Clinical Trials /

FOLFIRI and Panitumumab in Treating Patients With RAS and BRAF Wild-Type Metastatic Colorectal Cancer

NCT02508077

Description:

This phase II trial studies how well fluorouracil, leucovorin calcium, and irinotecan hydrochloride (FOLFIRI) together with panitumumab work in treating patients with colorectal cancer that expresses the RAS and B-Raf proto-oncogene, serine/threonine kinase (BRAF) wild-type genes, has spread from the original site of growth to another part of the body (metastatic), resists the effects of treatment with prior cetuximab (or panitumumab) plus irinotecan hydrochloride-based therapy, and who have failed at least one subsequent non-anti-epidermal growth factor receptor (EGFR) containing treatment regimen. Drugs used in chemotherapy, such as fluorouracil, leucovorin calcium, and irinotecan hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more tumor cells. Monoclonal antibodies, such as panitumumab, may block tumor growth in different ways by targeting certain cells. Giving FOLFIRI together with panitumumab may be an effective treatment for colorectal cancer.

Related Conditions:
  • Colorectal Carcinoma
Recruiting Status:

Terminated

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: FOLFIRI and Panitumumab in Treating Patients With RAS and BRAF Wild-Type Metastatic Colorectal Cancer
  • Official Title: A Prospective Study of FOLFIRI Plus Panitumumab in Extended RAS Wild Type and BRAF Wild Type Metastatic Colorectal Cancer With Acquired Resistance to Prior Cetuximab (or Panitumumab) Plus Irinotecan-Based Therapy and Who Failed at Least One Subsequent Non-anti-EGFR Containing Regimen

Clinical Trial IDs

  • ORG STUDY ID: 15117
  • SECONDARY ID: NCI-2015-01241
  • SECONDARY ID: 118713
  • SECONDARY ID: 15117
  • NCT ID: NCT02508077

Conditions

  • Recurrent Colorectal Carcinoma
  • Stage IVA Colorectal Cancer
  • Stage IVB Colorectal Cancer

Interventions

DrugSynonymsArms
Fluorouracil5-Fluoro-2,4(1H, 3H)-pyrimidinedione, 5-Fluorouracil, 5-Fluracil, 5-FU, AccuSite, Actino-Hermal, Adrucil, Arumel, Cytosafe, Efudex, Efurix, Fiverocil, Fluoro Uracil, Fluoroplex, Fluouracil, Flurablastin, Fluracedyl, Fluracil, Fluril, Fluroblastin, Flurox, Ribofluor, Ro 2-9757, Ro-2-9757, TimazinTreatment (panitumumab and FOLFIRI)
Irinotecan HydrochlorideCampto, Camptosar, Camptothecin 11, Camptothecin-11, CPT 11, CPT-11, U-101440ETreatment (panitumumab and FOLFIRI)
Leucovorin CalciumAdinepar, Calcifolin, Calcium (6S)-Folinate, Calcium Folinate, Calcium Leucovorin, Calfolex, Calinat, Cehafolin, Citofolin, Citrec, Citrovorum Factor, Cromatonbic Folinico, Dalisol, Disintox, Divical, Ecofol, Emovis, Factor, Citrovorum, Flynoken A, Folaren, Folaxin, FOLI-cell, Foliben, Folidan, Folidar, Folinac, Folinate Calcium, folinic acid, Folinic Acid Calcium Salt Pentahydrate, Folinoral, Folinvit, Foliplus, Folix, Imo, Lederfolat, Lederfolin, Leucosar, leucovorin, Rescufolin, Rescuvolin, Tonofolin, WellcovorinTreatment (panitumumab and FOLFIRI)
PanitumumabABX-EGF, ABX-EGF Monoclonal Antibody, ABX-EGF, Clone E7.6.3, MoAb ABX-EGF, Monoclonal Antibody ABX-EGF, VectibixTreatment (panitumumab and FOLFIRI)

