Randomized Phase 2 Study Comparing Pathological Responses Observed on Colorectal Cancer Metastases Resected After Preoperative Treatment Combining Bevacizumab With FOLFOX or FOLFIRI
- 1. Female or male patients with at least 18 years at the time the informed consent is
- 2.ECOG (Eastern Cooperative Oncology Group)performance status 0 or 1
- 3.Histological or cytological confirmed diagnostic of adenocarcinoma of the colon or
rectum, with or without primary tumour in situ. Wild-type or mutated KRAS tumor
- 4.Patients must present a resectable metastatic disease for which the decision of
preoperative chemotherapy is considered. Resectability could be planned in one or
multiple stage if indicated. As commonly admitted, resectability means the surgical
clearance (+/- radiofrequency ablation) of all detectable (liver) lesions with
tumor-free margins and compatible with an adequate hepatic reserve. Practically,
bilateral tumor location, number and location of lesions, and inadequate hepatic
reserve remain the main decisional factors.
- 5.Partial and minor resection of metastatic disease is allowed within 3 months before
inclusion if patient has never received chemotherapy for mCRC.
- 6.Extra hepatic metastatic location is limited to 1 site. Extra-hepatic location must
be easily resectable in one stage surgery.
- 7.Patients may have received adjuvant chemotherapy or (neo-) adjuvant
chemo-radiotherapy to the pelvis, provided the last dose of chemotherapy was
administered at least 6 months prior to inclusion (12 months for oxaliplatin).
Previous radiotherapy to the pelvis is not an exclusion criterion.
- 8.Adequate haematological, renal and hepatic function as follows: Haematological
Neutrophils > 1.5 x 109/L Platelets > 100 x 109/L Renal Creatinine < 1.5 x ULN (Upper
Limit of Normal) Hepatic Bilirubin < 1.5 X ULN AST(Aspartate aminotransferase), ALT
(Alanine Aminotransferase) < 3 x ULN Phos Alc. < 5 x ULN
- 9.Proteinuria <2+ (dipstick urinalysis) or =1g/24hour.
- 10.No history of myocardial infarction and/or stroke within 6 months prior to
randomization. No uncontrolled hypertension (defined as systolic blood pressure >150
mmHg and/or diastolic blood pressure > 100 mmHg), or history of hypertensive crisis,
or hypertensive encephalopathy.
- 11.Female patients must either be postmenopausal, sterile (surgically or radiation-
or chemically-induced), or if sexually active using an acceptable method of
- 12.Male patients must be surgically sterile or if sexually active and having a
pre-menopausal partner must be using an acceptable method of contraception.
- 13.Life expectancy of at least 3 months without any active treatment.
- 1.Non resectable mCRC (metastatic ColoRectal Cancer) (if resectability remains
uncertain or unprobable after 3 months chemotherapy, patient is excluded from the
- 2.Prior chemotherapy or systemic therapy for mCRC. Adjuvant chemotherapy for
colorectal cancer is not an exclusion criterion provided that it was completed more
than 6 months prior to inclusion. Oxaliplatin-based chemotherapy must be completed
more than 1 year prior to inclusion.
- 3.Prior utilization of bevacizumab, aflibercept (or other anti-VEGF(vascular
endothelial growth factor) therapy).
- 4.Previous radiotherapy delivered to the upper abdomen.
- 5.Evidence of ascites, cirrhosis, portal hypertension, main portal venous tumour
involvement or thrombosis as determined by clinical or radiologic assessment.
- 6.Prior major liver resection: remnant liver < 50% of the initial liver volume.
- 7.Non-malignant disease that would render the patient unsuitable for treatment
according to this protocol.
- 8.Concurrent central nervous systems metastases
- 9.Peripheric neuropathy ≥ grade 2.
- 10.Interstitial lung disease
- 11.Pregnant or breast feeding.
- 12.The patient has previous or concomitant malignancies, except: Invasive
malignancies in remission for more than 5 years and non melanoma skin cancer or
carcinoma in situ of the cervix.