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An Open Label, Phase II Study Assessing Potential Predictive Tumor Markers in Patients With Metastatic Colorectal Cancer and Wild Type K-RAS Tumor Treated With FOLFOX Plus Panitumumab as First-line Therapy


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Metastatic Colorectal Cancer

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Trial Information

An Open Label, Phase II Study Assessing Potential Predictive Tumor Markers in Patients With Metastatic Colorectal Cancer and Wild Type K-RAS Tumor Treated With FOLFOX Plus Panitumumab as First-line Therapy


By transactivation, phosphorylated insulin growth factor receptor I (p-IGF-IR) can activate
epidermal growth factor receptor (EGFR). Matrilysin (MMP-7), can activate IGF-IR
(insulin-like growth factor receptor ) by degrading IGFBP-3 (Insulin-like growth
factor-binding protein 3) and releasing IGF-I (Insulin-like growth factor 1). Concomitant
expression of MMP-7 and p-IGF-IR (using a specific monoclonal antibody (p-1316) recognizing
the phosphorylated carboxy-terminal part of the IGF-IR) (DP (Double Positivity)) correlates
with poor prognosis in WT KRAS patients treated with anti-EGFR antibodies plus
irinotecan.The primary objective of this trial is to estimate the progression free survival
(PFS) by DP (Double Positivity)immunohistochemistry (IHC) expression in patients with
wild-type KRAS mCRC (metastatic colorectal cancer)treated with panitumumab and mFOLFOX6. Two
groups are established by DP status (MMP7+/p-IGF-IR+ vs. MMP7+/p-IGF-IR-, MMP7-/p-IGF-IR+ or
MMP7-/p-IGF-IR-). With a power of 80% and a bilateral alpha level of 0.05, assuming an
accrual period of 12 months (m) and a follow-up period of 18 m, 40 patients are planned to
be included in each group to detect a Hazard Ratio of 2. The median PFS of the DP group is
expected to be 6 m and the total number of expected events is 56. Secondary objectives
include disease control rate, duration of response, time to response and survival according
the DP status. Neither interim analysis nor multiple comparison adjustment is
planned.Treatment: Both groups will receive panitumumab 6 mg/kg and mFOLFOX6 every 2 weeks.
If patients have not progressed after 6 m of treatment they will continue with panitumumab
monotherapy until disease progression.


Inclusion Criteria:



- Man or woman ≥ 18 years.

- Competent to comprehend, sign, and date an IEC-approved (Ethics Committee) informed
consent form

- Histologically-confirmed metastatic adenocarcinoma of the colon or rectum by the
investigator.

- Wild Type K-RAS colorectal cancer determined by the designated Central Laboratory
prior to inclusion in the study in the primary tumor and/or at least one metastasis.

- At least 1 uni-dimensionally measurable lesion of at least > 10 mm with spiral CT per
modified RECIST criteria 1.1. (Response Evaluation Criteria In Solid Tumors)

- Patients with the following characteristics will be included:

1. Recurrence after adjuvant treatment with 5-fluorouracil/folinic acid or
capecitabine +/- radiotherapy with a disease-free interval > than 6 months after
its completion.

2. Recurrence after adjuvant treatment with oxaliplatin +/- radiotherapy with a
disease-free interval > than 12 months

3. De novo diagnosis of the disease.

- Eastern Cooperative Oncology Group performance status of 0 or 1.

- Life expectancy ≥ 3 months

- Adequate bone marrow function

- Adequate Hepatic and metabolic functions

- Adequate Renal function

- Magnesium > LLN (Lower limit of Normal)

Exclusion Criteria:

- Patients they have received prior systemic therapy for the treatment of metastatic
colorectal carcinoma.

- Prior anti-EGFr antibody therapy (eg, cetuximab) or treatment small molecule EGFr
tyrosine kinase inhibitors (eg, erlotinib) or EGFR signal transduction inhibitors.

- Patients who had resection of metastatic disease

- Central nervous system/brain metastases

- Prior malignant tumor in the last 5 years, except a history of basal cell carcinoma
of the skin or pre-invasive cervical cancer.

- Unresolved toxicities from prior systemic therapy that, in the opinion of the
investigator, does not qualify the patient for inclusion

- Presence of peripheral neuropathy (Common Toxicity Criteria (CTC) version 3.0 > grade
1), and of serious nonhealing wound, ulcer, or bone fracture.

- Hormonal therapy, immunotherapy or experimental or approved proteins/antibodies (eg,
bevacizumab) ≤ 30 days before inclusion

- Significant cardiovascular disease including unstable angina or myocardial infarction
within 12 months before initiating study treatment or a history of ventricular
arrhythmia.

- History of interstitial pneumonitis or pulmonary fibrosis or evidence of interstitial
pneumonitis or pulmonary fibrosis on baseline chest CT scan

- Treatment for systemic infection within 14 days before initiating study treatment

- Acute or sub-acute intestinal occlusion and /or active inflammatory bowel disease or
other bowel disease causing chronic diarrhea (defined as > 4 loose stools per day).

- Known positive test for human immunodeficiency virus infection, hepatitis C virus,
chronic active hepatitis B infection

- Any investigational agent within 30 days before enrollment

- Subject who is pregnant or breast feeding

- Surgery (excluding diagnostic biopsy or central venous catheter placement) and/or
radiotherapy within 14 days prior to inclusion in the study.

- Woman or man of childbearing potential not consenting to use adequate contraceptive
precautions

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Progression-free survival time according to the MMP7 status (PFS)

Outcome Description:

To estimate the PFS by DP immunohistochemistry (IHC) expression in patients with wild-type KRAS mCRC treated with panitumumab and mFOLFOX6. Two groups are established by DP status (MMP7+/p-IGF-IR+ vs. MMP7+/p-IGF-IR-, MMP7-/p-IGF-IR+ or MMP7-/p-IGF-IR-).

Outcome Time Frame:

5 years

Safety Issue:

No

Principal Investigator

Joan Maurel, Dr.

Investigator Role:

Study Chair

Investigator Affiliation:

Hospital Clinic i Provincial de Barcelona

Authority:

Spain: Spanish Agency of Medicines

Study ID:

GEMCAD-0903

NCT ID:

NCT01288339

Start Date:

November 2010

Completion Date:

September 2015

Related Keywords:

  • Metastatic Colorectal Cancer
  • Colorectal Neoplasms

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