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Panitumumab After Resection of Liver Metastases From Colorectal Cancer in KRAS Wild-type Patients

Primary Purpose

Colorectal Cancer, KRAS Wildtype, After Resection of Liver Metastases

Status
Unknown status
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Folic Acid
5-FU
5-FU
Oxaliplatin
Panitumumab
Panitumumab
Folic Acid
5-FU
5-FU
Oxaliplatin
Sponsored by
PD Dr. med. Volker Heinemann
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring Colorectal Cancer, PARLIM, KRAS Wildtype, Liver metastases

Eligibility Criteria

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

Inclusion Criteria:

  • Patient has provided written informed consent.
  • R0-resection of liver metastasis, at least four weeks but not longer than 8 weeks ago.
  • Histologically confirmed diagnosis of metastatic colorectal cancer confined to the liver
  • KRAS-wildtype of the tumor
  • Age 18 years or older
  • ECOG performance status 0-1
  • Females with child-bearing potential must use adequate contraceptive measures
  • Exclusion of pregnancy
  • Relevant toxicities of previous treatments must have subsided
  • Magnesium >= lower limit of normal; Calcium >= lower limit of normal
  • Normal cardiac function demonstrated by ECG and echocardiogram (LVEF ≥ 55%)

    • No symptomatic congestive heart failure
    • No unstable angina pectoris
    • No cardiac arrhythmia
  • Adequate organ function as defined by Table 1:

    • Hematologic: ANC (absolute neutrophil count) >= 1.5 G/L, Leucocytes > 3.0 G/L, Hemoglobin >= 9 g/dL, Platelets >= 100 G/L
    • Hepatic: Albumin >= 2.5 g/dL, Serum bilirubin <= 2 mg/dL, AST and ALT <= 3 x ULN
    • Renal: Serum Creatinine <= 1.5 mg/dL

Exclusion Criteria:

  • Known manifestations of metastatic disease
  • Progression during preoperative treatment
  • Missing KRAS mutation status of the tumor
  • Contraindication against therapy with 5-fluorouracil/ folinic acid or oxaliplatin
  • Known intolerability of panitumumab
  • Known DPD deficiency
  • Polyneuropathy > grade 1 (NCI-CTCv4) which precludes the use of oxaliplatin
  • Evidence of ascites or cirrhosis
  • Patient is pregnant or lactating or planning to become pregnant within 6 months after end of treatment
  • Subject (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment
  • Has had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study enrolment, or there is an anticipated need for major surgical procedure during the course of the study
  • Clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) <= 1 year before enrolment/randomization
  • History of interstitial lung disease e.g. pneumonitis or pulmonary fibrosis or evidence of interstitial lung disease on baseline chest CT scan
  • Has a concurrent disease or condition that would make the subject inappropriate for study participation or would interfere with the subject's safety.
  • Has any psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol.
  • Requires concurrent cancer therapy (chemotherapy, radiation therapy, biologic therapy, immunotherapy, or hormonal therapy) while on study.
  • Requires concurrent treatment with an investigational agent, participation in another clinical trial, or any specifically prohibited medication while on study.
  • Has a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to 5-fluorouracil, folinic acid, oxaliplatin, or panitumumab.
  • Other active malignancy
  • Known alcohol abuse or drug addiction
  • Incapability to give informed consent

Sites / Locations

  • Ludwig-Maximilians - University of MunichRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

FOLFOX + Panitumumab

FOLFOX

Arm Description

Outcomes

Primary Outcome Measures

Progression Free Survival

Secondary Outcome Measures

Tolerability and side effects
Overall Survival

Full Information

First Posted
May 2, 2011
Last Updated
July 5, 2012
Sponsor
PD Dr. med. Volker Heinemann
Collaborators
Amgen
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1. Study Identification

Unique Protocol Identification Number
NCT01384994
Brief Title
Panitumumab After Resection of Liver Metastases From Colorectal Cancer in KRAS Wild-type Patients
Study Type
Interventional

2. Study Status

Record Verification Date
July 2012
Overall Recruitment Status
Unknown status
Study Start Date
August 2011 (undefined)
Primary Completion Date
August 2013 (Anticipated)
Study Completion Date
August 2014 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
PD Dr. med. Volker Heinemann
Collaborators
Amgen

