An Open-label, Randomized, Controlled, Multicenter Phase III Trial to Compare Cetuximab in Combination With FOLFOX-4 Versus FOLFOX-4 Alone in the First Line Treatment of Metastatic Colorectal Cancer in Chinese Subjects With KRAS Wild-type Status
Inclusion Criteria:
- Signed written informed consent (first and second)
- Chinese with Chinese citizenship
- Male or female subjects ≥18 years of age
- Medically accepted effective contraception if procreative potential exists
(applicable for both male and female subjects until at least 90 days after the last
dose of trial treatment)
- Diagnosis of histologically confirmed adenocarcinoma of the colon or rectum
- First occurrence of metastatic disease (not curatively resectable) KRAS wild-type
status in tumor tissue
- At least one measurable lesion by computer tomography (CT) or magnetic resonance
imaging (MRI) according to RECIST (not in an irradiated area)
- Life expectancy of at least 12 weeks
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at trial entry
- White blood cell count ≥ 3 × 10x9/L with neutrophils ≥ 1.5 × 10x9/L, platelet count ≥
100 × 10x9/L and hemoglobin ≥ 6.21 mmol/L (10 g/dL)
- Total bilirubin ≤ 1.5 × upper limit of reference range
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5 × upper limit of
reference range or ≤ 5 × upper reference range in subjects with liver metastasis
- Serum creatinine ≤ 1.5 × upper limit of reference range
- Recovery from relevant toxicity due to previous treatment before trial entry
Exclusion Criteria:
- Previous chemotherapy for CRC except adjuvant treatment if terminated > 9 months
(oxaliplatin-based chemotherapy) or > 6 months (non-oxaliplatin-based chemotherapy)
before the start of treatment in this trial
- Radiotherapy or surgery (excluding prior diagnostic biopsy) in the 30 days before
trial treatment
- Previous treatment with monoclonal antibody therapy, vascular endothelial growth
factor (VEGF) pathway-targeting therapy, epidermal growth factor receptor (EGFR)
pathway-targeting therapy, or other signal transduction inhibitors
- History of organ allograft, autologous stem cell transplantation, or allogeneic stem
cell transplantation
- Renal replacement therapy
- Intake of any investigational medication within 30 days before trial entry
- Concurrent chronic systemic immune therapy or hormone therapy except physiologic
replacement
- Granulocyte colony stimulating factor (G-CSF) or granulocyte macrophage colony
stimulating factor (GM-CSF) within 3 weeks of trial entry (these growth factors may
be used during the trial thereafter)
- Other non-permitted concomitant anticancer therapies
- Known brain metastasis and/or leptomeningeal disease. Subjects with neurological
symptoms should undergo a CT scan/MRI of the brain to exclude brain metastasis
- Previous malignancy other than CRC in the last 5 years except basal cell cancer of
the skin or preinvasive cancer of the cervix
- Clinically significant cardiovascular disease, e.g. cardiac failure of New York Heart
Association classes III-IV, uncontrolled coronary artery disease, cardiomyopathy,
uncontrolled arrhythmia, uncontrolled hypertension, or history of myocardial
infarction in the last 5 years, or left ventricular ejection fraction below the
institutional range of normal on a baseline multiple gated acquisition scan or
echocardiogram
- Acute or sub-acute intestinal occlusion or history of inflammatory bowel disease
- Active clinically serious infections (> grade 2 National Cancer Institute-Common
Terminology Criteria for Adverse Events (NCI-CTCAE) version 3.0), including active
tuberculosis
- Known and declared history of human immunodeficiency virus (HIV) infection or chronic
hepatitis B or C
- Peripheral neuropathy > grade 1
- Signs and symptoms suggestive of transmissible spongiform encephalopathy, or family
members who suffer(ed) from such
- Uncontrolled diabetes mellitus, pulmonary fibrosis, acute pulmonary disorder,
interstitial pneumonia, or liver failure
- Known hypersensitivity or allergic reactions against any of the components of the
trial treatments
- Pregnancy (absence to be confirmed by serum β-human chorionic gonadotropin test) or
breastfeeding
- Ongoing alcohol or drug abuse
- Presence of a medical or psychological condition that would not permit the subject to
complete the trial or sign informed consent
- Participation in another clinical trial within the past 30 days
- Other significant disease that in the investigator's opinion should exclude the
subject from the trial
- Legal incapacity or limited legal capacity