Purpose

This phase II trial studies how well fluorouracil, leucovorin calcium, and irinotecan hydrochloride (FOLFIRI) together with panitumumab work in treating patients with colorectal cancer that expresses the RAS and B-Raf proto-oncogene, serine/threonine kinase (BRAF) wild-type genes, has spread from the original site of growth to another part of the body (metastatic), resists the effects of treatment with prior cetuximab (or panitumumab) plus irinotecan hydrochloride-based therapy, and who have failed at least one subsequent non-anti-epidermal growth factor receptor (EGFR) containing treatment regimen. Drugs used in chemotherapy, such as fluorouracil, leucovorin calcium, and irinotecan hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more tumor cells. Monoclonal antibodies, such as panitumumab, may block tumor growth in different ways by targeting certain cells. Giving FOLFIRI together with panitumumab may be an effective treatment for colorectal cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Estimate the response rate (RR) and progression-free survival (PFS) with FOLFIRI +
      panitumumab in patients with acquired resistance to panitumumab (or cetuximab) + irinotecan
      (irinotecan hydrochloride)-based therapy after a documented clinical response or prolonged
      PFS and following progression on a subsequent non-anti-EGFR containing regimen in extended
      RAS wild-type and BRAF wild-type patients.

      SECONDARY OBJECTIVES:

      I. Estimate the overall survival (OS) in the re-challenge populations.

      II. Describe the safety of re-challenge in this population.

      III. Investigate the impact of PFS, RR on prior anti-EGFR + irinotecan-based exposure on the
      response and PFS on the current study.

      TERTIARY OBJECTIVES:

      I. Collect serial plasma samples to investigate the incidence of RAS and BRAF mutation in
      circulating free deoxyribonucleic acid (DNA) at baseline, every 2 months, and at the time to
      progression (and following progression when feasible).

      II. Collect serial plasma samples for future biomarker exploration, including the potential
      investigation of micro-ribonucleic acid (RNA).

      OUTLINE:

      Patients receive panitumumab intravenously (IV) over 30-90 minutes, irinotecan hydrochloride
      IV over 90 minutes, leucovorin calcium orally (PO), and fluorouracil IV over 46 hours on day
      1. Courses repeat every 2 weeks in the absence of disease progression or unacceptable
      toxicity.

      After completion of study treatment, patients are followed up at 30 days and then every 3
      months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (panitumumab and FOLFIRI)ExperimentalPatients receive panitumumab IV over 30-90 minutes, irinotecan hydrochloride IV over 90 minutes, leucovorin calcium PO, and fluorouracil IV over 46 hours on day 1. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity.
  • Fluorouracil
  • Irinotecan Hydrochloride
  • Leucovorin Calcium
  • Panitumumab

Eligibility Criteria

        Inclusion Criteria:

          -  Participant must have the ability to understand and the willingness to sign a written
             informed consent document

          -  Participant must be willing to comply with study and/or follow-up procedures

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0-2

          -  Life expectancy of 3 >= months

          -  Histologically confirmed colon or rectal cancer with metastatic disease

          -  Extended RAS and BRAF wild type status documented on archival tumor tissue or on fresh
             biopsy if no archival tissue present

          -  Measurable disease defined by at least 1 lesion >= 1 cm

          -  Documented objective response or stable disease lasting for 6 months or more to last
             prior anti-EGFR (cetuximab or panitumumab) in combination with irinotecan or FOLFIRI

          -  Progression within 6 weeks following their last dose of anti-EGFR therapy

          -  Treatment with a non-EGFR targeting regimen following progression on anti-EGFR plus
             irinotecan-based therapy

          -  At least 4 months from prior anti-EGFR therapy prior to start of study treatment

          -  At least three weeks from any non-anti-EGFR therapy prior to start of study treatment;
             any number of prior therapies is permitted

          -  Adequate recovery in the investigators opinion from any clinically significant
             toxicity from prior therapy

          -  Absolute neutrophil count (ANC) >= 1.5 x 10^9/L

          -  Hemoglobin (Hgb) >= 9 g/dL without transfusions

          -  Platelets (PLT) >= 100 x 10^9/L without transfusions

          -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])
             and/or alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 2.5 x upper limit of normal (ULN); patient with liver metastases =< 5 x ULN

