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A Phase I Study of AZD2281 in Combination With Irinotecan in Patients With Locally Advanced or Metastatic Incurable Colorectal Cancer

Phase 1
18 Years
70 Years
Open (Enrolling)
Colorectal Cancer

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Trial Information

A Phase I Study of AZD2281 in Combination With Irinotecan in Patients With Locally Advanced or Metastatic Incurable Colorectal Cancer


- To determine the recommended phase II dose of AZD2281 and irinotecan hydrochloride in
patients with locally advanced or metastatic colorectal cancer.

- To determine the safety, tolerability, toxicity profile, dose-limiting toxicities, and
pharmacokinetic profile of this regimen.

- To assess the correlation, if any, between the toxicity profile and pharmacokinetics of
this regimen.

- To assess, preliminarily, the antitumor activity of this regimen in patients with
measurable disease.

- To demonstrate the pharmacodynamic activity of this regimen by establishing its effects
in tumor biopsies, cheek swabs, and blood samples.

- To assess the correlation, if any, between patients with tumors demonstrating
microsatellite instability and antitumor activity and pharmacodynamic effects of this

- To investigate the impact of common genetic polymorphisms of genes of relevant pathways
(drug metabolism, DNA repair, and apoptosis) on outcome and toxicity as well as other
pharmacodynamic effects.

OUTLINE: This is a multicenter, dose-escalation study of AZD2281 and irinotecan

- Part I: Patients receive oral AZD2281 twice a day on days -7 to 21 in course 1 and on
days 1-21 in all subsequent courses. Patients also receive irinotecan hydrochloride IV
over 90 minutes on day 1. Courses repeat every 21 days (course 1 is 28 days) until the
maximum tolerated dose is determined in the absence of disease progression or
unacceptable toxicity.

- Part II: Patients then receive oral AZD2281 once daily on days 1-5 and irinotecan
hydrochloride IV over 90 minutes on day 3 at the maximum tolerated dose determined in
Part I. Courses repeat every 14 days in the absence of disease progression or
unacceptable toxicity.

Patients undergo cheek swabs, tumor tissue, and blood sample collection periodically for
pharmacokinetic, pharmacodynamic, and correlative studies.

After completion of study treatment, patients are followed at 4 weeks and then every 3
months thereafter.

Inclusion Criteria


- Histologically or cytologically confirmed colorectal cancer

- Locally advanced and/or metastatic disease

- Disease considered incurable

- Suitable for treatment with single agent irinotecan hydrochloride as a palliative
intervention, as determined by the investigator

- Must have clinically and/or radiologically documented disease

- Patients whose only evidence of disease progression is tumor marker elevation
are not eligible

- Must have received no more than one prior oxaliplatin- and/or irinotecan
hydrochloride-based chemotherapy regimen given either with adjuvant, neoadjuvant, or
palliative intent

- One additional adjuvant fluoropyrimidine (fluorouracil or capecitabine) regimen
may have been given for relapsed or metastatic disease

- No untreated brain or meningeal metastases (CT scan required if there is a clinical
suspicion of CNS disease)


- ECOG performance status 0-2

- Absolute granulocyte count ≥ 1,500/mm³

- Platelet count ≥ 100,000/mm³

- Bilirubin ≤ 1.5 times upper limit of normal (ULN)

- ALT and AST ≤ 2 times ULN (≤ 5 times ULN if liver metastasis is present)

- Serum creatinine ≤ 1.5 x ULN OR creatinine clearance ≥ 50 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for 90 days after
completion of study therapy

- Must reside within a 1½ hour drive from participating center

- No other invasive malignancies, unless curatively treated with no evidence of disease

- No GI tract disease resulting in an inability to absorb oral medication, including
the following:

- Uncontrolled inflammatory GI disease (e.g., Crohn's disease or ulcerative

- Post-surgical malabsorption characterized by uncontrolled diarrhea that results
in weight loss and vitamin deficiency or requires IV hyperalimentation

- Pancreatic enzyme supplementation is allowed

- No untreated and/or uncontrolled hypertension, cardiovascular conditions, and/or
symptomatic cardiac dysfunction

- No active or uncontrolled infections

- No serious illnesses or medical conditions that would preclude study participation

- No known hypersensitivity to the study drugs or their components, atropine, or

- Not known to be homozygous for the UGT1A1*28 allele

- No known deficiency in glucuronidation of bilirubin, such as Gilbert's syndrome

- No neuropathy ≥ grade 2

- Patients with persistent, stable, grade 3 sensory neuropathy, who meet other
eligibility criteria may be allowed at the discretion of the investigator


- Recovered from all prior therapy

- No prior PARP inhibitor

- No prior radical pelvic irradiation

- No prior radiotherapy to ≥ 25% of bone marrow stores

- Prior irinotecan hydrochloride allowed provided the drug was not discontinued due to
toxic effects and the patient did not have severe irinotecan hydrochloride-related
toxicity (grade 4 or requiring hospitalization)

- At least 21 days since prior radiotherapy (exceptions may be made for low-dose,
nonmyelosuppressive radiotherapy)

- At least 30 days since prior chemotherapy

- At least 21 days since prior hormonal, immunologic, biologic, or signal transduction
inhibitor therapies

- More than 3 weeks since prior and no other concurrent investigational drugs or
anticancer therapy

- At least 14 days since prior major surgery

- Wound healing must have occurred

- At least 14 days since prior and no concurrent CYP3A4 enzyme-inducing or -inhibiting
drugs, including enzyme-inducing anticonvulsants, rifampin, rifabutin, St. John's
wort, atazanavir, or ketoconazole

- Dexamethasone is allowed for antiemetic prophylaxis

Type of Study:


Study Design:

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

Outcome Measure:

Recommended phase II dose of AZD2281 and irinotecan hydrochloride

Outcome Description:

End of study

Outcome Time Frame:

Nov 2011

Safety Issue:


Principal Investigator

Eric X. Chen, MD, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

Princess Margaret Hospital, Canada


Canada: Health Canada

Study ID:




Start Date:

August 2007

Completion Date:

December 2013

Related Keywords:

  • Colorectal Cancer
  • recurrent colon cancer
  • stage IV colon cancer
  • recurrent rectal cancer
  • stage IV rectal cancer
  • stage III rectal cancer
  • stage III colon cancer
  • Colorectal Neoplasms