Riluzole in Combination With mFOLFOX6 and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer
Primary Purpose
Metastatic Colorectal Carcinoma, Stage IV Colorectal Cancer AJCC v8, Stage IVA Colorectal Cancer AJCC v8
Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Bevacizumab
Fluorouracil
Leucovorin Calcium
Oxaliplatin
Riluzole
Sponsored by
About this trial
This is an interventional treatment trial for Metastatic Colorectal Carcinoma
Eligibility Criteria
Inclusion Criteria:
- Patients with metastatic colorectal cancer, who are appropriate candidates to receive mFOLFOX6/bevacizumab. Patients who progressed on FOLFOX-based regimen are allowed
- Willingness to undergo both pre-treatment and post-treatment tumor tissue biopsies (pre-treatment tumor tissue will be sent to pathology lab to confirm metastatic colorectal cancer as the standard of care)
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Age >= 18 years
- Absolute neutrophil count >= (ANC) 1,500/ul
- Platelets >= 100,000/ul
- Hemoglobin >= 9 g/dl
- Serum total bilirubin < 1.5 x ULN
- Serum albumin >= 2.5 g/dl
- If no liver involvement, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 1.5 x ULN. If liver involvement, AST and ALT =< 3.0 x ULN
- Ability to understand and the willingness to sign a written informed consent document
- A male subject of fathering potential must use an adequate method of contraception to avoid conception throughout the study (and for up to 12 weeks after the last dose of study drug) to minimize the risk of pregnancy. If the partner is pregnant or breastfeeding, the subject must use a condom
- Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of study drug to minimize the risk of pregnancy. WOCBP must have a negative serum or urine pregnancy test within 72 hours before the start of the investigational product
Exclusion Criteria:
- Patients who are receiving any other investigational agents
- Patients with history of hepatitis B or C
- Patients with severe renal impairment (CrCl < 30 mL/min)
- Prior full field radiotherapy < 4 weeks or limited field radiotherapy < 2 weeks prior to first study drug administration. Patients with central nervous system (CNS) metastases may participate in this trial provided they are clinically stable. Patients who are < 1 month from radiation therapy must not be included
- Patients with existing grade 2 peripheral neuropathy
- Patients with a history of thrombotic or embolic events within the last six months such as a cerebrovascular accident (including transient ischemic attacks), pulmonary embolism or deep vein thrombosis
Cardiac conditions as follows:
- Active coronary artery disease, unstable or newly diagnosed angina or myocardial infarction less than 6 months prior to first study drug administration
- Class III-IV New York Heart Association (NYHA) congestive heart failure
- Uncontrolled hypertension (Systolic blood pressure [BP] > 150 mmHg and diastolic BP > 90 mmHg for 24 hours) despite optimal medical management
- Corrected QT (QTc) (Friderica) prolongation > 480 msec
- Uncontrolled concurrent illness including, but not limited to, ongoing or active infection, cardiac arrhythmia, active bleeding diatheses, and psychiatric illness/social situations that would limit compliance with study requirements
- Major surgical procedure or significant traumatic injury less than 3 weeks or those who receive minor surgical procedures within 1 week from first dose of study drug administration
- Known inability to swallow capsules
- Inability to comply with study and/or follow-up procedures
- Pregnant women are excluded from this study. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother, breastfeeding should be discontinued
Sites / Locations
- Ohio State University Comprehensive Cancer Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Treatment (riluzole, mFOLFOX6, bevacizumab)
Arm Description
Patients receive riluzole PO BID on days 1-14. Patients also receive oxaliplatin via IVPB over 2 hours, leucovorin calcium IVPB over 2 hours, and bevacizumab IVPB over 30 minutes on day 1 and fluorouracil via IV push over 5 minutes and then IV continuously over 46 hours on days 1-2. Treatment repeats every 2 weeks for up to 8 cycles in the absence of disease progression or unacceptable toxicity.
Outcomes
Primary Outcome Measures
Dose limiting toxicities (DLTs)
Will be defined by treatment related grade >= 4 adverse events or >= grade 3 alanine aminotransferase or aspartate aminotransferase elevation during the DLT period using the Common Terminology Criteria for Adverse Events version 5.0.
