Description:
This study involves standard combination chemotherapy treatment for colon cancer,
5-Fluorouracil (5FU), leucovorin and irinotecan (known as FOLFIRI), plus bevacizumab
(Avastin). The study is designed to test the FOLFIRI regimen based on certain characteristics
of a person's genetic makeup or "genes". Genes are made of DNA and determine not only
inherited traits or appearance (hair and eye color, height, body type, etc.) but also play an
important role in health and how the body responds to illness and treatments for those
illnesses.
In this study, the investigators will examine the relationship between a patient's genes
(DNA), or "genotype", and how the patient's body breaks down and removes or "metabolizes" the
anti-cancer drug irinotecan. Circulating blood level of irinotecan plays an important role in
how well this drug works against a patient's cancer as well as the adverse side effects the
patient may experience. The current standard dose of irinotecan was determined in clinical
trials without knowing individual genotypes and thus does not take into account a patient's
ability to metabolize irinotecan. This means that based on one genotype the current standard
dose of irinotecan may be correct or based on other genotypes the standard dose could result
in lower and possibly less effective blood levels and result in significant under-dosing of
irinotecan.
Based on genotype the patient will be assigned to one of the following doses of irinotecan:
- 180 mg/m2 (standard dose)
- 260 mg/m2
- 310 mg/m2
The purpose of this research study is to determine if dosing irinotecan based on genotype is
effective and safe for patients with colon cancer. Patient genotype will be determined from a
small sample of blood and a laboratory test or "assay" performed at UNC Laboratories. For the
purpose of this study, this assay is new and considered to be "investigational". This means
that the genotype assay used in this study has not yet been approved by the FDA for
determining irinotecan dose levels in patients with colon cancer.
Title
- Brief Title: Genotype-Directed Study Of Irinotecan Dosing In FOLFIRI + BevacizumabTreated Metastatic Colorectal Cancer
- Official Title: Genotype-Directed Phase II Study Of Higher Dose Of Irinotecan In First-Line Metastatic Colorectal Cancer Patients Treated With Folfiri Plus Bevacizumab
Clinical Trial IDs
- ORG STUDY ID:
LCCC 1317
- NCT ID:
NCT02138617
Conditions
Interventions
Drug | Synonyms | Arms |
---|
5-Fluorouracil | 5-FU, Adrucil | *1/*1 Genotype |
Leucovorin | LV, leucovorin calcium, folinic acid, citrovorum factor | *1/*1 Genotype |
Irinotecan | Camptosar, Novaplus Irinotecan Hydrochloride | *1/*1 Genotype |
Bevacizumab | Avastin, MVASI | *1/*1 Genotype |
Purpose
This study involves standard combination chemotherapy treatment for colon cancer,
5-Fluorouracil (5FU), leucovorin and irinotecan (known as FOLFIRI), plus bevacizumab
(Avastin). The study is designed to test the FOLFIRI regimen based on certain characteristics
of a person's genetic makeup or "genes". Genes are made of DNA and determine not only
inherited traits or appearance (hair and eye color, height, body type, etc.) but also play an
important role in health and how the body responds to illness and treatments for those
illnesses.
In this study, the investigators will examine the relationship between a patient's genes
(DNA), or "genotype", and how the patient's body breaks down and removes or "metabolizes" the
anti-cancer drug irinotecan. Circulating blood level of irinotecan plays an important role in
how well this drug works against a patient's cancer as well as the adverse side effects the
patient may experience. The current standard dose of irinotecan was determined in clinical
trials without knowing individual genotypes and thus does not take into account a patient's
ability to metabolize irinotecan. This means that based on one genotype the current standard
dose of irinotecan may be correct or based on other genotypes the standard dose could result
in lower and possibly less effective blood levels and result in significant under-dosing of
irinotecan.
Based on genotype the patient will be assigned to one of the following doses of irinotecan:
- 180 mg/m2 (standard dose)
- 260 mg/m2
- 310 mg/m2
The purpose of this research study is to determine if dosing irinotecan based on genotype is
effective and safe for patients with colon cancer. Patient genotype will be determined from a
small sample of blood and a laboratory test or "assay" performed at UNC Laboratories. For the
purpose of this study, this assay is new and considered to be "investigational". This means
that the genotype assay used in this study has not yet been approved by the FDA for
determining irinotecan dose levels in patients with colon cancer.
