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Cetuximab Plus Biweekly Capecitabine and Oxaliplatin in KRAS Wild Type Metastatic Colorectal Cancer

Primary Purpose

Colorectal Cancer, Neoplasm Metastasis

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cetuximab
Oxaliplatin
Capecitabine
Sponsored by
NYU Langone Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring Previously untreated metastatic colorectal cancer, Metastatic Colorectal Cancer, combined therapy, biologics therapy, antibody, chemotherapy, EGFR, epidermal growth factor receptor

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subjects must have signed an approved informed consent.
  • Histologically confirmed diagnosis of advanced adenocarcinoma of the colon or rectum, with KRAS wild type on mutational analysis.
  • No prior chemotherapy for metastatic disease (chemotherapy naive). Prior adjuvant therapy with 5FU/LV or IFL (irinotecan, fluorouracilis, and leucovorin (folinic acid)) permitted if completed at least six months prior to entering this study.
  • Measurable disease by RECIST criteria as defined in Section 3.3.1.
  • Subjects for whom tumor tissue is available for IHC ( Immunohistochemistry) testing for EGFR expression.
  • ECOG (Eastern Cooperative Oncology Group) Performance Status 0-1.
  • Recovery in full from any previous surgical procedure.
  • Expected survival greater than 12 weeks.
  • Subjects at least 18 years of age.
  • Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 4 weeks after the study in such a manner that the risk of pregnancy is minimized. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours prior to the start of study medication.
  • Adequate hematologic function defined by an absolute neutrophil count (ANC) > 1,500/mm3, a platelet count > 100,000/mm3 .
  • Adequate hepatic function defined by a total bilirubin level no greater than 2.0 times the upper limit of normal (ULN) and AST (Aspartate Aminotransferase) and ALT (alanine transaminase) levels noo greater than 2.5 times the ULN (AST and ALT levels no greater than 5 times the ULN in the presence of liver metastases).
  • Adequate renal function defined by a serum creatinine level no greater than 1.5 times the ULN.

Exclusion Criteria:

  • WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 4 weeks after the study.
  • Women who are pregnant or breastfeeding.
  • Women with a positive pregnancy test on enrollment or prior to study drug administration.
  • Sexually active fertile men not using effective birth control if their partners are women of child-bearing potential.
  • Subjects with > Grade 1 neuropathy.
  • Any active or uncontrolled infection.
  • History of myocardial infarction within the previous six months or current clinical evidence of congestive heart failure.
  • History of any other cancer (except nonmelanoma skin cancer or carcinoma in situ of the cervix) unless in complete remission and off all therapy for that cancer for at least 5 years.
  • Central nervous system metastases.
  • Pregnant or lactating women. Men and women of reproductive potential must agree to use an effective contraceptive method.
  • Medical or psychiatric disorders that would interfere with informed consent or make them a poor risk for participation in this trial.
  • Prior allergic reaction to chimerized or murine monoclonal antibody therapy or documented presence of human anti-mouse antibodies (HAMA).
  • Subjects receiving a prior investigational agent within 30 days.
  • Prior therapy with oxaliplatin, cetuximab, or prior therapy that targets the EGF ( epidermal growth factor) pathway.
  • Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious disease) illness must not be enrolled into this study.
  • Mutation in the KRAS gene

Sites / Locations

  • Bellevue Hospital
  • New York University Langone Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cetuximab, Capecitabine and Oxaliplatin

Arm Description

Outcomes

Primary Outcome Measures

Response Rate for the Combination Treatment
The tumor response rate (RR) will be defined as the total number of subjects whose best response is partial response (PR) or complete response (CR) during the first six months of treatment, divided by the number of subjects.

Secondary Outcome Measures

Toxicity Rates
# of subjects who experienced >= grade 1 adverse event that is positively related to treatment.
Time to Progression
Time to Treatment Failure (progression or death) will be defined as the time from the first day of treatment until the date Progressive Disease (PD) or death is first reported. Subjects who die without a reported prior progression will be considered to have progressed on the day of their death. Subjects who did not progress will be censored at the day of their last tumor assessment.
Survival
Survival will be defined as the number of days from the first day of therapy to the date of death. If the subject is lost to follow-up, survival will be censored on the last date the subject was known to be alive.

Full Information

First Posted
March 7, 2007
Last Updated
April 2, 2020
Sponsor
NYU Langone Health
Collaborators
Eli Lilly and Company, Bristol-Myers Squibb
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1. Study Identification

Unique Protocol Identification Number
NCT00444678
Brief Title
Cetuximab Plus Biweekly Capecitabine and Oxaliplatin in KRAS Wild Type Metastatic Colorectal Cancer
Official Title
A Phase II Study of Cetuximab Plus Biweekly Capecitabine and Oxaliplatin (C-CO2) in the Treatment of Patients With KRAS Wild Type Metastatic Colorectal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
June 1, 2004 (undefined)
Primary Completion Date
August 1, 2012 (Actual)
Study Completion Date
June 1, 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NYU Langone Health
Collaborators
Eli Lilly and Company, Bristol-Myers Squibb

