Randomized Phase III Study of Oxaliplatin, Fluorouracil and Leucovorin (FOLFOX) With or Without Regorafenib in Patients With Metastatic Colorectal Cancer Progressed After First-line Irinotecan Plus Fluoropyrimidines
Limited active drugs are available for the treatment of patients with metastatic colorectal
cancer (mCRC) at present and upfront doublet combination of fluoropyrimidines plus either
oxaliplatin or irinotecan is regarded as reference strategy for patients appropriate for
intensive therapy. Before the era of targeted agents, the treatment strategies in terms of
either combination or sequence of cytotoxic agents were rather simple; survival outcomes did
not differ according to either the administration sequence of oxaliplatin or irinotecan, or
the sequential versus combination chemotherapy in the treatment continuum. However, the
treatment strategies have become more complicated in the era of targeted agents.
In case of failure to first-line oxaliplatin plus fluoropyrimidines (FOLFOX or CapeOX) with
or without bevacizumab, second-line chemotherapy with FOLFIRI would be administered for
treatment continuum, and more various targeted agents can be combined in these setting;
bevacizumab beyond progression only in patients who have been treated with first-line
bevacizumab plus FOLFOX or CapeOX (TML and BRiTE), cetuximab (only for patients with
wild-type KRAS), panitumumab (only for patients with wild-type KRAS), and aflibercept
(VELOUR). However, there have been a few valid targeted agents which could be combined in
the second line FOLFOX or CapeOX in those progressed after first-line FOLFIRI with or
without targeted agents; bevacizumab beyond progression could be a valid treatment strategy
only in those received first-line bevacizumab plus FOLFIRI. Higher dose of bevacizumab (10
mg/kg/2-week) could be combined to FOLFOX as second-line chemotherapy; however, it is not
recommended at present in terms of cost effectiveness and higher adverse events, and
cetuximab plus oxaliplatin-based chemotherapy is neither recommended by current consensus.
Thus, there have been unmet needs for the discovery of valid targeted agent combination for
the second-line FOLFOX as above reasons.
Interventional
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment
Progression-free survival
time from randomization to disease-progression or any event (up to 1 year from the end of study treatment)
No
Korea: Food and Drug Administration
Regorafenib/FOLFOX
NCT01786538
June 2013
May 2017
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