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Cetuximab With or Without Brivanib in Treating Patients With Metastatic Colorectal Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), April 2009
First Received: March 20, 2008   Last Updated: April 29, 2009   History of Changes
Sponsored by: NCIC Clinical Trials Group
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00640471
  Purpose

RATIONALE: Brivanib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Monoclonal antibodies, such as cetuximab, 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 giving brivanib together with cetuximab is more effective than cetuximab alone in treating patients with metastatic colorectal cancer.

PURPOSE: This randomized phase III trial is studying cetuximab to see how well it works compared with cetuximab given together with brivanib in treating patients with metastatic colorectal cancer.


Condition Intervention Phase
Colorectal Cancer
Biological: cetuximab
Drug: brivanib alaninate
Other: laboratory biomarker analysis
Phase III

Study Type: Interventional
Study Design: Treatment, Randomized, Double-Blind, Placebo Control
Official Title: A Phase III Randomized Study of Brivanib Alaninate (BMS-582664) in Combination With Cetuximab (Erbitux®) Versus Placebo in Combination With Cetuximab (Erbitux®) in Patients Previously Treated With Combination Chemotherapy for Metastatic Colorectal Carcinoma

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Progression-free survival [ Designated as safety issue: No ]
  • Objective response rate [ Designated as safety issue: No ]
  • Duration of response [ Designated as safety issue: No ]
  • Quality of life (using EORTC QLQ-C30 and Skindex-16 Dermatology Survey) [ Designated as safety issue: No ]
  • Health utilities (using HUI3 Health Utilities Index) [ Designated as safety issue: No ]
  • Economic evaluation [ Designated as safety issue: No ]
  • Safety profile [ Designated as safety issue: Yes ]
  • Molecular markers [ Designated as safety issue: No ]

Estimated Enrollment: 750
Study Start Date: May 2008
Estimated Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To compare the overall survival of patients with previously treated metastatic colorectal carcinoma treated with brivanib alaninate in combination with cetuximab versus placebo in combination with cetuximab.

Secondary

  • To compare the progression-free survival of these patients.
  • To compare the objective response rate and duration of response in these patients.
  • To compare the quality of life of these patients.
  • To compare the health utilities of these patients.
  • To conduct a comparative economic evaluation of these patients.
  • To evaluate the safety profile of this regimen in these patients.
  • To explore an association between FGF-2, K-RAS mutations, amphiregulin (AREG) and epiregulin (EREG) as determined from paraffin embedded tumor specimens and the potential for clinical benefit from the addition of brivanib alaninate or placebo to cetuximab in terms of overall survival, progression-free survival and objective response rate compared to cetuximab alone.
  • To explore an association with changes of Collagen IV in the blood and the potential for clinical benefit from the addition of brivanib alaninate to cetuximab in terms of overall survival, progression-free survival and objective response rate compared to cetuximab alone.
  • To establish a comprehensive tumor bank linked to a clinical database for the further study of molecular markers in colorectal cancer.

OUTLINE: This is a multicenter study. Patients are stratified according to participating center and ECOG performance status (0-1 vs 2). Patients are randomized to 1 of 2 arms.

  • Arm I: Patients receive oral brivanib alaninate once daily and cetuximab IV over 60-120 minutes once weekly.
  • Arm II: Patients receive oral placebo once daily and cetuximab IV over 60-120 minutes once weekly.

In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.

Tumor tissue and blood samples are collected for correlative studies. Samples are analyzed for biomarker levels (Collagen IV, FGF-2, and epiregulin, amphiregulin, and K-ras mutations status) and correlation with response.

