Full Text View  
  Tabular View  
  Contacts and Locations  
  No Study Results Posted  
  Related Studies  
Second-Line Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Metastatic Colorectal Cancer Who Have Received First-Line Chemotherapy and Bevacizumab
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
Sponsored by: Gruppo Oncologico del Nord-Ovest
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00720512
  Purpose

RATIONALE: Drugs used in chemotherapy, such as irinotecan, oxaliplatin, leucovorin, and fluorouracil, 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 bevacizumab, 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 combination chemotherapy is more effective with or without bevacizumab in treating metastatic colorectal cancer.

PURPOSE: This randomized phase III trial is studying second-line combination chemotherapy to see how well it works compared with or without bevacizumab in treating patients with metastatic colorectal cancer who have received first-line chemotherapy and bevacizumab.


Condition Intervention Phase
Colorectal Cancer
Drug: bevacizumab
Drug: fluorouracil
Drug: irinotecan hydrochloride
Drug: leucovorin calcium
Drug: oxaliplatin
Phase III

MedlinePlus related topics: Cancer Colorectal Cancer
Drug Information available for: Leucovorin Calcium Citrovorum factor Folinic acid calcium salt pentahydrate Leucovorin Irinotecan Irinotecan hydrochloride Bevacizumab Fluorouracil Oxaliplatin Calcium gluconate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Open Label
Official Title: AN OPEN-LABEL, MULTICENTER, RANDOMIZED PHASE III STUDY OF SECOND-LINE CHEMOTHERAPY WITH OR WITHOUT BEVACIZUMAB IN METASTATIC COLORECTAL CANCER PATIENTS WHO HAVE RECEIVED FIRST-LINE CHEMOTHERAPY PLUS BEVACIZUMAB.

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Progression-free survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]
  • Response rate [ Designated as safety issue: No ]
  • Safety [ Designated as safety issue: Yes ]

Estimated Enrollment: 262
Study Start Date: June 2008
Arms Assigned Interventions
Arm I: Active Comparator
Patients receive either irinotecan hydrochloride over 1 hour or oxaliplatin over 1 hour on day 1. Patients also receive leucovorin calcium IV over 2 hours and fluorouracil IV over 46 hours continuously beginning on day 1. Treatment repeats every 2 weeks for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Drug: fluorouracil
Given IV
Drug: irinotecan hydrochloride
Given IV
Drug: leucovorin calcium
Given IV
Drug: oxaliplatin
Given IV
Arm II: Experimental
Patients receive combination chemotherapy as in arm I and bevacizumab IV on day 1. Treatment repeats every 2 weeks for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Drug: bevacizumab
Given IV
Drug: fluorouracil
Given IV
Drug: irinotecan hydrochloride
Given IV
Drug: leucovorin calcium
Given IV
Drug: oxaliplatin
Given IV

Detailed Description:

OBJECTIVES:

Primary

  • To compare the progression-free survival of second-line chemotherapy with or without bevacizumab in patients with metastatic colorectal cancer who have received first-line chemotherapy with bevacizumab.

Secondary

  • To compare the overall survival, response rate, and safety profile of second-line chemotherapy of these regimens in these patients.
  • To conduct pharmacogenomics assessment of candidate variants in the VEGF gene and evaluate their association with progression-free survival and other study outcomes.

OUTLINE: This is a multicenter study. Patients are stratified according to participating center, ECOG performance status (0 vs 1-2), disease-free interval from the last administration of first-line chemotherapy for metastatic disease (≤ 3 months vs > 3 months), and type of second-line chemotherapy (irinotecan hydrochloride, leucovorin calcium, and fluorouracil [FOLFIRI] vs oxaliplatin, leucovorin calcium, and fluorouracil [mFOLFOX-6]). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive either irinotecan hydrochloride over 1 hour or oxaliplatin over 1 hour on day 1. Patients also receive leucovorin calcium IV over 2 hours and fluorouracil IV over 46 hours continuously beginning on day 1.
  • Arm II: Patients receive combination chemotherapy as in arm I and bevacizumab IV on day 1.

Treatment in both arms repeats every 2 weeks for up to 12 courses in the absence of disease progression or unacceptable toxicity.

Existing formalin-fixed paraffin-embedded tumor tissue samples are assessed for pharmacogenomics and markers predictive of response, resistance to, or toxicity from bevacizumab. Samples are analyzed via RT-PCR, array comparative genomic hybridization, fluorescence in situ hybridization, sequencing of candidate genes, and immunohistochemistry.

