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S1613, Trastuzumab and Pertuzumab or Cetuximab and Irinotecan Hydrochloride in Treating Patients With Locally Advanced or Metastatic HER2/Neu Amplified Colorectal Cancer That Cannot Be Removed by Surgery

NCT03365882

Description:

This randomized phase II trial studies how well trastuzumab and pertuzumab work compared to cetuximab and irinotecan hydrochloride in treating patients with HER2/neu amplified colorectal cancer that has spread from where it started to other places in the body and cannot be removed by surgery. Monoclonal antibodies, such as trastuzumab and pertuzumab, may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as cetuximab 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 trastuzumab and pertuzumab may work better compared to cetuximab and irinotecan hydrochloride in treating patients with colorectal cancer.

Related Conditions:
  • Colorectal Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: S1613, Trastuzumab and Pertuzumab or Cetuximab and Irinotecan Hydrochloride in Treating Patients With Locally Advanced or Metastatic HER2/Neu Amplified Colorectal Cancer That Cannot Be Removed by Surgery
  • Official Title: S1613, A Randomized Phase II Study of Trastuzumab and Pertuzumab (TP) Compared to Cetuximab and Irinotecan (CETIRI) in Advanced/Metastatic Colorectal Cancer (mCRC) With HER-2 Amplification

Clinical Trial IDs

  • ORG STUDY ID: S1613
  • SECONDARY ID: NCI-2016-01422
  • SECONDARY ID: S1613
  • SECONDARY ID: S1613
  • SECONDARY ID: S1613
  • SECONDARY ID: U10CA180888
  • NCT ID: NCT03365882

Conditions

  • Colon Adenocarcinoma
  • ERBB2 Gene Amplification
  • Rectal Adenocarcinoma
  • Recurrent Colon Carcinoma
  • Recurrent Rectal Carcinoma
  • Stage III Colon Cancer AJCC v7
  • Stage III Rectal Cancer AJCC v7
  • Stage IIIA Colon Cancer AJCC v7
  • Stage IIIA Rectal Cancer AJCC v7
  • Stage IIIB Colon Cancer AJCC v7
  • Stage IIIB Rectal Cancer AJCC v7
  • Stage IIIC Colon Cancer AJCC v7
  • Stage IIIC Rectal Cancer AJCC v7
  • Stage IV Colon Cancer AJCC v7
  • Stage IV Rectal Cancer AJCC v7
  • Stage IVA Colon Cancer AJCC v7
  • Stage IVA Rectal Cancer AJCC v7
  • Stage IVB Colon Cancer AJCC v7
  • Stage IVB Rectal Cancer AJCC v7

Interventions

DrugSynonymsArms
CetuximabChimeric Anti-EGFR Monoclonal Antibody, Chimeric MoAb C225, Chimeric Monoclonal Antibody C225, Erbitux, IMC-C225Arm II (cetuximab, irinotecan hydrochloride)
Irinotecan HydrochlorideCampto, Camptosar, Camptothecin 11, Camptothecin-11, CPT 11, CPT-11, Irinomedac, U-101440EArm II (cetuximab, irinotecan hydrochloride)
Pertuzumab2C4, 2C4 Antibody, MoAb 2C4, Monoclonal Antibody 2C4, Perjeta, rhuMAb2C4, RO4368451Arm I (pertuzumab, trastuzumab)
TrastuzumabABP 980, Anti-c-ERB-2, Anti-c-erbB2 Monoclonal Antibody, Anti-ERB-2, Anti-erbB-2, Anti-erbB2 Monoclonal Antibody, Anti-HER2/c-erbB2 Monoclonal Antibody, Anti-p185-HER2, c-erb-2 Monoclonal Antibody, HER2 Monoclonal Antibody, Herceptin, Herceptin Biosimilar PF-05280014, Herceptin Trastuzumab Biosimilar PF-05280014, MoAb HER2, Monoclonal Antibody c-erb-2, Monoclonal Antibody HER2, PF-05280014, rhuMAb HER2, RO0452317, Trastuzumab Biosimilar ABP 980, Trastuzumab Biosimilar PF-05280014Arm I (pertuzumab, trastuzumab)