After completion of study treatment, patients are followed at 4 weeks and then every 8 weeks thereafter.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed primary colorectal cancer

    • Metastatic disease
  • Must have received a prior thymidylate synthase inhibitor (e.g., fluorouracil, capecitabine, raltitrexed, or tegafur-uracil) for adjuvant and/or metastatic disease

    • Thymidylate synthase inhibitor may have been given in combination with oxaliplatin or irinotecan hydrochloride
  • Must meet one of the following criteria:

    • Received and failed* an irinotecan hydrochloride-containing regimen (i.e., single-agent or in combination) for treatment of metastatic disease
    • Relapsed within 6 months of completion of an irinotecan hydrochloride-containing adjuvant therapy
    • Has documented unsuitability** for an irinotecan hydrochloride-containing regimen NOTE: *Failure is defined as either progression of disease or intolerance to the irinotecan-containing regimen, where intolerance is defined as discontinuation due to any of the following: severe allergic reaction or delayed recovery from toxicity preventing retreatment

NOTE: **Documented unsuitability for irinotecan includes known hypersensitivity to irinotecan, abnormal glucuronidation of bilirubin, Gilbert's syndrome, previous pelvic/abdominal irradiation, or elderly with comorbid conditions

  • Must meet one of the following:

    • Received and failed* an oxaliplatin-containing regimen (i.e. single-agent or in combination) for treatment of metastatic disease
    • Relapsed within 6 months of completion of an oxaliplatin containing adjuvant therapy
    • Has documented unsuitability** for an oxaliplatin-containing regimen NOTE: *Failure is defined as either progression of disease or intolerance to the oxaliplatin-containing regimen, where intolerance is defined as discontinuation due to any of the following: severe allergic reaction, persistent severe neurotoxicity or delayed recovery from toxicity preventing retreatment

NOTE: **Documented unsuitability for oxaliplatin includes known hypersensitivity to oxaliplatin or other platinum compounds, pre-existing renal impairment, or Grade 2 or greater neurosensory neuropathy

  • Measurable or evaluable disease
  • Patient must consent to provision of, and investigator(s) must confirm access to and agree to submit at the request of the NCIC CTG Central Tumor Bank, a representative formalin fixed paraffin block of tumour tissue
  • Patient must consent to provision of a sample of blood
  • No symptomatic CNS metastases

    • Patients with signs or symptoms suggestive of brain metastasis are not eligible unless brain metastases are ruled out by CT or MRI scans

PATIENT CHARACTERISTICS:

Inclusion criteria:

  • ECOG performance status 0-2
  • Absolute granulocyte count ≥ 1.5 x 10^9/L
  • Platelet count ≥ 75 x 10^9/L
  • Hemoglobin ≥ 80 g/L
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN) (2.0 times ULN with documented liver metastases)
  • ALT and AST ≤ 2.5 times ULN (5.0 times ULN with documented liver metastases)
  • Serum creatinine ≤ 1.5 times ULN or creatinine clearance > 50 mL/min
  • Magnesium > 0.5 mmol/L (1.2 mg/dL)
  • LVEF > 45% by ECHO or MUGA scan
  • No proteinuria ≥ 2+ on dipstick or ≥ 1 g on 24 hour urine collection
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception prior to, during, and for 12 weeks after completion of study treatment
  • Able (i.e., sufficiently fluent) and willing to complete the quality of life (EORTC QLQ-C30 and Skindex-16) and health utilities questionnaires (HUI3) in either English or French

Exclusion criteria:

  • A history of other malignancies, except: adequately treated nonmelanoma skin cancer, curatively treated in situ cancer of the cervix, or other solid tumors curatively treated with no evidence of disease for ≥ 5 years
  • Any active disease condition which would render the protocol treatment dangerous or impair the ability of the patient to receive protocol therapy
  • Any condition (e.g., psychological, geographical, etc.) that does not permit compliance with the protocol
  • Uncontrolled or significant cardiovascular disease including any of the following:

    • Myocardial infarction within 12 months
    • Uncontrolled angina within 6 months
    • Clinically significant congestive heart failure
    • Stroke, transient ischemic attack, or other ischemic event within 12 months
    • Severe cardiac valve dysfunction
  • Uncontrolled hypertension (consistent elevation of systolic BP > 150 and diastolic BP > 100 mmHg)
  • History of a thromboembolic event in the last 6 months despite being treated with anticoagulation

