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A Randomized, Placebo-controlled, Double-blind Multicenter Phase II Study to Investigate the Protectivity and Efficacy of Metformin Against Steatosis in Combination With FOLFIRI and Cetuximab in Subjects With First-line Palliative Treated, KRAS-Wild-Type, Metastatic Colorectal Cancer


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

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Trial Information

A Randomized, Placebo-controlled, Double-blind Multicenter Phase II Study to Investigate the Protectivity and Efficacy of Metformin Against Steatosis in Combination With FOLFIRI and Cetuximab in Subjects With First-line Palliative Treated, KRAS-Wild-Type, Metastatic Colorectal Cancer


This multicenter randomized, placebo-controlled phase II study will enroll 132 first-line
palliative treated subjects with metastatic KRAS wild type CRC.

Wild-type KRAS is required for study entry. Further target-related parameters, based on
current scientific knowledge may be assessed.

Subjects are randomized to Arm A or Arm B Arm A: FOLFIRI in combination with cetuximab and
metformin Arm B: FOLFIRI in combination with cetuximab and placebo

A liver biopsy of hepatic metastasis and normal liver tissue is planned before the first
cycle and at the end of treatment; with regard to the primary study objective, these
subjects are evaluable.

Both efficacy and safety data will be collected. The investigators will assess response to
treatment every 8 weeks based on imaging.

Following permanent treatment cessation, subjects will be followed-up for survival.

One interim analysis for futility (54 evaluable patients) and in addition two safety
analysis for evaluation of reported adverse events between the two treatment groups will be
performed at two different timepoints (20 evaluable patients/54 evaluable patients).


Inclusion Criteria:



- Signed written informed consent

- Male or female >= 18 years of age

- Diagnosis of histologically confirmed, KRAS "wild-type" adenocarcinoma of the colon
or rectum

- Non-resectable metastatic colorectal carcinoma

- Either presence of at least one liver lesion measurable unidimensionally by CT scan
or MRI or at least one resectable liver metastasis with non-resectable extrahepatic
disease (as assessed within 3 weeks prior to randomisation)

- Subjects scheduled to receive cetuximab and FOLFIRI

- ECOG performance status of 0 - 1 at study entry

- Leukocytes >= 3.0 x 10^9/L and neutrophils >= 1.5 x 10^9/L, platelets >= 100 x
10^9/L, and hemoglobin >= 8 g/dL

- Bilirubin <= 1.5 x ULN

- ASAT and ALAT <= 5 x ULN

Exclusion Criteria:

- Brain metastasis (if suspected, brain scan indicated)

- Previous chemotherapy for the currently existing metastatic disease

- Known or newly diagnosed diabetes

- Patients with ACS within the last three months

- Stage 3 or 4 heart failure defined according to the NYHA criteria

- Uncontrolled angina

- Contraindications to metformin (renal impairment [eGFR <45 mL/min/1.73m^2], known
hypersensitivity to metformin, acute illness [dehydration, severe infection, shock,
acute cardiac failure]), and suspected tissue hypoxia

- Surgery (excl. diagnostic biopsy, central venous catheter) or irradiation within 2
weeks prior to study entry defined as given written informed consent

- Concurrent chronic systemic immune therapy, chemotherapy, or hormone therapy not
indicated in the study protocol

- Administration of any investigational agent(s) within 4 weeks prior to study entry,

- Previous exposure to EGFR-pathway targeting therapy

- Acute or sub-acute intestinal occlusion or history of inflammatory bowel disease

- Known grade 3 or 4 allergic reaction to any of the components of the treatment

- Any concurrent malignancy other than non-melanoma skin cancer, or carcinoma in situ
of the cervix. (Subjects with a previous malignancy but without evidence of disease
for >= 5 years will be allowed to enter the trial)

- Pregnancy or lactation

- Inadequate contraception (male or female patients) if of childbearing or procreative
potential

- Known drug abuse/ alcohol abuse

- Legal incapacity or limited contractual capacity Medical or psychological condition
which in the opinion of the investigator would not permit the patient to complete the
study or sign meaningful informed consent

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Reduction in the chemotherapy-associated steatosis

Outcome Description:

Reduction in the chemotherapy-associated steatosis, as assessed by the steatosis subcore of NAFLD activity score (NAS)

Outcome Time Frame:

up to 24 weeks

Safety Issue:

Yes

Principal Investigator

Birgit Gruenberger, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Austrian Breast & Colorectal Cancer Study Group

Authority:

Austria: Federal Office for Safety in Health Care

Study ID:

G-LUCAS

NCT ID:

NCT01523639

Start Date:

April 2012

Completion Date:

July 2016

Related Keywords:

  • Colorectal Cancer
  • Steatohepatitis
  • liver injury
  • steatosis
  • KRAS-Wild-Type
  • metastatic colorectal cancer
  • metformin
  • placebo
  • chemotherapy
  • Colorectal Neoplasms
  • Fatty Liver

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