A Randomized Phase II Trial Assessing Sorafenib in Combination With Irinotecan in Metastatic Colorectal Cancer Patients With KRAS Mutated Tumors After Failure of All Drugs Known to be Effective
Inclusion Criteria:
- Male or female ≥ 18 years old
- Histologically confirmed diagnosis of colorectal cancer
- Asymptomatic or resected primary tumor
- Metastatic colorectal cancer patient not eligible for curative surgery
- At least one target lesion:
- Unidimensionally measurable on cross-sectional imaging
- In an area not previously irradiated
- Disease progression after failure of active drugs (5-Fu or 5-Fu prodrugs, irinotecan,
oxaliplatin, bevacizumab)
- Patients with bone metastases are eligible if they have other measurable lesions
- WHO performance status ≤ 2
- Confirmation of KRAS mutation in codons 12 or 13 in the primary tumor or metastases
- Total bilirubin ≤ 1.5 ULN, ALT or AST ≤ 2.5 ULN (or < 5 in case of liver impairment)
- Haemoglobin ≥ 10 g/dL, neutrophils ≥ 1,500/mm3, platelets ≥ 100,000/mm3
- Serum creatinine ≤ 1.5 ULN
- Negative pregnancy test in women of childbearing potential
- Use of an effective contraceptive method during the whole treatment and up to 3
months after the completion of treatment in males and females
- Life expectancy of at least 3 months
- Informed consent signed prior any study specific procedures
- Tumor evaluation should be performed within 3 weeks prior to starting treatment
Exclusion Criteria:
- History of Gilbert's syndrome
- Symptomatic brain metastases or carcinomatous meningitis
- Bone-only metastases
- History or presence of other cancers within the past 5 years (except curatively
treated non-melanoma skin cancer and in situ cervical cancer)
- Prior surgery or radiotherapy within 4 weeks before entering the study
- Cardiac arrhythmia requiring treatment (except for beta-blockers and digoxin),
unstable cardiac disease, myocardial infarction within the previous 6 months, > grade
II NYHA heart failure, uncontrolled hypertension
- Kalemia lower than normal serum potassium value
- From ECG, QTc interval > 470 ms
- History of acute or chronic pancreatitis
- History of epileptic seizures requiring long-term anticonvulsant therapy
- History of organ transplantation with use of immunosuppression therapy
- Severe bacterial or fungal infection (Grade > 2 NCI-CTCAE v.4.0)
- Known HIV infection
- Long-term use of CYP 3A4 enzyme-inducing agents such as rifampicin, St. John's Wort
(hypericum perforatum), phenytoin, carbamazepine, phenobarbital, dexamethasone, and
ketoconazole
- Pregnant or breastfeeding women
- Bowel malabsorption or extended bowel resection that could affect the absorption of
sorafenib, occlusive syndrome, inability to take oral medications
- Inflammatory bowel disease with chronic diarrhea (NCI-CTCAE v.4.0)
- Participation in another clinical trial 30 days prior to study entry
- Concurrent treatment with any other investigational product or anticancer therapy
(except for irinotecan or sorafenib)
- Psychological, social, geographical disorders or any other condition that would
preclude study compliance (treatment administration and study follow-up).