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Phase II Double-blind Placebo-controlled Trial of CY503 in Patients With Chemotherapy-refractory Metastatic Colorectal Cancer

Phase 2
18 Years
Open (Enrolling)
Metastatic Colorectal Cancer

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Trial Information

Phase II Double-blind Placebo-controlled Trial of CY503 in Patients With Chemotherapy-refractory Metastatic Colorectal Cancer

Colorectal cancer has a worldwide annual incidence of approximately 1 million new cases
diagnosed yearly and it is the second leading cause of cancer-related death in Western
nations. There are a couple of approved standard therapies for the treatment of MCRC with
cytotoxic agents irinotecan, oxaliplatin, and the fluoropyrimidines , as well as
bevacizumab, the antibody against vascular endothelial growth factor A, and cetuximab, the
antibody against the epidermal growth factor receptor. But there are only a few studies
achieving a median survival time of more than 20 months in MCRC patients with standard
regimens. After a 1st line therapy a high proportion (50% to 80%) of patients receives a 2nd
line therapy with drugs not used in 1st line therapy and a part of them gets a 3rd line
treatment. Results from a 2nd line therapy are best response rates ranging from 4 % - 23 %,
a median PFS rate of 5.1 months, a median TTP of 4.1 - 4.6 months and median overall
survival 6.9 - 12 months. However, for patients who experience disease progression after
standard therapy (definition see inclusion criteria) there is no further standard
therapeutic option. These patients developed a resistance to these therapies and finally die
of their disease. They generally get best supportive care (BSC). Thus, there is a need for
new active treatment options in this setting.

In this phase II double-blind placebo-controlled trial the efficacy and safety of CY-503,
350 ng s.c. injected in patients with chemotherapy refractory MCRC are tested. Approved
treatments given to MCRC patients are usually discontinued after a treatment over some weeks
at the first detection of objective PD. It will be tested if CY-503 is able to achieve
progression-free-survival (PFS) in comparison to placebo. Patients will initially be
included to receive either CY-503 or placebo until documentation of objective PD.

Standard therapy must be finished and has shown objective PD. Also patients with
contraindications to standard therapy can be included.

CY-503 shows the potential to improve treatment of MCRC. This study aims at evaluating the
activity and therapeutic effects of the substance. Anticipated capabilities are
substitution of cytostatic drugs or improvement of their efficacy and tolerability .
Furthermore, the expected improvement of PFS rates after failure of standard chemotherapies
has to be investigated.

In a phase I trial CY-503 showed SD in patients who had exhausted standard therapy options
for metastatic disease with subsequent disease progression with a median TTP of 17.4 weeks.

Inclusion Criteria

Inclusion Criteria

- Age ≥ 18 years

- Patients are eligible with diagnosis of measurable metastatic colorectal carcinoma
and radiologic documentation of disease progression during or with 3 months after
termination of standard chemotherapy (fluoropyrimidine-based therapy with oxaliplatin
and irinotecan). Patients who had to interrupt the 1st or 1nd line therapy due to
intolerance or who were refractory or intolerant to the standard treatment regimens
are eligible, too. Bevacizumab can, but does not need to be administered at
discretion of treating physician. Patients with K-RAS wild-type can be treated with
cetuximab or panitumumab before they enter the study.

- No chemotherapy within 4 weeks before treatment start

- No residual significant toxicity (greater than NCI grade 1), in case of peripheral
neuropathy: no symptoms of peripheral neuropathy of NCI CTC grade 4 within 4 weeks
before treatment start.

- No previous treatment with experimental therapies after standard therapies is

- Patients must use effective contraception if of reproductive potential. Females must
not be pregnant or lactating

- Eastern Cooperative Oncology Group (ECOG) Performance status of 0 - 2

- WBC ≥ 3,000/mm3, absolute neutrophil count (ANC) ≥ 1,500/mm3, platelet count

- Bilirubin ≤ 2.0 mg/dL (40 μmol/L) (unless due to Gilbert's syndrome in which case the
bilirubin should be ≤3.5 mg/dL (59.86 μmol/L)), aspartate transaminase (AST)/alanine
transaminase (ALT) ≤ 5 × upper limit of normal (ULN); hepatic alkaline phosphatase ≤
3.0 × ULN (in case of liver metastases higher levels do not hinder inclusion of

- Serum creatinine ≤ 2.0 mg/dL (180 μmol/L)or creatinine clearance >= 50 ml/min. ,
proteinuria < 2.0 g/24 hr urine collection in patients with a positive urine dipstick
for protein

- Written informed consent according to ICH-GCP and national laws and regulations prior
to receipt of any trial medication or beginning trial procedures

Exclusion Criteria:

- Evidence of any other malignant disease (with the exception of tumors operatively
cured at least 5 years prior to the trial)

- Known brain metastases

- Uncontrolled pleural effusions

- Interstitial pneumonitis or pulmonary fibrosis

- Severe/ unstable systemic disease or infection and circumstances not permitting trial
participation (e.g., alcoholism or substance abuse)

- Unstable cardiac disease in the last 6 months

- Use of conventional mistletoe preparations, any immunostimulating substances and/or
monoclonal antibodies within four weeks prior to and during the trial - ongoing
therapy with steroids is permitted if the dose is not higher than 20 mg of
prednisone-equivalent at the time of inclusion and during this clinical trial

- Any evidence or history (elicited by the investigator) of symptomatic cerebrovascular
events (i.e., stroke or transient ischemic attack) within 6 months prior to

- Any history or evidence of pulmonary embolism or thrombophlebitis (including deep
vein thrombosis) requiring anticoagulant therapy (e.g., marcumar or heparin)

- History of hypersensitivity to mistletoe

- History of primary immunodeficiency

- Known human immunodeficiency virus (HIV) or known active viral hepatic infections

- Prior treatment with CY-503

- A general medical or psychological condition or behaviour, including substance
dependence or abuse that, in the opinion of the investigator, might not permit the
patient to complete the trial or sign the informed consent

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Outcome Measure:

Tumor assessment by using CT scans and/or MRIs

Outcome Time Frame:

every 8 weeks (each 2 cycles)

Safety Issue:


Principal Investigator

Heinz Zwierzina, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

University Hospital Innsbruck, Austria


Germany: Federal Institute for Drugs and Medical Devices

Study ID:




Start Date:

July 2009

Completion Date:

December 2013

Related Keywords:

  • Metastatic Colorectal Cancer
  • Metastatic
  • Colorectal
  • Cancer
  • refractory
  • Phase II
  • randomised
  • double-blind
  • controlled
  • multicenter
  • CY-503
  • Cytavis
  • Colorectal Neoplasms