)
metastectomy (with curative intent) rate
Tidsram: Within 1 year of starting therapy
Metastatectomy rate is the number of patients who undergo a surgical resection with curative intent divided by the total number of patients
Within 1 year of starting therapy

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Chicago

Samarbetspartners

National Cancer Institute (NCI)

Utredare

  • Huvudutredare: Manish Sharma, University of Chicago Comprehensive Cancer Center

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juni 2015

Primärt slutförande (Faktisk)

1 augusti 2016

Avslutad studie (Faktisk)

1 augusti 2016

Studieregistreringsdatum

Först inskickad

21 september 2015

Först inskickad som uppfyllde QC-kriterierna

7 oktober 2015

Första postat (Uppskatta)

9 oktober 2015

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

9 december 2016

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

8 december 2016

Senast verifierad

1 december 2016

Mer information

Termer relaterade till denna studie

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • IRB15-0081 (Annan identifierare: University of Chicago Comprehensive Cancer Center)
  • P30CA014599 (U.S.S. NIH-anslag/kontrakt)
  • NCI-2015-01432 (Registeridentifierare: CTRP (Clinical Trial Reporting Program))

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

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