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A Phase II Prospective Trial of mXELOXIRI Reintroduction for mCRC

Primary Purpose

Unresectable Metastatic Colorectal Carcinoma

Status
Unknown status
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Capecitabine-Oxaliplatin-Irinotecan-Bevacizumab Combination
Sponsored by
First Affiliated Hospital of Zhejiang University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Unresectable Metastatic Colorectal Carcinoma

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Personal written informed consent is obtained after the study has been fully explained
  2. Histologically confirmed colon or rectal adenocarcinoma

    *Excluding appendix cancer and anal canal cancer

  3. Clinically unresectable
  4. Borderline resectable liver metastases of colorectal cancer considered to have poor-risk disease not deemed to be suitable for upfront resection if they had one or more of the following features assessed by a local multidisciplinary team: more than four metastases, location and distribution of metastatic disease within the liver unsuitable for resection with clear margins (e.g. involvement of both lobes of liver, invasion of intrahepatic vascular structures), extent of liver involvement precluding resection with adequate post-resection residual liver parenchyma volume for viable liver function in the immediate postoperative period, and inability to retain adequate vascular inflow and outflow to maintain viable liver function.
  5. Age at enrollment is >= 18 and <= 75 years
  6. Life expectancy of at least 12 weeks.
  7. Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1
  8. .Vital organ functions meet the following criteria within 14 days before enrollment.

If multiple test results are available in that period, the results closest to enrollment will be used. No blood transfusions or hematopoietic factor administration will be permitted within 2 weeks before the date on which measurements are taken.

i. Absolute neutrophil count (ANC): ≥3,000 /cu.mm ii. Platelet count: ≥10.0 × 104/cu.mm iii. Hemoglobin concentration: ≥8.0 g/dL iv. Prothrombin time (PT), activated partial thromboplastin time(APTT): ≤1.5 times upper limit of normal (ULN) v. Total bilirubin: ≤1.5 times ULN (≤3 times ULN for metastases to liver).Aspartate aminotransferase (AST), Alanine aminotransferase (ALT): ≤2.5 times ULN (≤5 times ULN for metastases to liver).vi. Serum creatinine: ≤1.5 times ULN, or creatinine clearance: ≥30 mL/min

Exclusion Criteria:

  1. Clinically resectable. Major surgical procedure within 28 days prior to study treatment initiation (such as open chest, laparoscopy, thoracoscopic surgery, laparoscopic surgery), unless only colostomy is performed; open biopsy or suturing for major trauma within 14 days of study treatment initiation; or planned major surgical procedure during the study (open chest, laparoscopy) ("major surgical procedures" does not include central venous (CV) port insertion)
  2. Previous adjuvant oxaliplatin-containing chemotherapy
  3. 5-Fu-containing chemotherapy within 12 months.
  4. .Have received any experimental therapy (such as take part in another clinical study) within 4 weeks before treatment;
  5. Receiving immunotherapy, chemotherapy, radiotherapy (except palliative radiotherapy), or hormonotherapy, which are not included in study protocol;
  6. Untreated brain metastases, spinal cord compression, or primary brain tumor;
  7. Pregnant, breastfeeding, positive pregnancy test (women who have menstruated in the last year will be tested), or women who are unwilling to use contraception; men who are unwilling to use contraception during the study
  8. Any of the following comorbidities i. Uncontrolled hypertension ii. Uncontrolled diabetes mellitus iii. Uncontrolled diarrhea iv. Peripheral sensory neuropathy (≥Grade 1) v. Active peptic ulcer vi. Unhealed wound (except for suturing associated with implanted port placement) vii. Other clinically significant disease (such as interstitial pneumonia or renal impairment)
  9. Subjects with known allergy to the study drugs or to any of its excipients.
  10. Any indication of contraindications to chemotherapy;
  11. Other active malignancies (synchronous malignancies, and asynchronous malignancies separated by a 5-year disease-free interval) (excluding malignancies that are expected to be completely cured, such as intramucosal carcinoma and carcinoma in situ)

Sites / Locations

  • The First Affiliated Hospital, Zhejiang University School of MedicineRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

mXELOXIRI+Bev reintroduction

Arm Description

Patients will receive mXELOXIRI+BEV as first-line therapy (to be repeated every 2 weeks for a maximum of 12 cycles), followed to initiate a MDT to determine whether to perform a surgery or receive maintenance therapy. Maintenance treatment: CAP+BEV. The following CAP+BEV therapy will be repeated in 2-week cycles. At the time of disease progression, patients will be re-introduced XELOXIRI plus bev at the same doses and schedule previously tolerated, for a maximum of 12 cycles. If no progression occurs during XELOXIRI plus bev, patients will receive maintenance CAP+BEV at the same dose used in the last cycle of the induction treatment.

