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.
研究概览
地位
地位
完全的
干预/治疗
干预/治疗
详细说明
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.
研究类型
研究类型
观察性的
注册 (实际的)
注册
49
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
-
-
Surrey
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Carshalton、Surrey、英国、SM2 5PT
- The Royal Marsden NHS Foundation Trust London and Surrey
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-
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
取样方法
非概率样本
研究人群
Patients will be selected from the clinics and multi-disciplinary meetings, so long that they meet all the inclusion criteria and no exclusion criteria.
描述
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
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
团体/队列数
1
队列和干预
团体/队列团体/队列 |
干预/治疗干预/治疗 |
|---|---|
|
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.
其他名称：
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研究衡量的是什么？
主要结果指标
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
disease control rate (DCR), measured in months
大体时间：12 months
|
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
|
次要结果测量
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
progression free survival (PFS), measured in months
大体时间：12 months
|
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
|
12 months
|
|
overall survival (OS), measured in months
大体时间：12 months
|
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
大体时间：15 days
|
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.
|
15 days
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
学习开始
2015年1月1日
初级完成 (实际的)
初级完成
2017年1月1日
研究完成 (实际的)
研究完成
2017年7月1日
研究注册日期
首次提交
首次提交
2015年1月6日
首先提交符合 QC 标准的
首先提交符合 QC 标准的
2017年1月4日
首次发布 (估计)
首次发布
2017年1月5日
研究记录更新
最后更新发布 (实际的)
最后更新发布
2021年5月3日
上次提交的符合 QC 标准的更新
上次提交的符合 QC 标准的更新
2021年4月30日
最后验证
最后验证
2017年1月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
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-
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