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Up to 50% of patients with colorectal cancer (CRC) develop liver metastasis during the course of their disease. In 30-40% of patients metastasis is confined to the liver. In these patients R0-resection of metastases may contribute to marked improvement of overall survival. Primary resection of liver metastasis is possible in about 15-20% of patients (Scheele 2005, Petrelli 2005). Recent studies indicate that perioperative chemotherapy may improve survival after resection of liver metastases (Portier 2007, Nordlinger 2007). Nevertheless, there is evidence that 70-80% of patients have recurrent disease after resection of liver metastasis. Stratification for the risk of recurrence may be performed using the FONG-score (Fong 1999). This study is designed to investigate the efficacy of postoperative chemotherapy combined with an anti-EGFR treatment using panitumumab. The majority of patients present to the surgeon after chemotherapeutic pretreatment with various not necessarily standardized regimens. Also postoperative therapy after resection of liver metastasis is not a clearly defined standard of care in Germany. Based on the study by Nordlinger et al. an oxaliplatin-based regimen is chosen for postoperative therapy (Nordlinger 2008). For reasons of practicability mFOLFOX6 was selected as the chemotherapy backbone for additive treatment (Allegra 2010). Also, there is evidence that the combination of FOLFOX with panitumumab is associated with enhanced antitumor activity (Douillard et al. ESMO 2009). The experimental treatment arm will therefore evaluate the combination of FOLFOX plus panitumumab. Since in colorectal cancer monoclonal antibodies directed against the EGFR are not active in KRAS mutant patients, the experimental arm including panitumumab will only be performed in KRAS wild-type patients (Amado 2008). The planned study aims to assess the efficacy of postoperative therapy with FOLFOX plus panitumumab followed by maintenance with panitumumab for 3 months in KRAS wild-type patients, compared to the historical data for standard FOLFOX chemotherapy alone, which are verified by a randomised control group without the antibody. (Figure 1: Study Design). The study will allow preoperative treatment with regimens such as FOLFIRI, XELIRI, FOLFOX or XELOX +/-bevacizumab or +/- cetuximab. However, only those patients will be considered eligible who did not progress during preoperative therapy. After surgery, a treatment-free interval of at least 4 weeks, but no longer than 8 weeks will be granted. KRAS-wild-type patients (60% of all pts) will then be randomized in a 2:1 ratio to an experimental arm with FOLFOX + panitumumab or to a reference arm with FOLFOX alone. Combination treatment will be performed for a duration of 3 months, after which patients in the experimental arm will receive maintenance therapy with panitumumab for further 3 months. In the reference arm, treatment will, however, be ended after 3 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, KRAS Wildtype, After Resection of Liver Metastases
Keywords
Colorectal Cancer, PARLIM, KRAS Wildtype, Liver metastases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
111 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
FOLFOX + Panitumumab
Arm Type
Experimental
Arm Title
FOLFOX
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Folic Acid
Intervention Description
400 mg/m2, 2h infusion, d1, q2w
Intervention Type
Drug
Intervention Name(s)
5-FU
Intervention Description
400 mg/m2 bolus iv, d1, q2w
Intervention Type
Drug
Intervention Name(s)
5-FU
Intervention Description
2400 mg/m2 46-h infusion, d1-2, q2w
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Intervention Description
85 mg/m2 d1, q2w
Intervention Type
Drug
Intervention Name(s)
Panitumumab
Intervention Description
6 mg/kg BW every 2 weeks
Intervention Type
Drug
Intervention Name(s)
Panitumumab
Intervention Description
Panitumumab maintenance phase (3 months) 9mg/kg BW every 3 weeks
Intervention Type
Drug
Intervention Name(s)
Folic Acid
Intervention Description
400 mg/m2, 2-h infusion, d1, q2w
Intervention Type
Drug
Intervention Name(s)
5-FU
Intervention Description
400 mg/m2 bolus iv, d1, q2w
Intervention Type
Drug
Intervention Name(s)
5-FU
Intervention Description
2400 mg/m2 46-h infusion, d1-2, q2w
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Intervention Description
85 mg/m2 d1, q2w
Primary Outcome Measure Information:
Title
Progression Free Survival
