Description:
Background:
Many people with colorectal cancer get liver metastases. Standard treatment for this is a
combination of chemotherapy drugs. Directing the chemotherapy to the liver may be effective.
A device that does this a pump that delivers drugs over 2 weeks at constant rate into the
hepatic artery. The person s body temperature causes the drug to flow from the pump.
Researchers want to see if this helps people with colorectal metastases to the liver.
Objective:
To study the effectiveness of a hepatic artery infusion pump at treating colorectal
metastases to the liver.
Eligibility:
Adults at least 18 years old with colorectal metastases to the liver
Design:
Participants will be screened with:
Medical history
Physical exam
Heart, blood, and urine tests
Scans
Participants will stay in the hospital a few days. A small plastic tube (catheter) will be
inserted in an artery into the liver. The catheter will be attached to the pump. That will
lie under the skin on the abdomen. It will be small and participants will be able to feel it.
Participants will get treatment in 28-day cycles.
Every Day 1, they will have physical exam, symptom review, and blood tests.
Every 2 weeks, they will come to the clinic to get chemotherapy by a catheter or port.
Every 12 weeks, they will have a scan.
Tissue samples may be taken during the study.
When they finish the drug, participants may have the pump removed. They will repeat the Day 1
tests. They will be called every 6 months to see how they are doing.
Sponsoring Institute: National Cancer Institute
Title
- Brief Title: Hepatic Artery Infusion Pump Chemotherapy With Floxuridine and Dexamethasone in Combination With Systemic Chemotherapy for Patients With Colorectal Cancer Metastatic to the Liver
- Official Title: A Single-Arm Phase II Study of Hepatic Artery Infusion Pump Chemotherapy With Floxuridine and Dexamethasone in Combination With Systemic Chemotherapy for Patients With Colorectal Cancer Metastatic to the Liver
Clinical Trial IDs
- ORG STUDY ID:
180024
- SECONDARY ID:
18-C-0024
- NCT ID:
NCT03366155
Conditions
- Colorectal Cancer
- Liver Metastases
- Colorectal Adenocarcinoma
- Colorectal Cancer With Hepatic Metastases
- Colorectal Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
Panitumumab | | 1/Arm 1 |
FUDR-Dex | | 1/Arm 1 |
Oxaliplatin | | 1/Arm 1 |
5FU | | 1/Arm 1 |
Irinotecan | | 1/Arm 1 |
cetuximab | | 1/Arm 1 |
Purpose
Background:
Many people with colorectal cancer get liver metastases. Standard treatment for this is a
combination of chemotherapy drugs. Directing the chemotherapy to the liver may be effective.
A device that does this a pump that delivers drugs over 2 weeks at constant rate into the
hepatic artery. The person s body temperature causes the drug to flow from the pump.
Researchers want to see if this helps people with colorectal metastases to the liver.
Objective:
To study the effectiveness of a hepatic artery infusion pump at treating colorectal
metastases to the liver.
Eligibility:
Adults at least 18 years old with colorectal metastases to the liver
Design:
Participants will be screened with:
Medical history
Physical exam
Heart, blood, and urine tests
Scans
Participants will stay in the hospital a few days. A small plastic tube (catheter) will be
inserted in an artery into the liver. The catheter will be attached to the pump. That will
lie under the skin on the abdomen. It will be small and participants will be able to feel it.
Participants will get treatment in 28-day cycles.
Every Day 1, they will have physical exam, symptom review, and blood tests.
Every 2 weeks, they will come to the clinic to get chemotherapy by a catheter or port.
Every 12 weeks, they will have a scan.
Tissue samples may be taken during the study.
When they finish the drug, participants may have the pump removed. They will repeat the Day 1
tests. They will be called every 6 months to see how they are doing.
Sponsoring Institute: National Cancer Institute
Detailed Description
Background:
- Nearly 60% of patients with colorectal cancers will develop liver metastases over the
course of their disease.
- Of patients with metastatic colorectal cancer, the liver will be the sole site of
recurrence or the survival-limiting site of disease for 20%.
- Liver directed therapy, which has taken many forms over the last several decades, is a
potential means to prolong survival for properly selected patients and delay progression
at that site.
- Hepatic artery infusion of floxuridine (FUDR) via an implantable hepatic artery infusion
pump (HAIP) induces objective clinical response rates of nearly 50% in heavily
pretreated patients with metastatic colorectal cancer to the liver.
- The identification of patients likely to respond to HAIP and those likely to suffer
pumprelated adverse events is currently unknown, and has limited the wide-spread
adoption of this otherwise well tolerated intervention.
Objective:
-To assess the safety of hepatic artery infusion therapy using the Medtronic pump with the
Codman catheter.
- To determine the response rate in patients with unresectable metastatic colorectal cancer
treated with HAIP chemotherapy as measured by RECIST.
Eligibility:
- Histologically or cytologically confirmed colorectal adenocarcinoma metastatic to the
liver.
- Patients with liver metastases not amenable to resection to No Evidence of Disease (NED)
in one stage.
