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A PHASE IIIIII RANDOMIIZED TRIIAL OF FOLFOXIIRII + BEVACIIZUMAB VERSUS FOLFIIRII + BEVACIIZUMAB AS FIIRST-- LIINE TREATMENT FOR METASTATIIC COLORECTAL CANCER


Phase 3
18 Years
75 Years
Not Enrolling
Both
Colorectal Cancer

Thank you

Trial Information

A PHASE IIIIII RANDOMIIZED TRIIAL OF FOLFOXIIRII + BEVACIIZUMAB VERSUS FOLFIIRII + BEVACIIZUMAB AS FIIRST-- LIINE TREATMENT FOR METASTATIIC COLORECTAL CANCER


OBJECTIVES:

Primary

- To compare the progression-free survival of bevacizumab in combination with
oxaliplatin, irinotecan hydrochloride, fluorouracil, and leucovorin calcium (FOLFOXIRI)
versus bevacizumab in combination with irinotecan hydrochloride, fluorouracil, and
leucovorin calcium (FOLFIRI) in patients with unresectable, metastatic colorectal
cancer.

Secondary

- To evaluate the safety profile, including long-term adverse events of these regimens in
these patients.

- To compare the overall response rate, duration of response, and secondary R0 surgery
rates of metastases and overall survival between treatment arms.

- To evaluate potential surrogate markers predictive of bevacizumab activity.

OUTLINE: This is a multicenter study. Patients are stratified according to ECOG performance
status (0 vs 1-2), prior adjuvant chemotherapy (yes vs no), and participating center.
Patients are randomized to 1 of 2 treatment arms.

- Arm I (FOLFOXIRI): Patients receive irinotecan hydrochloride IV over 1 hour,
oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and bevacizumab IV on
day 1. Patients also receive fluorouracil IV continuously over 48 hours beginning on
day 1.

- Arm II (FOLFIRI): Patients receive irinotecan hydrochloride IV over 1 hour, leucovorin
calcium IV over 2 hours, and bevacizumab IV on day 1. Patients also receive
fluorouracil IV continuously over 48 hours beginning on day 1.

In both arms, treatment repeats every 2 weeks for up to 12 courses. Treatment with
bevacizumab, fluorouracil, and leucovorin calcium continues in the absence of disease
progression or unacceptable toxicity.

Patients undergo serum extraction and blood sample collection periodically for genotyping
studies. Patients also undergo collection of tumoral sections from paraffin embedded primary
and/or metastatic lesions periodically for immunohistochemical analyses.

After completion of study treatment, patients are followed every 8 weeks.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed colorectal cancer

- Unresectable metastatic disease

- Measurable disease, defined as ≥ 1 measurable lesion according to RECIST criteria

- No prior chemotherapy for metastatic disease

- No untreated brain metastases, spinal cord compression, or primary brain tumors

- No history or evidence of CNS disease by physical examination unless adequately
treated (e.g., uncontrolled seizure despite standard medical therapy or history of
stroke)

PATIENT CHARACTERISTICS:

Inclusion criteria:

- ECOG performance status (PS) 0-2 (≤ 70 years of age) OR ECOG PS 0 (71-75 years of
age)

- Life expectancy ≥ 12 weeks

- Neutrophils ≥ 1.5 x 10^9/L

- Platelet count ≥ 100 x 10^9/L

- Hemoglobin > 9 g/dL

- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)

- AST and ALT ≤ 2.5 times ULN (≤ 5 times ULN if f liver metastases present)

- Alkaline phosphatase ≤ 2.5 times ULN (≤ 5 times ULN if liver metastases present)

- Creatinine clearance > 50 mL/min OR serum creatinine ≤ 1.5 times ULN

- Proteinuria < 2+ by dipstick OR urine protein ≤ 1 g by 24-hr urine collection

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

Exclusion criteria:

- Serious, nonhealing wound, ulcer, or bone fracture

- Evidence of bleeding diathesis or coagulopathy

- Uncontrolled hypertension

- Clinically significant (i.e., active) cardiovascular disease, including any of the
following:

- Cerebrovascular accidents within the past 6 months

- Myocardial infarction within the past 6 months

- Unstable angina

- New York Heart Association class II-IV congestive heart failure

- Serious cardiac arrhythmia requiring medication

- Known allergy to Chinese hamster ovary cell proteins or any of the components of the
study medications

- Other co-existing malignancy or malignancy diagnosed within the past 5 years, except
for basal cell or squamous cell carcinoma, or carcinoma in situ of the cervix

- Symptomatic peripheral neuropathy ≥ grade 1 according to the NCI Common Toxicity
Criteria

- Lack of physical integrity of the upper gastrointestinal tract

- Malabsorption syndrome

- Inability to take oral medication

- Significant traumatic injury within the past 28 days

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- More than 4 weeks since prior radiotherapy

- More than 10 days since prior and no concurrent ongoing treatment with anticoagulants
for therapeutic purposes

- More than 28 days since prior and no concurrent major surgical procedure

- More than 28 days since prior open biopsy

- More than 30 days since prior investigational agents

- No concurrent chronic daily high-dose acetylsalicylic acid (> 325 mg/day)

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Progression free survival

Outcome Description:

To compare the progression free survival of bevacizumab in combination with oxaliplatin, irinotecan and infusional 5FU/LV ("GONO" FOLFOXIRI regimen) to bevacizumab in combination with irinotecan and infusional 5FU/LV (FOLFIRI regimen)

Outcome Time Frame:

up to 54 months

Safety Issue:

No

Principal Investigator

Alfredo Falcone, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Presidio Ospedaliero di Livorno

Authority:

Italy: Ethics Committee

Study ID:

CDR0000598582

NCT ID:

NCT00719797

Start Date:

July 2008

Completion Date:

Related Keywords:

  • Colorectal Cancer
  • stage IV rectal cancer
  • stage IV colon cancer
  • stage III rectal cancer
  • stage III colon cancer
  • Colorectal Neoplasms

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