    • Patients are eligible if they have experienced a thromboembolic event greater than 6 months previously and have initiated and are stable on anticoagulation or if they have previously initiated and are stable on anticoagulation for prevention of thromboembolic events
  • Severe restrictive lung disease or radiological pulmonary findings of "interstitial lung disease" on the baseline chest x-ray which, in the opinion of the investigator, represents significant pathology
  • Serious non-healing wounds, ulcers, or bone fractures
  • History of allergy to brivanib (alaninate or related drug class

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Adequately recovered from recent surgery, chemotherapy and/or radiation therapy
  • At least 4 weeks must have elapsed from major surgery, prior chemotherapy, prior treatment with an investigational agent or prior radiation therapy
  • No prior cetuximab or other therapy* with targets the EGFR pathway (e.g., erlotinib hydrochloride, gefitinib hydrochloride, panitumumab)
  • May have received a single prior regimen which targets the VEGFR pathway (e.g., bevacizumab , vatalanib, AZD2171, sorafenib tosylate, sunitinib malate, or others)
  • No prior murine monoclonal antibody therapy (e.g., edrecolomab)
  • No other concurrent chemotherapy
  • No other concurrent therapies targeting the EGFR pathway (e.g., erlotinib, gefitinib, panitumumab, or others) or other therapies targeting the VEGFR pathway (e.g., bevacizumab , vatalanib, AZD2171, sorafenib tosylate, sunitinib malate, or others)
  • Concurrent antihypertensive therapies allowed
  • Concurrent aspirin allowed
  • No other concurrent noncytotoxic experimental agents
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00640471