Detailed Description
This phase II multicenter clinical trial will use a genotype-guided dosing strategy for
irinotecan to prospectively analyze efficacy in 100 metastatic colorectal cancer patients
(mCRC) receiving FOLFIRI (5-fluorouracil (5-FU), leucovorin, irinotecan) plus bevacizumab.
Irinotecan is detoxified and excreted primarily by glucuronidation in the liver via the
isoenzyme uridine diphosphate glucuronosyl transferase (UGT1A1). Common variants in UGT1A1
alter the rate of glucuronidation and thus alter exposure to irinotecan.
The UGT1A1 *28 allele results in slower irinotecan glucuronidation, and thus greater exposure
to its active metabolite SN-38. At the standard irinotecan dose used in FOLFIRI (180 mg/m2;
established prior to our understanding of the importance of genotype in the rate of this
drug's metabolism), there is a small increased risk of neutropenia in *28 homozygotes.
However, the risk of clinically important consequences of neutropenia, such as febrile
neutropenia and infection, are not significantly increased. Patients with other genotypes
have a quite low risk of adverse effects suggesting patients with these low risk genotypes
may tolerate higher doses of irinotecan in FOLFIRI. This finding was demonstrated in a phase
I study in which *1/*28 and *1/*1 genotypes were able to tolerate escalating doses of
irinotecan up to 260 mg/m2 and 310 mg/m2, respectively.
The central hypothesis of this trial is that increasing the irinotecan dose in *1/*28 and
*1/*1 genotypes will increase the overall benefit of FOLFIRI for patients with mCRC as these
two groups are likely under-dosed with the current dosing regimen. Eligible patients will be
genotyped for UGT1A1 and assigned into 1 of 3 different dosing groups, based on their
relative rate of metabolism. The primary objective of this trial is to estimate
progression-free survival (PFS), and secondary objectives include characterization of
toxicity and objective response rate (OR; complete response (CR) + partial response (PR)).
Trial Arms
Name | Type | Description | Interventions |
---|
*1/*1 Genotype | Experimental | FOLFIRI (5-fluorouracil (5-FU), leucovorin, irinotecan) Irinotecan dose 310 mg/m2,(IV, Day 1, 15); Bevacizumab (IV, Day 1, 15), repeat treatment cycle every 28 days. | - 5-Fluorouracil
- Leucovorin
- Irinotecan
- Bevacizumab
|
*1/*28 Genotype | Experimental | FOLFIRI (5-fluorouracil (5-FU), leucovorin, irinotecan) Irinotecan dose 260 mg/m2, FOLFIRI (IV, Day 1, 15); Bevacizumab (IV, Day 1, 15), repeat treatment cycle every 28 days. | - 5-Fluorouracil
- Leucovorin
- Irinotecan
- Bevacizumab
|
*28/*28 | Experimental | FOLFIRI (5-fluorouracil (5-FU), leucovorin, irinotecan) Irinotecan dose 180 mg/m2, FOLFIRI (IV, Day 1, 15); Bevacizumab (IV, Day 1, 15), repeat treatment cycle every 28 days. | - 5-Fluorouracil
- Leucovorin
- Irinotecan
- Bevacizumab
|
Eligibility Criteria
Inclusion Criteria:
Subjects must meet all of the inclusion criteria to participate in this study:
1. IRB-approved informed consent obtained and signed
2. Age ≥ 18 years
3. Histological or cytological documentation of adenocarcinoma of the colon or rectum
4. Measurable or non-measurable (but evaluable) disease as defined via RECIST 1.1
5. Metastatic disease not amenable to surgical resection with curative intent
6. No prior chemotherapy for metastatic disease
7. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (see section 11.1,
Appendix A)
8. Adequate bone marrow, renal and hepatic function, as evidenced by the following:
- absolute neutrophil count (ANC) ≥1,500/mm3
- platelets ≥100,000/mm3
- hemoglobin ≥9.0 g/dL
- serum creatinine ≤1.5 x upper limit of normal (ULN)
- AST and ALT ≤3x ULN ( ≤5.0 × ULN for patients with liver involvement of their
cancer
- Bilirubin ≤1.5 X ULN
- Alkaline phosphatase ≤3 x ULN (≤5 x ULN with liver involvement of their cancer)
9. Willing to undergo UGT1A1 genotyping
10. Negative pregnancy test (urine or serum), within 7 day prior to Day 1 of FOLFIRI in
women of childbearing potential
11. Women of childbearing potential and male subjects must agree to use adequate
contraception for the duration of study participation. Adequate contraception is
defined as any medically recommended method (or combination of methods) as per
standard of care.