- Patients must have received systemic chemotherapy.
- Age greater than or equal to 18 years.
Design:
- Single arm, phase II study of HAIP chemotherapy.
Trial Arms
Name | Type | Description | Interventions |
---|
1/Arm 1 | Experimental | HAIP chemotherapy + Systemic chemotherapy | - Panitumumab
- FUDR-Dex
- Oxaliplatin
- 5FU
- Irinotecan
- cetuximab
|
Eligibility Criteria
- INCLUSION CRITERIA:
- Patients must have histologically or cytologically confirmed diagnosis of colorectal
adenocarcinoma, confirmed by the Laboratory of Pathology, NCI.
- Patients must have measurable liver metastatic disease.
- Patients must have progressed on, been intolerant of or have residual disease after
oxaliplatin- or irinotecan-containing, fluorouracil-based, chemotherapeutic regimen.
- Age greater than or equal to 18 years.
- ECOG performance status less than or equal to 1
- Patients must have adequate organ and marrow function as defined below:
- leukocytes > 3,000/mcL
- absolute neutrophil count > 1,500/mcL
- platelets > 90,000/mcL
- total bilirubin < 1.5 X institutional upper limit of normal
- AST(SGOT)/ALT(SGPT) < 2.5 X institutional upper limit of normal
- creatinine within normal institutional limits OR eGFR within normal as predicted
by the CKD-EPI equation > 60 mL/min/1.73 m2.
- The hepatic artery infusion pump chemotherapy has potential teratogenic and/or
abortifacient effects. For this reason, women of child-bearing potential and men must
agree to use adequate contraception (hormonal or barrier method of birth control;
abstinence) prior to study entry, for the duration of study participation and for 3
months after completion of study treatment. Should a woman become pregnant or suspect
she is pregnant while she or her partner is participating in this study, she should
inform her treating physician immediately.
- Arterial anatomy on CT angiogram amenable to placement of the HAIP.
- Ability of subject to understand and the willingness to sign a written informed
consent document.
- HIV-positive patients may be considered for this study only after consultation with an
HIV trained physician.
- Patients must agree to co-enroll on the Surgical Oncology Program s tissue collection
protocol 13C0176, 'Tumor, Normal Tissue and Specimens from Patients Undergoing
Evaluation or Surgical Resection of Solid Tumors'
EXCLUSION CRITERIA:
- Patients with liver metastases amenable to resection to No Evidence of Disease (NED)
in one stage.
- Patients who are receiving any other investigational agents.
- Patients with incontrovertible radiographic evidence of disease outside of the
colon/rectum (primary) and liver given unlikelihood of benefit from liver-directed
therapy.
Note: The exception to this exclusion is patients with fewer than five lung lesions greater
than 1 cm that have not increased in size by more than 10% over a 4-month period of time,
and are amenable to resection should subsequent problematic growth occur. Lesions less than
1 cm are indeterminant as far as etiology is concerned and will be ignored. Patients with
liver metastases and oligometastatic lung lesions (we define oligometastatic as less than 5
amen ble to thoracoscopic removal) are still likely to benefit from liver directed therapy.
- Patients who have undergone extra-hepatic metastasectomy and have a documented
disease-free interval less than or equal to 4 months.
- MSI-high patients who need to be treated with a check-point inhibitors
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements. This also includes any condition, including the presence of
laboratory abnormalities, which in the opinion of the Principal Investigator places
the subject at unacceptable risk if they were to participate in the study or confounds
the ability to interpret data from the study.
- Active concurrent malignancies within the last five years other than colorectal
primary except basal cell skin carcinoma and thyroid carcinoma.
- Prior radiation to liver.
- Pregnant women are excluded from this study because of the potential for teratogenic
or abortifacient effects of the HAIP chemotherapy. Because there is an unknown but
potential risk for adverse events in nursing infants secondary to treatment of the
mother with HAIP, breastfeeding should be discontinued if the mother is treated. These
potential risks may also apply to other agents used in this study.
- Patients with active Hepatitis B or C infection because of the potential for increased
liver toxicity given the damaging effects of the virus.
- History of allergic reactions attributed to compounds of similar chemical composition
to FUDR or heparin.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Response rate RR |
Time Frame: | at progression |
Safety Issue: | |
Description: | The fraction of patients who experience a PR or CR using the study treatment |
Secondary Outcome Measures
Measure: | Hepatic progression-free survival |
Time Frame: | at progression |
Safety Issue: | |
Description: | The fraction of patients whose tumors in liver shrunk after therapy |
Measure: | Extra-hepatic progression-free survival |
Time Frame: | at progression |
Safety Issue: | |
Description: | The fraction of patients whose tumors outside liver shrunk after therapy |
Measure: | Overall survival |
Time Frame: | death |
Safety Issue: | |
Description: | Median amount of time subject survives after therapy |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- Unresectable Liver Tumor
- Response Rates
- Progression-Free Survival
- Patient Survival
Last Updated
July 13, 2021