Outcomes

Primary Outcome Measures

Reintroduction Rate
The rate of patients who receive reintroduction therapy after the first progression.

Secondary Outcome Measures

R0 rate
resection rate
PFS
the time from randomization to the first documentation of objective disease progression or death due to any cause, whichever occurs first.
OS
the time from randomization to the date of death due to any cause.
PFS1
the time from randomization to the first documentation of objective disease progression or death due to any cause before second-line therapy, whichever occurs first.
ORR1
percentage of patients, relative to the total of enrolled subjects, achieving a complete (CR) or partial (PR) response, according to RECIST 1.1 criteria, during the first-line induction and the maintenance phases of treatment.
PFS2
from the beginning of the second-line treatment to the documentation of objective disease progression or death due to any cause, whichever occurs first
ORR2
percentage of patients, relative to the total of enrolled subjects, achieving a complete (CR) or partial (PR) response, according to RECIST 1.1 criteria, during the second-line induction and the maintenance phases of treatment.

Full Information

First Posted
August 9, 2020
Last Updated
January 31, 2021
Sponsor
First Affiliated Hospital of Zhejiang University
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1. Study Identification

Unique Protocol Identification Number
NCT04508452
Brief Title
A Phase II Prospective Trial of mXELOXIRI Reintroduction for mCRC
Official Title
A Phase II Prospective Trial of mXELOXIRI Reintroduction for the Unresectable Metastatic Colorectal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
May 18, 2020 (Actual)
Primary Completion Date
June 1, 2022 (Anticipated)
Study Completion Date
June 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
First Affiliated Hospital of Zhejiang University

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.
Yes

5. Study Description

Brief Summary
The objective is to evaluate the efficacy and safety of reintroduction of modified XELOXIRI combined with molecular targeted drug in patients with metastatic colorectal cancer (mCRC)
Detailed Description
It is an investigator-initiated, single institution, prospective, single-arm clinical study to evaluate the efficacy and safety of reintroduction of modified XELOXIRI combined with bevacizumab as first-line therapy in patients with unresectable mCRC. Eligible patients will receive 12 cycles of mXELOXIRI with bevacizumab and then MDT will be initiated to determine whether to perform a surgery or receive the maintenance therapy until disease progression (PD). At the time of PD, patients will re-introduce XELOXIRI plus bev at the same doses and schedule previously tolerated, for a maximum of 12 cycles.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Unresectable Metastatic Colorectal Carcinoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
mXELOXIRI+Bev reintroduction
Arm Type
Experimental
Arm Description
Patients will receive mXELOXIRI+BEV as first-line therapy (to be repeated every 2 weeks for a maximum of 12 cycles), followed to initiate a MDT to determine whether to perform a surgery or receive maintenance therapy. Maintenance treatment: CAP+BEV. The following CAP+BEV therapy will be repeated in 2-week cycles. At the time of disease progression, patients will be re-introduced XELOXIRI plus bev at the same doses and schedule previously tolerated, for a maximum of 12 cycles. If no progression occurs during XELOXIRI plus bev, patients will receive maintenance CAP+BEV at the same dose used in the last cycle of the induction treatment.
Intervention Type
Drug
Intervention Name(s)
Capecitabine-Oxaliplatin-Irinotecan-Bevacizumab Combination
Intervention Description
CAP 1,600 mg/sq.m /day (p.o. day1-10) D1-10; Oxaliplatin (OX): 68 mg/sq.m (d.i.v.) D1; Irinotecan (IRI):135 mg/sq.m (d.i.v.) D1; BEV: 5mg/kg (d.i.v.) D1; Administered every 2 weeks.
Primary Outcome Measure Information:
Title
Reintroduction Rate
Description
The rate of patients who receive reintroduction therapy after the first progression.
Time Frame
Up to 18 months
Secondary Outcome Measure Information:
Title
R0 rate
Description
resection rate
Time Frame
Up to 18 months
Title
PFS
Description
the time from randomization to the first documentation of objective disease progression or death due to any cause, whichever occurs first.
Time Frame
Up to 18 months
Title
OS
Description
the time from randomization to the date of death due to any cause.
Time Frame
Up to 18 months
Title
PFS1
Description
the time from randomization to the first documentation of objective disease progression or death due to any cause before second-line therapy, whichever occurs first.
Time Frame
Up to 18 months
Title
ORR1
Description
percentage of patients, relative to the total of enrolled subjects, achieving a complete (CR) or partial (PR) response, according to RECIST 1.1 criteria, during the first-line induction and the maintenance phases of treatment.
Time Frame
Every 8 weeks, up to 18 months after last patient last visit
Title
PFS2
Description
from the beginning of the second-line treatment to the documentation of objective disease progression or death due to any cause, whichever occurs first
Time Frame
up to 18 months after last patient last visit
Title
ORR2
Description
percentage of patients, relative to the total of enrolled subjects, achieving a complete (CR) or partial (PR) response, according to RECIST 1.1 criteria, during the second-line induction and the maintenance phases of treatment.
Time Frame
Every 8 weeks, up to 18 months after last patient last visit

