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Bevacizumab and Cetuximab With or Without Irinotecan in Treating Patients With Irinotecan-Refractory Metastatic Colorectal Cancer
This study has been completed.
Sponsors and Collaborators: Memorial Sloan-Kettering Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00077298
  Purpose

RATIONALE: Monoclonal antibodies such as cetuximab and bevacizumab can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or deliver cancer-killing substances to them. Drugs used in chemotherapy, such as irinotecan, also work in different ways to kill cancer cells or stop them from growing. Giving cetuximab and bevacizumab together with irinotecan may improve the ability to block cancer growth.

PURPOSE: This randomized phase II trial is studying giving bevacizumab and cetuximab together with irinotecan to see how well it works compared to giving bevacizumab and cetuximab alone in treating patients with irinotecan-refractory metastatic colorectal cancer.


Condition Intervention Phase
Colorectal Cancer
Drug: bevacizumab
Drug: cetuximab
Drug: irinotecan hydrochloride
Phase II

MedlinePlus related topics: Cancer Colorectal Cancer
Drug Information available for: Irinotecan Irinotecan hydrochloride Bevacizumab Cetuximab
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Active Control
Official Title: A Randomized Phase II Study Of Bevacizumab In Combination With Cetuximab Plus Irinotecan, Or In Combination With Cetuximab Alone, In Irinotecan Refractory Colorectal Cancer

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

Study Start Date: December 2003
Detailed Description:

OBJECTIVES:

  • Evaluate time to tumor progression in patients with irinotecan-refractory metastatic colorectal cancer treated with bevacizumab and cetuximab with or without irinotecan.
  • Evaluate objective response rate in patients treated with these regimens.
  • Evaluate overall survival of patients treated with these regimens.
  • Evaluate safety, tolerability, and adverse event profiles of these regimens in these patients.
  • Correlate a panel of molecular markers (e.g., those involved in the epidermal growth factor receptor signaling pathway, angiogenic pathway, and irinotecan metabolism) with clinical outcome in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to participating center, ECOG performance status (0 vs 1), and albumin (> 3.0 g/dL vs ≤ 3.0 g/dL). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive cetuximab IV over 1 hour on days 1, 8, 15, 22, 29, and 36; bevacizumab IV over 30-90 minutes on days 1*, 15, and 29 OR on days 1 and 22; and irinotecan IV over 30-90 minutes (at the same dose and schedule that the patient previously received) beginning on day 1.
  • Arm II: Patients receive cetuximab as in arm I and bevacizumab IV over 30-90 minutes on days 1*, 15, and 29.

NOTE: *Bevacizumab is given on day 2 (instead of day 1) of course 1, and is given on day 1 of subsequent courses.

In both arms, courses repeat every 6 weeks in the absence of disease progression or unacceptable toxicity.

Patients are followed for 3 years.

PROJECTED ACCRUAL: A total of 70 patients (35 per treatment arm) will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed colorectal cancer

    • Metastatic disease by diagnostic imaging studies
  • Measurable disease

    • At least 1 unidimensionally measurable lesion with minimum lesion size at least twice the slice thickness of the imaging study used
  • Refractory* to irinotecan, evidenced by clinical documentation

    • Received at least 1 prior irinotecan-containing chemotherapy regimen for metastatic disease and progressed during or within 6 weeks after completion of therapy NOTE: *Tumor marker (e.g., carcinoembryonic antigen [CEA]) elevation alone is not considered adequate evidence of treatment failure
  • Must have received prior irinotecan according to 1 of the following schedules:

    • Weekly administration with a starting dose of 100-125 mg/m^2
    • Biweekly administration (every other week) with a starting dose of approximately 180 mg/m^2
    • Once every three weekly administration with a starting dose of 300-350 mg/m^2
  • No known brain metastases
  • No prior primary CNS tumors

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-1 OR
  • Karnofsky 80-100%

Life expectancy

  • More than 3 months

Hematopoietic

  • WBC ≥ 3,000/mm^3
  • Absolute neutrophil count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9 g/dL
  • No bleeding diathesis or coagulopathy

Hepatic

  • Bilirubin normal
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN in the presence of known liver metastases)
  • INR < 1.5 (for patients receiving warfarin)