Purpose

This randomized phase II trial studies how well trastuzumab and pertuzumab work compared to cetuximab and irinotecan hydrochloride in treating patients with HER2/neu amplified colorectal cancer that has spread from where it started to other places in the body and cannot be removed by surgery. Monoclonal antibodies, such as trastuzumab and pertuzumab, may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as cetuximab 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 trastuzumab and pertuzumab may work better compared to cetuximab and irinotecan hydrochloride in treating patients with colorectal cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To evaluate the efficacy of trastuzumab and pertuzumab (TP) (Arm 1) in HER-2 amplified
      metastatic colorectal cancer (mCRC) by comparing progression-free survival (PFS) on TP
      compared to control arm (Arm 2) of cetuximab and irinotecan hydrochloride (irinotecan)
      (CETIRI).

      SECONDARY OBJECTIVES:

      I. To evaluate the overall response rate (ORR), including confirmed complete and partial
      response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, in treatment Arms 1
      and 2.

      II. To evaluate the overall survival (OS) in treatment Arms 1 and 2. III. To evaluate the
      safety and toxicity of TP compared to CETIRI.

      TERTIARY OBJECTIVES:

      I. To estimate the rates of PFS, OS, and ORR in patients who crossover to TP (Arm 3) after
      disease progression on CETIRI.

      II. To bank images for future retrospective analysis. III. To evaluate if HER-2/centromeric
      probe (CEP17) signal ratio and HER-2 gene copy number (GCN) are predictive of clinical
      efficacy for patients receiving TP versus CETIRI.

      IV. To bank tissue and blood samples for other future correlative studies from patients
      enrolled on the study.

      OUTLINE: Patients with HER2 gene amplification are randomized to 1 of 2 arms.

      ARM I: Patients receive pertuzumab intravenously (IV) over 30-60 minutes and trastuzumab IV
      over 30-120 minutes on day 1. Courses repeat every 21 days in the absence of disease
      progression or unacceptable toxicity.

      ARM II: Patients receive cetuximab IV over 60-120 minutes and irinotecan hydrochloride IV
      over 90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression
      or unacceptable toxicity. Patients with documented disease progression may optionally
      crossover to Arm I.

      After completion of study treatment, patients are followed up for 3 years.
    

Trial Arms

NameTypeDescriptionInterventions
Arm I (pertuzumab, trastuzumab)ExperimentalPatients receive pertuzumab IV over 30-60 minutes and trastuzumab IV over 30-120 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Pertuzumab
  • Trastuzumab
Arm II (cetuximab, irinotecan hydrochloride)ExperimentalPatients receive cetuximab IV over 60-120 minutes and irinotecan hydrochloride IV over 90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may optionally crossover to Arm I.
  • Cetuximab
  • Irinotecan Hydrochloride

Eligibility Criteria

        Inclusion Criteria:

          -  STEP 1 INITIAL REGISTRATION: HER2 TESTING

          -  Patients must have histologically or cytologically documented adenocarcinoma of the
             colon or rectum that is metastatic or locally advanced and unresectable

          -  Mutation results:

               -  All patients must have molecular testing performed in a Clinical Laboratory
                  Improvement Act (CLIA) certified lab which includes which includes KRAS and NRAS
                  gene and exon 15 of BRAF gene (BRAF V600E mutation); patients with any known
                  activating mutation in exon 2 [codons 12 and 13], exon 3 [codons 59 and 61] and
                  exon 4 [codons 117 and 146]) of KRAS/NRAS genes and in exon 15 (BRAFV600E
                  mutation) of BRAF gene are not eligible

          -  Patients must not have been treated with any of the following prior to step 1 initial
             registration:

               -  Cetuximab, panitumumab, or any other monoclonal antibody against EGFR or
                  inhibitor of EGFR

               -  HER-2 targeting for treatment of colorectal cancer; patients who have received
                  prior trastuzumab or pertuzumab for other indications such as prior history of
                  adjuvant or neoadjuvant breast cancer treatment prior to the development of
                  advanced colorectal cancer are eligible

          -  Patients must not have had history of severe toxicity and intolerance to or
             hypersensitivity to irinotecan or any other study drug; patients must not have had a
             severe infusion-related reaction during any prior therapy with pertuzumab or
             trastuzumab