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Personal written informed consent is obtained after the study has been fully explained Histologically confirmed colon or rectal adenocarcinoma *Excluding appendix cancer and anal canal cancer Clinically unresectable Borderline resectable liver metastases of colorectal cancer considered to have poor-risk disease not deemed to be suitable for upfront resection if they had one or more of the following features assessed by a local multidisciplinary team: more than four metastases, location and distribution of metastatic disease within the liver unsuitable for resection with clear margins (e.g. involvement of both lobes of liver, invasion of intrahepatic vascular structures), extent of liver involvement precluding resection with adequate post-resection residual liver parenchyma volume for viable liver function in the immediate postoperative period, and inability to retain adequate vascular inflow and outflow to maintain viable liver function. Age at enrollment is >= 18 and <= 75 years Life expectancy of at least 12 weeks. Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1 .Vital organ functions meet the following criteria within 14 days before enrollment. If multiple test results are available in that period, the results closest to enrollment will be used. No blood transfusions or hematopoietic factor administration will be permitted within 2 weeks before the date on which measurements are taken. i. Absolute neutrophil count (ANC): ≥3,000 /cu.mm ii. Platelet count: ≥10.0 × 104/cu.mm iii. Hemoglobin concentration: ≥8.0 g/dL iv. Prothrombin time (PT), activated partial thromboplastin time(APTT): ≤1.5 times upper limit of normal (ULN) v. Total bilirubin: ≤1.5 times ULN (≤3 times ULN for metastases to liver).Aspartate aminotransferase (AST), Alanine aminotransferase (ALT): ≤2.5 times ULN (≤5 times ULN for metastases to liver).vi. Serum creatinine: ≤1.5 times ULN, or creatinine clearance: ≥30 mL/min Exclusion Criteria: Clinically resectable. Major surgical procedure within 28 days prior to study treatment initiation (such as open chest, laparoscopy, thoracoscopic surgery, laparoscopic surgery), unless only colostomy is performed; open biopsy or suturing for major trauma within 14 days of study treatment initiation; or planned major surgical procedure during the study (open chest, laparoscopy) ("major surgical procedures" does not include central venous (CV) port insertion) Previous adjuvant oxaliplatin-containing chemotherapy 5-Fu-containing chemotherapy within 12 months. .Have received any experimental therapy (such as take part in another clinical study) within 4 weeks before treatment; Receiving immunotherapy, chemotherapy, radiotherapy (except palliative radiotherapy), or hormonotherapy, which are not included in study protocol; Untreated brain metastases, spinal cord compression, or primary brain tumor; Pregnant, breastfeeding, positive pregnancy test (women who have menstruated in the last year will be tested), or women who are unwilling to use contraception; men who are unwilling to use contraception during the study Any of the following comorbidities i. Uncontrolled hypertension ii. Uncontrolled diabetes mellitus iii. Uncontrolled diarrhea iv. Peripheral sensory neuropathy (≥Grade 1) v. Active peptic ulcer vi. Unhealed wound (except for suturing associated with implanted port placement) vii. Other clinically significant disease (such as interstitial pneumonia or renal impairment) Subjects with known allergy to the study drugs or to any of its excipients. Any indication of contraindications to chemotherapy; Other active malignancies (synchronous malignancies, and asynchronous malignancies separated by a 5-year disease-free interval) (excluding malignancies that are expected to be completely cured, such as intramucosal carcinoma and carcinoma in situ)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ye Feng, M.D.
Phone
+8613858191208
Ext
87236858
Email
yefeng-h1@zju.edu.cn
First Name & Middle Initial & Last Name or Official Title & Degree
Jiang Weiqin, M.D.
Phone
+8615068117618
Email
weiqinjiang@zju.edu.cn
Facility Information:
Facility Name
The First Affiliated Hospital, Zhejiang University School of Medicine
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310003
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jiang Weiqin, M.D.
Phone
+8615068117618
Email
weiqinjiang@zju.edu.cn

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Phase II Prospective Trial of mXELOXIRI Reintroduction for mCRC

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