          -  Total bilirubin =< ULN

          -  Creatinine =< 1.5 mg/dL

          -  Magnesium >= 1.2mg/dL or 0.5 mmol/L

          -  Negative serum beta-human chorionic gonadotropin (HCG) test (female patient of
             childbearing potential only), to be performed locally within the screening period

          -  Agreement by females of childbearing potential and sexually active males to use an
             effective method of contraception (hormonal or barrier method of birth control or
             abstinence) prior to study entry and for three months following duration of study
             participation; should a woman become pregnant or suspect that she is pregnant while
             participating on the trial, she should inform her treating physician immediately

        Exclusion Criteria:

          -  History of severe anti-EGFR toxicity requiring drug discontinuation or
             dose-modification within the first 4 months of prior anti-EGFR therapy

          -  History of intolerance to irinotecan at dose-intensity of 125 mg/m^2/2 weeks or lower

          -  History of intolerance to 5-FU at dose-intensity of 1800 mg/m^2/2 weeks or lower

          -  Current use (or planned use during the treatment period) of other investigational
             agents, or biological, chemotherapy, radiation or other anti-tumor therapy

          -  Co-medication that may interfere with study results; e.g. immuno-suppressive agents
             other than corticosteroids, such as systemic cyclosporine and tacrolimus

          -  No St John's wort supplement or other herbal supplementation is allowed while on
             trial; patients are not to take grapefruit juice during study treatment

          -  Use of drugs known to inhibit UDP glycosyltransferase 1 family, polypeptide A1 gene
             (UGT1A1), such as Atazanavir, Gemfibrozil, Indinavir, or Ketoconazole while on study
             treatment; (patients using these drugs must not take these drugs on the day study
             treatment begins and for the duration of study treatment)

          -  Planned use of strong cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4)
             inhibitors or CYP3A4 inducers while on study treatment unless deemed clinically
             necessary with no reasonable alternatives and with expressed permission from the
             principal investigator

          -  If on anticoagulation, participant must be on stable therapeutic dose prior to
             enrollment

          -  Impairment of gastrointestinal function or gastrointestinal disease (e.g., active
             ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome,
             extensive small bowel resection)

          -  Major surgery =< 3 weeks prior to starting study drug or who have not recovered from
             side effects of such procedure

          -  Unstable pulmonary embolism, deep vein thrombosis, or other significant
             arterial/venous thromboembolic event =< 30 days before enrollment

          -  Clinically significant cardiovascular disease (including myocardial infarction,
             unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac
             arrhythmia) =< 6 months prior to enrollment

          -  History of interstitial lung disease (ILD) eg, interstitial pneumonitis, pulmonary
             fibrosis or evidence of ILD on baseline chest computed tomography (CT) or magnetic
             resonance imaging (MRI)

          -  Other active malignancies except cervical carcinomas in situ or clinically
             insignificant non-melanoma skin cancers

          -  Clinically significant uncontrolled illness or active infections

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to irinotecan, 5-FU, leucovorin or any of the products to be administered
             during dosing

          -  Pregnant women and women who are lactating; breastfeeding should be discontinued if
             the mother is enrolled on this study

          -  Any other condition that would, in the Investigator's judgment, contraindicate the
             patient's participation in the clinical study due to safety concerns or compliance
             with clinical study procedures, e.g., infection/inflammation, intestinal obstruction,
             unable to swallow medication, social/psychological issues, etc

          -  Prospective participants who, in the opinion of the investigator, may not be able to
             comply with all study procedures (including compliance issues related to
             feasibility/logistics)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:4-month Progression-free Survival (PFS) Rate
Time Frame:At 4 months
Safety Issue:
Description:PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. Will be estimated using the product-limit method of Kaplan and Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum on study (including baseline sum), or a measurable increase in a non-target lesion, or the appearance of new lesions.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Terminated
Lead Sponsor:City of Hope Medical Center

Last Updated

August 16, 2018