A Phase II Study of Bevacizumab, Irinotecan and Capecitabine in Patients With Previously Untreated Metastatic Colorectal Cancer
The FOLFIRI regimen has become the standard 1st line therapy for metastatic colorectal
cancer in Canada. This regimen consists of irinotecan in combination with bolus
5-FU/leucovorin, followed by 46-hour infusional 5-FU every 2 weeks. It requires a central
line and an infusion pump for delivering 5-FU, and necessitates at least 2 visits to the
chemotherapy units every 2 weeks, which not only incurs additional cost and inconvenience to
patients, but also increases the risk of complications such as thrombosis and infection due
to the central line. In addition, due to resources limitations, patients often have to wait
several weeks for central line placement. The XELIRI (irinotecan and capecitabine) regimen
has been in use at the Princess Margaret Hospital (PMH) as the first-line treatment of
patients with metastatic colorectal cancer since May, 2003. The choice of XELIRI over
FOLFIRI was made in efforts to reduce demands on resources, enable patients to start therapy
sooner, increase patient convenience and potentially reduce complications associated with
central venous access. The regimen consists of irinotecan 250 mg/m2 IV on day 1 and
capecitabine 1000 mg/m2 PO BID from days 1-14 every 3 weeks. The dose was reduced to
irinotecan 200 mg/m2 on day 1 and capecitabine 750 mg/m2 in patients > 65 years old or in
patients with renal impairment. So far, 101 patients have been treated on this regimen at
PMH. Among 76 patients evaluable for response, there have been 34 confirmed partial
responses (44.7%) and a further 18 patients with stable disease (23.7%), for a disease
control rate of 68.4%. Furthermore, this regimen was well tolerated with main side
effects being diarrhea and neutropenia. With availability of bevacizumab, 12 patients were
treated with the XELIRI regimen in combination with bevacizumab at PMH as part of the BEAT
(Bevcizumab Expanded Access Trial ) study up to October, 2005. Of 10 patients who were
treated with 3 or more cycles of chemotherapy, there were 7 confirmed partial responses and
2 additional patients with stable disease. One patient with non-measurable but evaluable
disease had marked reduction in infiltration in the sacrum. There were no instances of GI
perforation, febrile neutropenia, or toxic death. The median number of cycles of treatment
was 6, and 9 of 12 patients are still receiving treatment. There were, however, a total of
8 dose reductions of capecitabine in 6 patients, with majority of dose reductions as a
result of hand-foot syndrome. Although these efficacy and toxicity data are extremely
encouraging, the small number of patients limits the potential application of these
data.Because of the encouraging preliminary results, it is necessary to conduct a
prospective clinical study to further evaluate the efficacy and toxicity of irinotecan,
capecitabine and bevacizumab combination (the XELIRI-A regimen) as first-line chemotherapy
for patients with advanced colorectal cancer. Results from this study would provide the
scientific basis for a randomized phase III study to compare the XELIRI-A regimen to the IFL
(FOLFIRI) + bevacizumab regimen. Furthermore, it will have practical implications for our
centre. Compared to infusional or bolus 5-FU based regimens, the XELIRI-A regimen will
reduce workload in the chemotherapy daycare unit and drug costs, reduce demands for
resources such as infusion pumps and interventional radiology time, enable patients to start
therapy sooner, and improve patient convenience.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
To determine the objective response rate (ie. the rate of partial response plus complete response as defined by RECIST criteria) of irinotecan, capecitabine and bevacizumab (XELIRI-A) in patients with previously untreated metastatic colorectal cancer.
Radiological evaluation every 9 weeks, with confirmatory scans 4 weeks after objective response
No
Eric Chen
Principal Investigator
Princess Margaret Hospital, University Health Network
Canada: Ethics Review Committee
XELIRI-A
NCT00483834
December 2006
July 2011
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