Renal

  • Creatinine ≤ ULN OR
  • Creatinine clearance ≥ 60 mL/min
  • No proteinuria* NOTE: *Patients with ≥ 1+ proteinuria at baseline must have protein < 500 mg/24-hour urine collection

Cardiovascular

  • No prior stroke
  • No symptomatic congestive heart failure
  • No unstable angina pectoris
  • No uncontrolled hypertension
  • No clinically significant cardiac arrhythmia
  • None of the following arterial thromboembolic events within the past 6 months:

    • Myocardial infarction
    • Cerebrovascular accident
    • Transient ischemic attack
    • Unstable angina

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for at least 3 months after study participation
  • No significant traumatic injury within the past 28 days
  • No grade 3 or greater neurotoxicity
  • No uncontrolled seizures
  • No prior allergic reactions attributed to compounds of similar chemical or biological composition to study agents
  • No prior irinotecan intolerance
  • No ongoing or active infection requiring parenteral antibiotics
  • No serious nonhealing active wound, ulcer, or bone fracture
  • No psychiatric illness or social situation that would preclude study compliance
  • No other concurrent uncontrolled illness that would preclude study participation
  • No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • No prior cetuximab
  • No other prior epidermal growth factor receptor-directed therapy
  • No prior anticancer murine or chimeric monoclonal antibody therapy

    • Prior humanized monoclonal antibody therapy allowed
  • No prior bevacizumab
  • No other prior vascular endothelial growth factor-targeted therapy

Chemotherapy

  • See Disease Characteristics
  • More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)

Endocrine therapy

  • Not specified

Radiotherapy

  • More than 4 weeks since prior radiotherapy

Surgery

  • More than 28 days since prior major surgical procedure or open biopsy

Other

  • Recovered from all prior therapy
  • Any number of prior standard or investigational regimens allowed
  • No other concurrent investigational agents
  • No other concurrent anticancer therapy
  • No recent or concurrent thrombolytic agents
  • No recent or concurrent full-dose warfarin except as required to maintain patency of preexisting, permanent indwelling IV catheters
  • No concurrent therapeutic heparin

    • Concurrent prophylactic low-molecular weight heparin allowed
  • No concurrent chronic daily aspirin (> 325 mg/day)
  • No concurrent nonsteroidal anti-inflammatory medications known to inhibit platelet function
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00077298

Locations
United States, California
City of Hope Comprehensive Cancer Center
Duarte, California, United States, 91010-3000
University of California Davis Cancer Center
Sacramento, California, United States, 95817
USC/Norris Comprehensive Cancer Center and Hospital
Los Angeles, California, United States, 90033
United States, Illinois
University of Chicago Cancer Research Center
Chicago, Illinois, United States, 60637-1470
United States, New York
Memorial Sloan-Kettering Cancer Center
New York, New York, United States, 10021
New York Weill Cornell Cancer Center at Cornell University
New York, New York, United States, 10021
NYU School of Medicine's Kaplan Comprehensive Cancer Center
New York, New York, United States, 10016
United States, Pennsylvania
Hillman Cancer Center at University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania, United States, 15232
United States, Texas
MD Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
Sponsors and Collaborators
Memorial Sloan-Kettering Cancer Center
Investigators
Study Chair: Leonard B. Saltz, MD Memorial Sloan-Kettering Cancer Center
  More Information

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

Publications of Results:
Study ID Numbers: CDR0000350086, MSKCC-03135, NCI-6444
Study First Received: February 10, 2004
Last Updated: July 23, 2008
ClinicalTrials.gov Identifier: NCT00077298  
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
stage IV colon cancer
stage IV rectal cancer
recurrent colon cancer
recurrent rectal cancer

Study placed in the following topic categories:
Digestive System Neoplasms
Rectal Neoplasms
Gastrointestinal Diseases
Cetuximab
Irinotecan
Colonic Diseases
Bevacizumab
Intestinal Diseases
Rectal Diseases
Camptothecin
Recurrence
Intestinal Neoplasms
Rectal neoplasm
Digestive System Diseases
Gastrointestinal Neoplasms
Rectal cancer
Colorectal Neoplasms

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Growth Substances
Physiological Effects of Drugs
Enzyme Inhibitors
Angiogenesis Inhibitors
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Angiogenesis Modulating Agents
Growth Inhibitors
Antineoplastic Agents, Phytogenic

ClinicalTrials.gov processed this record on January 15, 2009