Locations
Canada, Alberta
Cross Cancer Institute at University of Alberta Recruiting
Edmonton, Alberta, Canada, T6G 1Z2
Contact: Heather-Jane Au     780-432-8762        
Tom Baker Cancer Centre - Calgary Recruiting
Calgary, Alberta, Canada, T2N 4N2
Contact: Patricia Tang     403-521-3490        
Canada, British Columbia
BCCA - Fraser Valley Cancer Centre Recruiting
Surrey, British Columbia, Canada, V3V 1Z2
Contact: Balvindar S. Johal     604-930-2098        
British Columbia Cancer Agency - Centre for the Southern Interior Recruiting
Kelowna, British Columbia, Canada, V1Y 5L3
Contact: Sanjay Chandar Rao     250-712-3930        
British Columbia Cancer Agency - Vancouver Cancer Centre Recruiting
Vancouver, British Columbia, Canada, V5Z 4E6
Contact: Hagen Kennecke     604-877-6000        
Canada, New Brunswick
Doctor Leon Richard Oncology Centre Recruiting
Moncton, New Brunswick, Canada, E1C 8X3
Contact: Pierre Whitlock     506-862-4030        
Moncton Hospital Recruiting
Moncton, New Brunswick, Canada, E1C 6Z8
Contact: Asif Shaikh     506-860-2269        
Canada, Newfoundland and Labrador
Doctor H. Bliss Murphy Cancer Centre Recruiting
St. John's, Newfoundland and Labrador, Canada, AIB 3V6
Contact: Muhammad Zulfiqar     709-777-7802        
Canada, Ontario
Algoma District Cancer Program at Sault Area Hospital Recruiting
Sault Ste. Marie, Ontario, Canada, P6A 2C4
Contact: Bruce D. Keith     705-759-3434        
Cancer Care Program at Thunder Bay Regional Health Sciences Recruiting
Thunder Bay, Ontario, Canada, P7B 6V4
Contact: Dorie-Anna Dueck     807-684-7204        
Carlo Fidani Peel Regional Cancer Centre at Credit Valley Hospital Recruiting
Mississauga, Ontario, Canada, L5M 2N1
Contact: Sudha Rajagopal     905-813-1100        
Grand River Regional Cancer Centre at Grand River Hospital Recruiting
Kitchener, Ontario, Canada, N2G 1G3
Contact: Gregory J. Knight     519-749-4378        
Northeastern Ontario Regional Cancer Centre Recruiting
Sudbury, Ontario, Canada, P3E 5J1
Contact: Jonathan Noble     705-522-6237        
Ottawa Hospital Regional Cancer Centre - General Campus Recruiting
Ottawa, Ontario, Canada, K1H 8L6
Contact: Derek Jonker     613-737-7700        
Princess Margaret Hospital Recruiting
Toronto, Ontario, Canada, M5G 2M9
Contact: Lillian Siu     416-946-2911        
R. S. McLaughlin Durham Regional Cancer Centre at Lakeridge Health Oshawa Recruiting
Oshawa, Ontario, Canada, L1G 2B9
Contact: Rafal Wierzbicki     905-576-8711        
St. Catharines General Hospital at Niagara Health System Recruiting
St. Catharines, Ontario, Canada, L2R 7C6
Contact: Brian Findlay     905-684-7271        
Southlake Regional Health Centre Recruiting
Newmarket, Ontario, Canada, L3Y 2P9
Contact: Janet A. MacKinnon     905-895-4521        
Royal Victoria Hospital of Barrie Recruiting
Barrie, Ontario, Canada, L4M 6M2
Contact: Robert El-Maraghi     705-728-9090        
Toronto East General Hospital Recruiting
Toronto, Ontario, Canada, M4C 3E7
Contact: Richard H-F Shao     416-469-6580        
Canada, Quebec
Centre Hospitalier Universitaire de Quebec Recruiting
Quebec City, Quebec, Canada, G1R 2J6
Contact: Felix Couture     418-691-5225        
Hopital du Saint-Sacrement - Quebec Recruiting
Quebec City, Quebec, Canada, G1S 4L8
Contact: Catherine Doyle     418-649-5726        
Hopital Notre-Dame du CHUM Recruiting
Montreal, Quebec, Canada, H2L 4M1
Contact: Danielle Charpentier     514-890-8200        
Canada, Saskatchewan
Allan Blair Cancer Centre at Pasqua Hospital Recruiting
Regina, Saskatchewan, Canada, S4T 7T1
Contact: Muhammad Salim     306-766-2691        
Saskatoon Cancer Centre at the University of Saskatchewan Recruiting
Saskatoon, Saskatchewan, Canada, S7N 4H4
Contact: Kamal Haider     306-655-2710        
Sponsors and Collaborators
NCIC Clinical Trials Group
Investigators
Study Chair: Lillian L. Siu, MD, FRCPC Princess Margaret Hospital, Canada
  More Information

Additional Information:
No publications provided

Study ID Numbers: CDR0000590316, CAN-NCIC-CO20, CAN-NCIC-CA182009
Study First Received: March 20, 2008
Last Updated: April 29, 2009
ClinicalTrials.gov Identifier: NCT00640471     History of Changes
Health Authority: Unspecified

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

Study placed in the following topic categories:
Digestive System Neoplasms
Rectal Neoplasms
Gastrointestinal Diseases
Cetuximab
Colonic Diseases
Rectal Neoplasm
Intestinal Diseases
Rectal Diseases
Recurrence
Intestinal Neoplasms
Carcinoma
Digestive System Diseases
Rectal Cancer
Gastrointestinal Neoplasms
Colorectal Neoplasms

Additional relevant MeSH terms:
Digestive System Neoplasms
Gastrointestinal Diseases
Antineoplastic Agents
Colonic Diseases
Cetuximab
Intestinal Diseases
Rectal Diseases
Pharmacologic Actions
Intestinal Neoplasms
Neoplasms
Neoplasms by Site
Digestive System Diseases
Therapeutic Uses
Gastrointestinal Neoplasms
Colorectal Neoplasms

ClinicalTrials.gov processed this record on September 10, 2009