          -  Patients must have tumor slides available for submission for HER-2 testing; HER-2
             testing must be completed by the central lab prior to step 2 randomization

          -  Patients must be informed of the investigational nature of this study and must sign
             and give informed consent in accordance with institutional and federal guidelines; for
             step 1 initial registration, the appropriate consent form is the step 1 consent form

          -  As a part of the OPEN registration process the treating institution's identity is
             provided in order to ensure that the current (within 365 days) date of institutional
             review board approval for this study has been entered in the system

          -  STEP 2 RANDOMIZATION

          -  Patients must have HER-2 amplification as determined by central testing (3+ or 2+ by
             immunohistochemistry and HER-2 gene amplification by in situ hybridization with a
             ratio of HER-2 gene signals to centromere 17 signals >= 2.0)

          -  Patients must have measurable disease that is metastatic or locally advanced and
             unresectable; imaging used to assess all disease per RECIST 1.1 must have been
             completed within 28 days prior to step 2 randomization; all disease must be assessed
             and documented on the Baseline Tumor Assessment Form

          -  Patients must have had at least one prior regimen of systemic chemotherapy for
             metastatic or locally advanced, unresectable disease; patients must have progressed
             following the most recent therapy; prior treatment with irinotecan is allowed; for
             patients that received adjuvant chemotherapy: prior treatment for metastatic disease
             is not required for patient who experienced disease recurrence during or within 6
             months of completion of adjuvant chemotherapy; if the patient received one line of
             adjuvant treatment and had disease recurrence after 6 months of completing
             chemotherapy, patients will only be eligible after failing one additional line of
             chemotherapy used to treat the metastatic or locally advanced, unresectable disease;
             patients who have received >= 3 lines of systemic chemotherapy for metastatic or
             locally advanced, unresectable disease are not eligible

          -  Patients must have completed prior chemotherapy, immunotherapy, or radiation therapy
             at least 14 days prior to step 2 randomization and all toxicity must be resolved to
             Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0 grade 1 (with
             the exception of CTCAE v4.0 grade 2 neuropathy) prior to step 2 randomization

          -  Brain metastases are allowed if they have been adequately treated with radiotherapy or
             surgery and stable for at least 30 days prior to step 2 randomization; eligible
             patients must be neurologically asymptomatic and without corticosteroid treatment for
             at least 7 days prior to step 2 randomization

          -  Patients must have a Zubrod performance status of 0 or 1

          -  Patients must have a complete physical examination and medical history within 28 days
             prior to step 2 randomization

          -  Absolute neutrophil count (ANC) >= 1,500/mcL

          -  Platelets >= 75,000/mcL

          -  Hemoglobin >= 9 g/dL

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) both =< 5 x
             institutional upper limit of normal (IULN)

          -  Bilirubin =< 1.5 mg/dL

          -  Calculated creatinine clearance > 30 ml/min within 14 days prior to step 2
             randomization

          -  Patients who have had an echocardiogram performed within 6 months prior to step 2
             randomization must have ventricular ejection fraction (left ventricular ejection
             fraction [LVEF]) >= 50% or >= within normal limits for the institution

          -  Patients must not have an uncontrolled intercurrent illness including, but not limited
             to diabetes, hypertension, severe infection, severe malnutrition, unstable angina,
             class III-IV New York Heart Association (NYHA) congestive heart failure, ventricular
             arrhythmias, active ischemic heart disease, or myocardial infarction within 6 months
             prior to step 2 randomization

          -  Patients must not have any known previous or concurrent condition suggesting
             susceptibility to hypersensitivity or allergic reactions, including, but not limited
             to: known hypersensitivity to any of the study treatments or to excipients of
             recombinant human or humanized antibodies; patients with mild or seasonal allergies
             may be included after discussion with the study chairs

          -  Patients must not be planning treatment with other systemic anti-cancer agents (e.g.,
             chemotherapy, hormonal therapy, immunotherapy) or other treatments not part of
             protocol-specified anti-cancer therapy including concurrent investigational agents of
             any type