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a Phase II, open label, non-randomized study in subjects with histologically confirmed diagnosis of advanced KRAS wild type adenocarcinoma of the colon or rectum, who have not received prior chemotherapy for metastatic disease.
Detailed Description
The current treatment options for metastatic colon cancer are in need of further improvement. The three-drug combination of oxaliplatin with 5-FU/LV (fluorouracil/leucovorin) in the second-line treatment of metastatic colorectal cancer have shown a significant increase in response rate compared to 5-FU/LV alone. Oxaliplatin has recently been FDA-approved for this indication and is now a standard first-line agent in combination with a fluoropyrimidine. Cetuximab, a chimeric monoclonal antibody against the growth factor receptor, has shown activity with and without irinotecan in subjects with colorectal cancer refractory to irinotecan alone. Cetuximab has also been shown to be safe and effective when administered with infusional 5-FU/folinic acid plus irinotecan. These results suggest that the addition of cetuximab to fluoropyrimidine/oxaliplatin-based regimen in the 1st line setting should be explored. The use of the oral fluoropyrimidine, capecitabine, to replace infusional 5FU has been widely used for improved convenience and possible safety. We have chosen a modified biweekly CapeOx (capecitabine plus oxaliplatin) regimen due to its improved tolerance and response rate with a fixed dose of capecitabine given its widespread practice and ease of use.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Neoplasm Metastasis
Keywords
Previously untreated metastatic colorectal cancer, Metastatic Colorectal Cancer, combined therapy, biologics therapy, antibody, chemotherapy, EGFR, epidermal growth factor receptor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cetuximab, Capecitabine and Oxaliplatin
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Cetuximab
Other Intervention Name(s)
Erbitux, C225
Intervention Description
500 mg/m2, IV every two weeks
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Other Intervention Name(s)
Eloxatin
Intervention Description
85 mg/m2, IV, q 2 weeks
Intervention Type
Drug
Intervention Name(s)
Capecitabine
Other Intervention Name(s)
Xeloda
Intervention Description
2500 mg, po bid x 7 days every two weeks
Primary Outcome Measure Information:
Title
Response Rate for the Combination Treatment
Description
The tumor response rate (RR) will be defined as the total number of subjects whose best response is partial response (PR) or complete response (CR) during the first six months of treatment, divided by the number of subjects.
Time Frame
6 months since the start of treatment
Secondary Outcome Measure Information:
Title
Toxicity Rates
Description
# of subjects who experienced >= grade 1 adverse event that is positively related to treatment.
Time Frame
1 year since the first treatment and every year after for up to 10 years
Title
Time to Progression
Description
Time to Treatment Failure (progression or death) will be defined as the time from the first day of treatment until the date Progressive Disease (PD) or death is first reported. Subjects who die without a reported prior progression will be considered to have progressed on the day of their death. Subjects who did not progress will be censored at the day of their last tumor assessment.
Time Frame
6 months since the start of treatment and every 3 months after treatment for up to 10 years
Title
Survival
Description
Survival will be defined as the number of days from the first day of therapy to the date of death. If the subject is lost to follow-up, survival will be censored on the last date the subject was known to be alive.
Time Frame
6 months since the start of treatment and every 3 months after treatment for up to 10 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must have signed an approved informed consent. Histologically confirmed diagnosis of advanced adenocarcinoma of the colon or rectum, with KRAS wild type on mutational analysis. No prior chemotherapy for metastatic disease (chemotherapy naive). Prior adjuvant therapy with 5FU/LV or IFL (irinotecan, fluorouracilis, and leucovorin (folinic acid)) permitted if completed at least six months prior to entering this study. Measurable disease by RECIST criteria as defined in Section 3.3.1. Subjects for whom tumor tissue is available for IHC ( Immunohistochemistry) testing for EGFR expression. ECOG (Eastern Cooperative Oncology Group) Performance Status 0-1. Recovery in full from any previous surgical procedure. Expected survival greater than 12 weeks. Subjects at least 18 years of age. Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 4 weeks after the study in such a manner that the risk of pregnancy is minimized. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours prior to the start of study medication. Adequate hematologic function defined by an absolute neutrophil count (ANC) > 1,500/mm3, a platelet count > 100,000/mm3 . Adequate hepatic function defined by a total bilirubin level no greater than 2.0 times the upper limit of normal (ULN) and AST (Aspartate Aminotransferase) and ALT (alanine transaminase) levels noo greater than 2.5 times the ULN (AST and ALT levels no greater than 5 times the ULN in the presence of liver metastases). Adequate renal function defined by a serum creatinine level no greater than 1.5 times the ULN. Exclusion Criteria: WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 4 weeks after the study. Women who are pregnant or breastfeeding. Women with a positive pregnancy test on enrollment or prior to study drug administration. Sexually active fertile men not using effective birth control if their partners are women of child-bearing potential. Subjects with > Grade 1 neuropathy. Any active or uncontrolled infection. History of myocardial infarction within the previous six months or current clinical evidence of congestive heart failure. History of any other cancer (except nonmelanoma skin cancer or carcinoma in situ of the cervix) unless in complete remission and off all therapy for that cancer for at least 5 years. Central nervous system metastases. Pregnant or lactating women. Men and women of reproductive potential must agree to use an effective contraceptive method. Medical or psychiatric disorders that would interfere with informed consent or make them a poor risk for participation in this trial. Prior allergic reaction to chimerized or murine monoclonal antibody therapy or documented presence of human anti-mouse antibodies (HAMA). Subjects receiving a prior investigational agent within 30 days. Prior therapy with oxaliplatin, cetuximab, or prior therapy that targets the EGF ( epidermal growth factor) pathway. Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious disease) illness must not be enrolled into this study. Mutation in the KRAS gene
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Deirdre Cohen, MD
Organizational Affiliation
NYU Langone Health
Official's Role
Principal Investigator
Facility Information:
Facility Name
Bellevue Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
New York University Langone Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States

12. IPD Sharing Statement

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Cetuximab Plus Biweekly Capecitabine and Oxaliplatin in KRAS Wild Type Metastatic Colorectal Cancer

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