Secondary Outcome Measures
Pharmacokinetic (PK) profile of riluzole (Cmax)
K data analysis will utilize a nonlinear mixed effects approach whereby PK parameter estimates will be generated from the data, and 'dose day' will be evaluated as a covariate on clearance and volume of distribution. The PK parameters including Cmax. Peak Plasma Concentration (Cmax)
Pharmacokinetic (PK) profile of riluzole (AUC)
PK data analysis will utilize a nonlinear mixed effects approach whereby PK parameter estimates will be generated from the data, and 'dose day' will be evaluated as a covariate on clearance and volume of distribution. The PK parameters including AUC. Area under the plasma concentration versus time curve (AUC)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04761614
Brief Title
Riluzole in Combination With mFOLFOX6 and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer
Official Title
A Phase I Study of Riluzole in Combination With mFOLFOX6/Bevacizumab in Patients With Metastatic Colorectal Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
April 2, 2021 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Ning Jin
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This phase I trial is to find out the best dose, possible benefits, and/or side effects of riluzole and how well it works in combination with standard of care mFOLFOX6 and bevacizumab in treating patients with colorectal cancer that has spread to other places in the body (metastatic). Riluzole is a well-tolerated oral medication that has demonstrated it may make chemotherapy work better. Chemotherapy drugs, such as oxaliplatin, leucovorin calcium and fluorouracil, work in different ways to stop the growth of [cancer/tumor] cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bevacizumab is an antibody that targets the blood vessel by blocking the activity of a protein called vascular endothelial growth factor alpha (VEGF-A). It helps to make the mFOLFOX6 more effective. Giving riluzole, mFOLFOX6, and bevacizumab may kill more tumor cells compared to mFOLFOX6 and bevacizumab alone in treating patients with colorectal cancer.
Detailed Description
PRIMARY OBJECTIVE:
I. Characterize the safety and toxicity of riluzole in combination with modified (m) leucovorin calcium, fluorouracil, and oxaliplatin (FOLFOX) 6/bevacizumab and determine the recommended phase II dose (RP2D) of riluzole in combination with mFOLFOX6/bevacizumab in patients with metastatic colorectal cancer.
SECONDARY OBJECTIVE:
I. Determine the pharmacokinetics of riluzole in patients with metastatic CRC.
EXPLORATORY OBJECTIVES:
I. Assess the efficacy of the combination treatment. II. Determine the effect of riluzole in downstream GRM3 signaling by immunofluorescent staining of phosphorylated (p)AKT and pCREB in pre- and post-treatment tumor tissues.
III. Assess FCGRT/FcRn expression, bevacizumab pharmacokinetics, inflammatory cytokines, and cachexia associated factors as early biomarkers for resistance to therapy.
IV. Assess cytotoxic T cells in peripheral blood to evaluate the immunomodulatory effect of this therapy.
OUTLINE: This is a dose-escalation study of riluzole.
Patients receive riluzole orally (PO) twice daily (BID) on days 1-14. Patients also receive oxaliplatin via intravenous piggyback (IVPB) over 2 hours, leucovorin calcium IVPB over 2 hours, and bevacizumab IVPB over 30 minutes on day 1 and fluorouracil via intravenous (IV) push over 5 minutes and then IV continuously over 46 hours on days 1-2. Treatment repeats every 2 weeks for up to 8 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 30 days.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Carcinoma, Stage IV Colorectal Cancer AJCC v8, Stage IVA Colorectal Cancer AJCC v8, Stage IVB Colorectal Cancer AJCC v8, Stage IVC Colorectal Cancer AJCC v8
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
13 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Treatment (riluzole, mFOLFOX6, bevacizumab)
Arm Type
Experimental
Arm Description
Patients receive riluzole PO BID on days 1-14. Patients also receive oxaliplatin via IVPB over 2 hours, leucovorin calcium IVPB over 2 hours, and bevacizumab IVPB over 30 minutes on day 1 and fluorouracil via IV push over 5 minutes and then IV continuously over 46 hours on days 1-2. Treatment repeats every 2 weeks for up to 8 cycles in the absence of disease progression or unacceptable toxicity.