Time Frame
2 years after randomisation
Secondary Outcome Measure Information:
Title
Tolerability and side effects
Time Frame
approximate 6 months after randomisation
Title
Overall Survival
Time Frame
2 years after randomisation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has provided written informed consent. R0-resection of liver metastasis, at least four weeks but not longer than 8 weeks ago. Histologically confirmed diagnosis of metastatic colorectal cancer confined to the liver KRAS-wildtype of the tumor Age 18 years or older ECOG performance status 0-1 Females with child-bearing potential must use adequate contraceptive measures Exclusion of pregnancy Relevant toxicities of previous treatments must have subsided Magnesium >= lower limit of normal; Calcium >= lower limit of normal Normal cardiac function demonstrated by ECG and echocardiogram (LVEF ≥ 55%) No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Adequate organ function as defined by Table 1: Hematologic: ANC (absolute neutrophil count) >= 1.5 G/L, Leucocytes > 3.0 G/L, Hemoglobin >= 9 g/dL, Platelets >= 100 G/L Hepatic: Albumin >= 2.5 g/dL, Serum bilirubin <= 2 mg/dL, AST and ALT <= 3 x ULN Renal: Serum Creatinine <= 1.5 mg/dL Exclusion Criteria: Known manifestations of metastatic disease Progression during preoperative treatment Missing KRAS mutation status of the tumor Contraindication against therapy with 5-fluorouracil/ folinic acid or oxaliplatin Known intolerability of panitumumab Known DPD deficiency Polyneuropathy > grade 1 (NCI-CTCv4) which precludes the use of oxaliplatin Evidence of ascites or cirrhosis Patient is pregnant or lactating or planning to become pregnant within 6 months after end of treatment Subject (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment Has had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study enrolment, or there is an anticipated need for major surgical procedure during the course of the study Clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) <= 1 year before enrolment/randomization History of interstitial lung disease e.g. pneumonitis or pulmonary fibrosis or evidence of interstitial lung disease on baseline chest CT scan Has a concurrent disease or condition that would make the subject inappropriate for study participation or would interfere with the subject's safety. Has any psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol. Requires concurrent cancer therapy (chemotherapy, radiation therapy, biologic therapy, immunotherapy, or hormonal therapy) while on study. Requires concurrent treatment with an investigational agent, participation in another clinical trial, or any specifically prohibited medication while on study. Has a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to 5-fluorouracil, folinic acid, oxaliplatin, or panitumumab. Other active malignancy Known alcohol abuse or drug addiction Incapability to give informed consent
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Volker Heinemann, Prof. Dr. med.
Phone
+49 89 7095
Ext
0
Email
volker.heinemann@med.uni-muenchen.de
First Name & Middle Initial & Last Name or Official Title & Degree
Clemens Gießen, Dr. med.
Phone
+49 89 7095
Ext
0
Email
clemens.giessen@med.uni-muenchen.de
Facility Information:
Facility Name
Ludwig-Maximilians - University of Munich
City
Munich
ZIP/Postal Code
81377
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Volker Heinemann, Prof. Dr. med.
Phone
+49 89 7095
Ext
0
Email
volker.heinemann@med.uni-muenchen.de
First Name & Middle Initial & Last Name & Degree
Clemens Giessen, Dr. med.
Phone
+49 89 7095
Ext
0
Email
clemens.giessen@med.uni-muenchen.de
First Name & Middle Initial & Last Name & Degree
Volker Heinemann, Prof. Dr. med.

12. IPD Sharing Statement

Citations:
PubMed Identifier
35970102
Citation
Modest DP, Karthaus M, Kasper S, Moosmann N, Keitel V, Kiani A, Uhlig J, Jacobasch L, Fischer V Weikersthal L, Fuchs M, Kaiser F, Lerchenmuller C, Sent D, Junghanss C, Held S, Lorenzen S, Kaczirek K, Jung A, Stintzing S, Heinemann V. FOLFOX plus panitumumab or FOLFOX alone as additive therapy following R0/1 resection of RAS wild-type colorectal cancer liver metastases - The PARLIM trial (AIO KRK 0314). Eur J Cancer. 2022 Sep;173:297-306. doi: 10.1016/j.ejca.2022.07.012. Epub 2022 Aug 12.
Results Reference
derived

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Panitumumab After Resection of Liver Metastases From Colorectal Cancer in KRAS Wild-type Patients

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