          -  No prior malignancy is allowed except for adequately treated basal cell or squamous
             cell skin cancer, in situ cervical cancer, ductal carcinoma in situ, other low grade
             lesions such as incidental appendix carcinoid, or any other cancer from which the
             patient has been disease and treatment free for two years; prostate cancer patients on
             active surveillance are eligible

          -  Patients must not be pregnant or nursing; females of child-bearing potential must have
             a negative serum pregnancy test within 7 days prior to registration; women/men of
             reproductive potential must have agreed to use an effective contraceptive method while
             on study and for at least 7 months after the last dose of study treatment; a woman is
             considered to be of "reproductive potential" if she has had menses at any time in the
             preceding 12 consecutive months; in addition to routine contraceptive methods,
             "effective contraception" also includes heterosexual celibacy and surgery intended to
             prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a
             hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any
             point a previously celibate patient chooses to become heterosexually active during the
             time period for use of contraceptive measures outlined in the protocol, he/she is
             responsible for beginning contraceptive measures

          -  Patients must be given the opportunity to consent to the optional submission of tissue
             for future research

          -  Patients must be informed of the investigational nature of this study and must sign
             and give written informed consent in accordance with institutional and federal
             guidelines; the appropriate consent form for this registration is the step 2 consent
             form

          -  STEP 2 RANDOMIZATION: As a part of the Oncology Patient Enrollment Network (OPEN)
             registration process the treating institution's identity is provided in order to
             ensure that the current (within 365 days) date of institutional review board approval
             for this study has been entered in the system

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Patients must have documented disease
             progression while on CETIRI (Arm 2) on this protocol; the Follow-up Tumor Assessment
             Form documenting disease progression must be submitted to Southwest Oncology Group
             (SWOG) prior to step 3 crossover registration; registration to step 3 crossover must
             be within 28 days of discontinuation of CETIRI protocol treatment; patients going off
             treatment for any other reason are not eligible

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Patients must have a Zubrod performance
             status of 0 or 1

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): ANC >= 1,500/mcL

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Platelets >= 75,000/mcL

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Hemoglobin >= 9 g/dL

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): AST and ALT both =< 5 x institutional upper
             limit of normal (IULN)

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Bilirubin =< 1.5 mg/dL

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Calculated creatinine clearance > 30 ml/min
             within 14 days prior to step 3 crossover registration

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Patients must have left ventricular ejection
             fraction (LVEF) >= 50% or >= lower limit of normal for the institution by
             echocardiogram within 14 days prior to step 3 crossover registration

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Patients must have a magnesium, potassium,
             calcium, sodium, bicarbonate, and chloride performed within 14 days prior to step 3
             crossover registration

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): Patients must be informed of the
             investigational nature of this study and must sign and give written informed consent
             in accordance with institutional and federal guidelines; the appropriate consent form
             for this registration is the step 2 consent form

          -  STEP 3 CROSSOVER REGISTRATION (OPTIONAL): As a part of the OPEN registration process
             the treating institution's identity is provided in order to ensure that the current
             (within 365 days) date of institutional review board approval for this study has been
             entered in the system
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression-free survival (PFS)
Time Frame:From date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 3 years
Safety Issue:
Description:Analysis of PFS will be conducted using the stratified log rank test upon the observation of 115 PFS events. PFS among patients who register to Arm 3 will be summarized using descriptive statistics.

Secondary Outcome Measures

Measure:Incidence of adverse events
Time Frame:Up to 3 years
Safety Issue:
Description:Evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0.
Measure:Overall response rate (ORR)
Time Frame:Up to 3 years
Safety Issue:
Description:ORR including confirmed complete and partial responses per Response Evaluation Criteria in Solid Tumors 1.1 will be compared using using the Cochran-Mantel-Haenszel test. ORR among patients who register to Arm 3 will be summarized using descriptive statistics.
Measure:Overall survival (OS)
Time Frame:From date of registration to date of death due to any cause, assessed up to 3 years
Safety Issue:
Description:Distributions of OS in each arm will be estimated using the method of Kaplan-Meier and compared using the stratified log-rank test. OS among patients who register to Arm 3 will be summarized using descriptive statistics.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Southwest Oncology Group

Last Updated

May 13, 2021