Intervention Type
Biological
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Anti-VEGF, Anti-VEGF Humanized Monoclonal Antibody, Anti-VEGF rhuMAb, Avastin, Bevacizumab awwb, Bevacizumab Biosimilar BEVZ92, Bevacizumab Biosimilar BI 695502, Bevacizumab Biosimilar CBT 124, Bevacizumab Biosimilar CT-P16, Bevacizumab Biosimilar FKB238, Bevacizumab Biosimilar GB-222, Bevacizumab Biosimilar HD204, Bevacizumab Biosimilar HLX04, Bevacizumab Biosimilar IBI305, Bevacizumab Biosimilar LY01008, Bevacizumab Biosimilar MIL60, Bevacizumab Biosimilar Mvasi, Bevacizumab Biosimilar QL 1101, Bevacizumab Biosimilar RPH-001, Bevacizumab Biosimilar SCT501, Bevacizumab Biosimilar Zirabev, Bevacizumab-awwb, Bevacizumab-bvzr, BP102, BP102 Biosimilar, HD204, Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer, Mvasi, Recombinant Humanized Anti-VEGF Monoclonal Antibody, rhuMab-VEGF, SCT501, Zirabev
Intervention Description
Given IVPB
Intervention Type
Drug
Intervention Name(s)
Fluorouracil
Other Intervention Name(s)
5 Fluorouracil, 5 Fluorouracilum, 5 FU, 5-Fluoro-2,4(1H, 3H)-pyrimidinedione, 5-Fluorouracil, 5-Fluracil, 5-Fu, 5FU, AccuSite, Carac, Fluoro Uracil, Fluouracil, Flurablastin, Fluracedyl, Fluracil, Fluril, Fluroblastin, Ribofluor, Ro 2-9757, Ro-2-9757
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Leucovorin Calcium
Other Intervention Name(s)
Adinepar, 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, Wellcovorin
Intervention Description
Given IVPB
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Other Intervention Name(s)
1-OHP, Ai Heng, Aiheng, Dacotin, Dacplat, Diaminocyclohexane Oxalatoplatinum, Eloxatin, Eloxatine, JM-83, Oxalatoplatin, Oxalatoplatinum, RP 54780, RP-54780, SR-96669
Intervention Description
Given IVPB
Intervention Type
Drug
Intervention Name(s)
Riluzole
Other Intervention Name(s)
Rilutek
Intervention Description
Given PO
Primary Outcome Measure Information:
Title
Dose limiting toxicities (DLTs)
Description
Will be defined by treatment related grade >= 4 adverse events or >= grade 3 alanine aminotransferase or aspartate aminotransferase elevation during the DLT period using the Common Terminology Criteria for Adverse Events version 5.0.
Time Frame
Up to 4 weeks (2 cycles of treatment) (1 cycle = 14 days)
Secondary Outcome Measure Information:
Title
Pharmacokinetic (PK) profile of riluzole (Cmax)
Description
K data analysis will utilize a nonlinear mixed effects approach whereby PK parameter estimates will be generated from the data, and 'dose day' will be evaluated as a covariate on clearance and volume of distribution. The PK parameters including Cmax. Peak Plasma Concentration (Cmax)
Time Frame
Day 1 on cycle 1 (each cycle is 14 days)
Title
Pharmacokinetic (PK) profile of riluzole (AUC)
Description
PK data analysis will utilize a nonlinear mixed effects approach whereby PK parameter estimates will be generated from the data, and 'dose day' will be evaluated as a covariate on clearance and volume of distribution. The PK parameters including AUC. Area under the plasma concentration versus time curve (AUC)
Time Frame
Day 1 on cycle 1 (each cycle is 14 days)
Other Pre-specified Outcome Measures:
Title
Objective response rate (complete response + partial response)
Description
Will be estimated along with exact 95% confidence interval.