After completion of study treatment, patients are followed for 1 year.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed colorectal adenocarcinoma

    • Metastatic or unresectable disease
  • Progressive disease based on the following criteria:

    • Progression during or after first-line chemotherapy for metastatic disease, including any of the following:

      • Fluoropyrimidine-based monotherapy with bevacizumab
      • Fluoropyrimidine and irinotecan hydrochloride-based doublet with bevacizumab
      • Fluoropyrimidine and oxaliplatin-based doublet with bevacizumab
    • Progression after more than 3 months from the last administration of first-line chemotherapy for metastatic disease with a fluoropyrimidine, irinotecan hydrochloride, and oxaliplatin triplet (FOLFOXIRI) with bevacizumab to which the patient had previously responded
  • Measurable disease, as assessed by RECIST criteria
  • No prior or concurrent CNS metastasis

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy > 3 months
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9 g/dL
  • INR ≤ 1.5 times upper limit of normal (ULN)
  • aPTT ≤ 1.5 ULN
  • Serum bilirubin ≤ 1.5 times ULN
  • AST and ALT ≤ 2.5 times ULN (< 5 times ULN if liver metastases present)
  • Alkaline phosphatase ≤ 2.5 times ULN (< 5 times ULN if liver metastases present)
  • Serum creatinine ≤ 1.5 times ULN
  • Proteinuria < 2+ OR protein ≤ 1g by 24-hour urine
  • Not pregnant or nursing
  • Fertile patients must use effective contraception
  • No bowel obstruction or subobstruction
  • No history of inflammatory enteropathy
  • No prior extensive intestinal resection (i.e., > hemicolectomy or extensive small intestine resection with chronic diarrhea)
  • No symptomatic peripheral neuropathy > grade 2
  • No active uncontrolled infection
  • No active disseminated intravascular coagulation
  • No prior or concurrent malignancy, except for curatively treated basal cell and squamous cell carcinoma of the skin, or in situ carcinoma of the cervix
  • No clinically significant cardiovascular disease, including any of the following:

    • Cerebrovascular accident within the past 6 months
    • Myocardial infarction within the past 6 months
    • Unstable angina
    • NYHA class II-IV chronic heart failure
    • Uncontrolled arrhythmia
  • No uncontrolled hypertension
  • No thromboembolic or hemorrhagic events within the past 6 months
  • No evidence of bleeding diathesis or coagulopathy
  • No serious, non healing wound/ulcer or serious bone fracture
  • No significant traumatic injury within the past 28 days

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 6 weeks since prior radiotherapy
  • At least 4 weeks since prior surgery
  • No prior first-line chemotherapy for metastatic disease without bevacizumab
  • No prior cetuximab or other investigational agents
  • More than 28 days since prior open biopsy
  • More than 28 days since prior and no concurrent major surgical procedure
  • No concurrent therapeutic anticoagulation, antiplatelet agents, or NSAID with anti-platelet activity

    • Acetylsalicylic acid ≤ 325 mg/day allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00720512

Locations
Italy
Presidio Ospedaliero di Livorno Recruiting
Livorno, Italy, 57100
Contact: Contact Person     39-058-622-3189        
Sponsors and Collaborators
Gruppo Oncologico del Nord-Ovest
Investigators
Principal Investigator: Alfredo Falcone, MD Presidio Ospedaliero di Livorno
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000598567, GONO-BEBYP-ASL607LIOM03, GONO-AIFA - FARM5C4FB4, EUDRACT:2007-002886-11
Study First Received: July 19, 2008
Last Updated: December 16, 2008
ClinicalTrials.gov Identifier: NCT00720512  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
adenocarcinoma of the colon
adenocarcinoma of the rectum
recurrent colon cancer
recurrent rectal cancer
stage IV colon cancer
stage IV rectal cancer
stage III rectal cancer
stage III colon cancer

Study placed in the following topic categories:
Digestive System Neoplasms
Rectal Neoplasms
Gastrointestinal Diseases
Irinotecan
Colonic Diseases
Leucovorin
Bevacizumab
Intestinal Diseases
Rectal Diseases
Camptothecin
Recurrence
Intestinal Neoplasms
Rectal neoplasm
Calcium, Dietary
Oxaliplatin
Digestive System Diseases
Fluorouracil
Gastrointestinal Neoplasms
Adenocarcinoma
Rectal cancer
Colorectal Neoplasms

Additional relevant MeSH terms:
Antimetabolites
Antimetabolites, Antineoplastic
Vitamin B Complex
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Growth Substances
Physiological Effects of Drugs
Enzyme Inhibitors
Angiogenesis Inhibitors
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Vitamins
Growth Inhibitors
Angiogenesis Modulating Agents
Micronutrients
Antineoplastic Agents, Phytogenic

ClinicalTrials.gov processed this record on January 16, 2009