A Phase II Study of Bevacizumab (Avastin™) and Erlotinib (Tarceva™) in Combination With FOLFOX for Patients With Untreated Metastatic Colorectal Cancer
- Eligible patients must have histologically or cytologically documented locally
advanced or metastatic colorectal cancer
- No prior chemotherapy treatment for advanced or metastatic colorectal cancer.
Patients may have received prior adjuvant chemotherapy or radiation with
radiosensitizing chemotherapy. The last course of adjuvant chemotherapy must have
concluded > 12 months prior to registration. Patients may not have previously
received irinotecan, oxaliplatin, antiangiogenesis agent, or EGFR inhibitor therapy
in either the adjuvant or metastatic setting. No concurrent use of additional
investigational agents (including up to 4 weeks prior to enrollment) is allowed while
participating in this study.
- Palliative radiation for metastatic disease is allowed, however at least 4 weeks must
elapse from last treatment to first cycle of therapy and patient must have fully
recovered from side effects of radiation therapy.
- Patients must have measurable disease
- Age > 18 years.
- ECOG Performance Score of 0-1.
- Patients should have completed any major surgery > 4 weeks from registration.
Patients must have completed any minor surgery (including CT or U/S guided biopsies)
> 7 days from registration. Patients must have fully recovered from the procedure.
(Insertion of a vascular access device is not considered major or minor surgery).
- Adequate bone marrow as evidenced by: *Absolute neutrophil count > 1,500/mL;
*Platelet count > 100,000/mL
- Adequate renal function as evidenced by serum creatinine < 1.5 mg/dL
- Adequate hepatic function as evidenced by: *Serum total bilirubin < 1.5 mg/dL;
*Alkaline phosphatase < 3X the ULN (< 5X the ULN for patients with known hepatic
- SGOT/SGPT < 3X the ULN (< 5X the ULN for patients with known hepatic metastases)
- Patients of childbearing potential and their partners must agree to use an effective
form of contraception during the study and for 90 days following the last dose of
- Patients with an active infection or with a fever within 3 days of the first
scheduled day of protocol treatment.
- Presence of central nervous system or brain metastases.
- History of prior malignancy within the past 5 years except for curatively treated
basal cell carcinoma of the skin, cervical intra-epithelial neoplasia, or treated
localized prostate cancer with a current PSA of < 1.0 mg/dL on 2 successive
evaluations, at least 3 months apart, with the most recent evaluation no more than 4
weeks prior to entry.
- Patients with known hypersensitivity to any of the components of oxaliplatin,
5-fluorouracil (or other fluoropyrimidines), leucovorin, bevacizumab or erlotinib.
- Peripheral neuropathy > Grade 2.
- Patients who are pregnant or lactating.
- Any other medical condition, including mental illness or substance abuse, deemed by
the clinician to be likely to interfere with a patient's ability to sign informed
consent, cooperate and participate in the study, or interfere with the interpretation
of the results.
- History of allogeneic transplant.
- Known HIV or Hepatitis B or C
- Inadequately controlled hypertension
- Unstable angina or New York Heart Association (NYHA) Grade II or greater congestive
- History of myocardial infarction within 6 months.
- History of stroke within 6 months.
- Clinically significant peripheral vascular disease.
- Evidence of bleeding diathesis or coagulopathy.
- Urine protein:creatinine ratio ≥ 1.0 at screening.
- History of abdominal fistula, gastrointestinal perforation, or intra-abdominal
abscess within 6 months prior to Day 0.
- Serious, non-healing wound, ulcer, or bone fracture.
- Patients lacking physical integrity of the upper gastrointestinal tract or who have