Time Frame
Up to 112 days
Title
Change in phosphorylated (p)AKT and pCREB levels
Description
Will be summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Up to 42 days (each cycle is 14 days)
Title
Change in FCGRT/FcRn expression
Description
Will be assessed using peripheral blood and summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Day 1 of cycle 1, 3, 5, 7 (each cycle is 14 days)
Title
Change in bevacizumab clearance (Cmax)
Description
Peak Plasma Concentration (Cmax)
Time Frame
Day 1 of cycle 1, 3, 5, 7 (each cycle is 14 days)
Title
Change in bevacizumab clearance (AUC)
Description
Area under the plasma concentration versus time curve (AUC)
Time Frame
Day 1 of cycle 1, 3, 5, 7 (each cycle is 14 days)
Title
interleukin 6
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
leukemia inhibitory factor
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
Necrosis factor alpha
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
Interferon gamma
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
C-reactive protein
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
ferritin
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
metalloproteinases 1
Description
Cytokines
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
body weight
Description
Will include body weight and summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
skeletal muscle index
Description
Will include skeletal muscle index and summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
body serum albumin
Description
Will include body serum albumin and summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Day 1 of cycle 1 and day 1 of cycle 7 (each cycle is 14 days)
Title
Change in levels of circulating cytotoxic T cells
Description
Will be assessed using peripheral blood mononuclear cells and summarized using mean +/- standard error of mean, range, and median at each time point. Graphical analyses will be largely used to assess potential patterns and relationships.
Time Frame
Day 1 of Cycle 1,3,5,7 (each cycle is 14 days)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients with metastatic colorectal cancer, who are appropriate candidates to receive mFOLFOX6/bevacizumab. Patients who progressed on FOLFOX-based regimen are allowed
Willingness to undergo both pre-treatment and post-treatment tumor tissue biopsies (pre-treatment tumor tissue will be sent to pathology lab to confirm metastatic colorectal cancer as the standard of care)
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Age >= 18 years
Absolute neutrophil count >= (ANC) 1,500/ul
Platelets >= 100,000/ul
Hemoglobin >= 9 g/dl
Serum total bilirubin < 1.5 x ULN
Serum albumin >= 2.5 g/dl
If no liver involvement, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 1.5 x ULN. If liver involvement, AST and ALT =< 3.0 x ULN
Ability to understand and the willingness to sign a written informed consent document
A male subject of fathering potential must use an adequate method of contraception to avoid conception throughout the study (and for up to 12 weeks after the last dose of study drug) to minimize the risk of pregnancy. If the partner is pregnant or breastfeeding, the subject must use a condom
Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of study drug to minimize the risk of pregnancy. WOCBP must have a negative serum or urine pregnancy test within 72 hours before the start of the investigational product
Exclusion Criteria:
Patients who are receiving any other investigational agents
Patients with history of hepatitis B or C
Patients with severe renal impairment (CrCl < 30 mL/min)
Prior full field radiotherapy < 4 weeks or limited field radiotherapy < 2 weeks prior to first study drug administration. Patients with central nervous system (CNS) metastases may participate in this trial provided they are clinically stable. Patients who are < 1 month from radiation therapy must not be included
Patients with existing grade 2 peripheral neuropathy
Patients with a history of thrombotic or embolic events within the last six months such as a cerebrovascular accident (including transient ischemic attacks), pulmonary embolism or deep vein thrombosis
Cardiac conditions as follows:
Active coronary artery disease, unstable or newly diagnosed angina or myocardial infarction less than 6 months prior to first study drug administration
Class III-IV New York Heart Association (NYHA) congestive heart failure
Uncontrolled hypertension (Systolic blood pressure [BP] > 150 mmHg and diastolic BP > 90 mmHg for 24 hours) despite optimal medical management
Corrected QT (QTc) (Friderica) prolongation > 480 msec
Uncontrolled concurrent illness including, but not limited to, ongoing or active infection, cardiac arrhythmia, active bleeding diatheses, and psychiatric illness/social situations that would limit compliance with study requirements
Major surgical procedure or significant traumatic injury less than 3 weeks or those who receive minor surgical procedures within 1 week from first dose of study drug administration
Known inability to swallow capsules
Inability to comply with study and/or follow-up procedures
Pregnant women are excluded from this study. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother, breastfeeding should be discontinued
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ning Jin, MD
Organizational Affiliation
Ohio State University Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ohio State University Comprehensive Cancer Center
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Links:
URL
http://cancer.osu.edu
Description
The Jamesline
Learn more about this trial
Riluzole in Combination With mFOLFOX6 and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer
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