Exclusion Criteria
1. UGT1A1 genotype other than *1/*1, *1/*28, or *28/*28
2. Known dihydropyrimidine dehydrogenase (DPD) deficiency
3. Prior treatment with irinotecan and/or bevacizumab
4. Unable or unwilling to discontinue (and substitute if necessary) use of prohibited
drugs for at least 14 days (fruits and juices for at least 7 days) prior to Day 1 of
FOLFIRI + bevacizumab initiation (see section 11.2, Appendix B, for list of prohibited
drugs)
5. Inadequately controlled hypertension (defined as systolic blood pressure > 140 mmHg
and/or diastolic blood pressure > 90 mmHg)
6. Prior history of hypertensive encephalopathy
7. Active cardiac disease including any of the following:
- New York Heart Association (NYHA) Grade II or greater congestive heart failure
(see section 11.3, Appendix C)
- History of myocardial infarction or unstable angina within 6 months prior to Day
1
- History of stroke or transient ischemic attack within 6 months prior to Day 1 of
FOLFIRI + bevacizumab initiation
8. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within 6 months prior to Day 1 of FOLFIRI +
bevacizumab initiation
9. History of hemoptysis (≥ 1/2 teaspoon of bright red blood per episode) within 1 month
prior to Day 1 of FOLFIRI + bevacizumab initiation
10. Evidence of bleeding diathesis or significant coagulopathy (in the absence of
therapeutic anticoagulation)
11. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 1 of FOLFIRI + bevacizumab initiation or anticipation of need for major
surgical procedure during the course of the study
12. Core biopsy or other minor surgical procedure, excluding placement of a vascular
access device, within 7 days prior to Day 1 of FOLFIRI + bevacizumab initiation
13. History of abdominal fistula or gastrointestinal perforation within 6 months prior to
Day 1 of FOLFIRI + bevacizumab initiation
14. Serious, non-healing wound, active ulcer, or untreated bone fracture
15. Proteinuria as demonstrated by:
Urine protein: creatinine (UPC) ratio ≥ 1.0 at screening OR Urine dipstick for
proteinuria ≥ 2+ (patients discovered to have ≥2+ proteinuria on dipstick urinalysis
at baseline should undergo a 24 hour urine collection and must demonstrate ≤ 1g of
protein in 24 hours to be eligible)
16. Any serious uncontrolled medical disorder that would impair the ability of the subject
to receive protocol-driven therapy
17. Other anti-cancer or investigational therapy while patients are on study therapy
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression Free Survival |
Time Frame: | From date of registration until date of first documented progression up to 8 years. |
Safety Issue: | |
Description: | Tumor measurements within 5 days prior to D1 every 2 cycles starting with cycle 3 to include CT/MRI scans of chest, abdomen and pelvis---any additional suspected sites of disease should be evaluated per treating physician discretion.Progression Free Survival is defined as time from day 1 (D1) of treatment to progression or death from any cause. |
Secondary Outcome Measures
Measure: | Number of Participants with adverse events |
Time Frame: | From date of registration up to 8 years. |
Safety Issue: | |
Description: | Toxicity will be classified and graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, version 4.03) |
Measure: | Overall Response |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Estimate Overall Response (OR =Complete Response +Partial Response) in previously untreated mCRC patients receiving FOLFIRI + bevacizumab when irinotecan dose is based on UGT1A1 genotype. OR will be defined per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). |
Measure: | Overall Survival |
Time Frame: | 8 years |
Safety Issue: | |
Description: | Estimate Overall Survival (OS) in previously untreated mCRC patients receiving FOLFIRI + bevacizumab when irinotecan dose is based on UGT1A1 genotype. OS is defined as the time from D1 of treatment to death from any cause |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | UNC Lineberger Comprehensive Cancer Center |
Trial Keywords
- Colon Cancer
- Irinotecan
- FOLFIRI
- Genotyping
- UGT1A1
Last Updated
September 23, 2020