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A Phase II Study of Cetuximab Plus Biweekly Capecitabine and Oxaliplatin (C-CO2) in the Treatment of Patients With EGFR-Expressing Metastatic Colorectal Cancer

Phase 2
18 Years
Open (Enrolling)
Colorectal Cancer, Neoplasm Metastasis

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Trial Information

A Phase II Study of Cetuximab Plus Biweekly Capecitabine and Oxaliplatin (C-CO2) in the Treatment of Patients With EGFR-Expressing Metastatic Colorectal Cancer

The current treatment options for metastatic colon cancer are in need of further
improvement. The three-drug combination of oxaliplatin with 5-FU/LV in the second-line
treatment of metastatic colorectal cancer have shown a significant increase in response rate
compared to 5-FU/LV alone. Oxaliplatin has recently been FDA-approved for this indication
and is now a standard first-line agent in combination with a fluoropyrimidine. Cetuximab, a
chimeric monoclonal antibody against the growth factor receptor, has shown activity with and
without irinotecan in subjects with colorectal cancer refractory to irinotecan alone.
Cetuximab has also been shown to be safe and effective when administered with infusional
5-FU/folinic acid plus irinotecan. These results suggest that the addition of cetuximab to
fluoropyrimidine/oxaliplatin-based regimen in the 1st line setting should be explored. The
use of the oral fluoropyrimidine, capecitabine, to replace infusional 5FU has been widely
used for improved convenience and possible safety. We have chosen a modified biweekly CapeOx
regimen due to its improved tolerance and response rate with a fixed dose of capecitabine
given its widespread practice and ease of use.

Inclusion Criteria:

- Subjects must have signed an approved informed consent.

- Histologically confirmed diagnosis of advanced adenocarcinoma of the colon or rectum,
with KRAS wild type on mutational analysis.

- No prior chemotherapy for metastatic disease (chemotherapy naive). Prior adjuvant
therapy with 5FU/LV or IFL is permitted if completed at least six months prior to
entering this study.

- Measurable disease by RECIST criteria as defined in Section 3.3.1.

- Subjects for whom tumor tissue is available for IHC testing for EGFR expression.

- ECOG Performance Status 0-1.

- Recovery in full from any previous surgical procedure.

- Expected survival greater than 12 weeks.

- Subjects at least 18 years of age.

- Women of childbearing potential (WOCBP) must be using an adequate method of
contraception to avoid pregnancy throughout the study and for up to 4 weeks after the
study in such a manner that the risk of pregnancy is minimized. WOCBP must have a
negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent
units of HCG) within 72 hours prior to the start of study medication.

- Adequate hematologic function defined by an absolute neutrophil count (ANC) >
1,500/mm3, a platelet count > 100,000/mm3 .

- Adequate hepatic function defined by a total bilirubin level no greater than 2.0
times the upper limit of normal (ULN) and AST and ALT levels noo greater than 2.5
times the ULN (AST and ALT levels no greater than 5 times the ULN in the presence of
liver metastases).

- Adequate renal function defined by a serum creatinine level no greater than 1.5
times the ULN.

Exclusion Criteria:

- WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for
the entire study period and for up to 4 weeks after the study.

- Women who are pregnant or breastfeeding.

- Women with a positive pregnancy test on enrollment or prior to study drug

- Sexually active fertile men not using effective birth control if their partners are
women of child-bearing potential.

- Subjects with > Grade 1 neuropathy.

- Any active or uncontrolled infection.

- History of myocardial infarction within the previous six months or current clinical
evidence of congestive heart failure.

- History of any other cancer (except nonmelanoma skin cancer or carcinoma in situ of
the cervix) unless in complete remission and off all therapy for that cancer for at
least 5 years.

- Central nervous system metastases.

- Pregnant or lactating women. Men and women of reproductive potential must agree to
use an effective contraceptive method.

- Medical or psychiatric disorders that would interfere with informed consent or make
them a poor risk for participation in this trial.

- Prior allergic reaction to chimerized or murine monoclonal antibody therapy or
documented presence of human anti-mouse antibodies (HAMA).

- Subjects receiving a prior investigational agent within 30 days.

- Prior therapy with oxaliplatin, cetuximab, or prior therapy that targets the EGF

- Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for
treatment of either a psychiatric or physical (e.g., infectious disease) illness must
not be enrolled into this study.

- Mutation in the KRAS gene

Type of Study:


Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Response rate for the combination treatment

Outcome Time Frame:

6 months since the start of treatment

Safety Issue:


Principal Investigator

Deirdre Cohen, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

New York University School of Medicine


United States: Institutional Review Board

Study ID:

NYU# 04-10 H11817



Start Date:

June 2004

Completion Date:

August 2013

Related Keywords:

  • Colorectal Cancer
  • Neoplasm Metastasis
  • Previously untreated metastatic colorectal cancer
  • Metastatic Colorectal Cancer
  • combined therapy
  • biologics therapy
  • antibody
  • chemotherapy
  • EGFR
  • Neoplasms
  • Colorectal Neoplasms
  • Neoplasm Metastasis



New York University Langone Medical Center New York, New York  10016
Bellevue Hospital New York, New York  10016