Description:
This pilot study is being mounted to assess whether treatment assignment by ERCC-1 gene
expression status suggests better clinical results from historical experience in metastatic
colorectal cancer (mCRC). In wild type KRAS mCRC patients treated with either FOLFOX or
FOLFIRI in combination with cetuximab the median response rate is approximately 60-65%.
Biomarker directed treatment in this study may demonstrate that patients with low ERCC-1
treated with FOLFOX and cetuximab, and those with high ERCC-1 treated with FOLFIRI and
cetuximab, will improve response rate to 70-75%. KRAS wild type patients will be treated with
6 cycles of one of the following regimens chosen for optimization based on patient
characteristics (primary treatment phase). Patients with ERCC-1 < 1.7 relative gene
expression of ERCC-1 over ß-actin (ERCC-1 low) will be assigned to treatment with mFOLFOX6 in
combination with Cetuximab. Patients with ERCC-1 gene expression > 1.7 relative gene
expression of ERCC-1 over over ß-actin (ERCC-1 high) will be assigned to treatment with
FOLFIRI in combination with Cetuximab.
Title
- Brief Title: Biomarker Directed Treatment in Metastatic Colorectal Cancer
- Official Title: Pilot Study: Biomarker Directed Treatment in Metastatic Colorectal Cancer
Clinical Trial IDs
- ORG STUDY ID:
AGMT_ERCC1
- SECONDARY ID:
2011-003217-41
- NCT ID:
NCT01703390
Conditions
- Metastatic Colorectal Cancer
Interventions
Drug | Synonyms | Arms |
---|
FOLFIRI + Cetuximab | | ERCC-1 high |
modifiedFOLFOX6 + Cetuximab | | ERCC-1 low |
Purpose
This pilot study is being mounted to assess whether treatment assignment by ERCC-1 gene
expression status suggests better clinical results from historical experience in metastatic
colorectal cancer (mCRC). In wild type KRAS mCRC patients treated with either FOLFOX or
FOLFIRI in combination with cetuximab the median response rate is approximately 60-65%.
Biomarker directed treatment in this study may demonstrate that patients with low ERCC-1
treated with FOLFOX and cetuximab, and those with high ERCC-1 treated with FOLFIRI and
cetuximab, will improve response rate to 70-75%. KRAS wild type patients will be treated with
6 cycles of one of the following regimens chosen for optimization based on patient
characteristics (primary treatment phase). Patients with ERCC-1 < 1.7 relative gene
expression of ERCC-1 over ß-actin (ERCC-1 low) will be assigned to treatment with mFOLFOX6 in
combination with Cetuximab. Patients with ERCC-1 gene expression > 1.7 relative gene
expression of ERCC-1 over over ß-actin (ERCC-1 high) will be assigned to treatment with
FOLFIRI in combination with Cetuximab.
Trial Arms
Name | Type | Description | Interventions |
---|
ERCC-1 low | Experimental | modifiedFOLFOX6 + Cetuximab oxaliplatin 85 mg/m2 on day 1, 15 q d29 for 6 cycles folinic acid (FA) 400 mg/m2 on days 1 and 15 and q d29 for 6 cycles fluorouracil (5-FU) 400 mg/m2 bolus day 1 + 2400 mg/m2 46-hour infusion on days 1, 2 and 15, 16 and q d29 for 6 cycles or until unacceptable toxicity Cetuximab will be administered as a 120- minute intravenous infusion at 500 mg/m2 on day 1 then 500 mg/m2 bi-weekly | - modifiedFOLFOX6 + Cetuximab
|
ERCC-1 high | Experimental | FOLFIRI + Cetuximab irinotecan 180 mg/m² on day 1, 15 q d29 for 6 cycles folinic acid (FA)400 mg/m2 on days 1 and 15 and q d29 for 6 cycles fluorouracil (5-FU) 400 mg/m2 bolus + 2400 mg/m2 46-hour infusion on days 1, 2 and 15, 16 and q d29 for 6 cycles or until unacceptable toxicity Cetuximab will be administered as a 120- minute intravenous infusion at 500 mg/m2 on day 1 then 500 mg/m2 bi-weekly | |
Eligibility Criteria
Inclusion Criteria:
1.1 Inclusion criteria for pre-screening phase:
- Untreated advanced metastatic colorectal cancer patients
- Adequate tissue to evaluate for genotyping (10 x 10µm thick formalin fixed paraffin
embedded tissue sections and one corresponding HE stained slide or a FFPE tumor block)
1.2 Inclusion criteria for treatment phase:
Patients must fulfill all criteria listed below prior to enrolment in the study:
- Untreated wild-type KRAS metastatic colorectal cancer
- Previous adjuvant therapy must have been completed > 6 months before therapy
initiation on this study
- Age >18 years
- Measureable disease with CT or MRI
- ECOG performance status of 0-2
- Adequate organ function
- Hematologic:
- Absolute neutrophil count > 1,500/µL
- Hemoglobin >9 mg/dl
- Platelet count >100,000 /µl
- Renal:
- Serum creatinine <1.5 x Upper limit of normal (UPN) or estimated clearance >
30 ml/min
- Hepatic:
- Serum bilirubin < 1.5 mg/dl
Exclusion Criteria:
- Creatinine clearance below 30 ml/min
- Patients with a history of other malignancies within 2 years prior to study entry,
except for adequately treated carcinoma in situ of the cervix; basal or squamous cell
skin cancer; low grade, early stage localized prostate cancer treated surgically with
curative intent; good prognosis DCIS of the breast treated with lumpectomy alone with
curative intent.
- Patients with a history of severe cardiac disease; e.g. NYHA Functional Class III or
IV heart failure, myocardial infarction within 6 months, ventricular tachyarrhythmias
requiring ongoing treatment, or unstable angina.
- Other known co-morbidity with the potential to dominate survival
- Hypersensitivity with anaphylactic reaction to humanized monoclonal antibodies or any
of the applied drugs
- Pregnant or breast feeding women
- Any co-existing medical or psychological condition that would preclude participation
in the study or compromise ability to give informed consent.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Response |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Treatment response according to Response Evaluation Criteria In Solid Tumors [RECIST] |
Secondary Outcome Measures
Measure: | Progression free survival (PFS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | Response rate |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Description of group differences between ERCC-1 low and ERCC-1 high patients with respect to response rate, PFS and OS |
Measure: | Patient characteristics |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Description of group differences between ERCC-1 low and ERCC-1 high patients with respect to KRAS status |
Measure: | Secondary resection rate |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | Molecular markers for toxicity |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | Number of adverse events during study treatment |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Arbeitsgemeinschaft medikamentoese Tumortherapie |
Trial Keywords
- metastatic colorectal cancer
- mCRC
- ERCC-1
- ERCC1
- AGMT
Last Updated
December 21, 2020