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Safety and Efficacy Study of mFOLFOX-6 Plus Cetuximab for 8 Cycles Followed by mFOLFOX-6 Plus Cetuximab or Single Agent Cetuximab as Maintenance Therapy in Patients With Metastatic Colorectal Cancer and WT KRAS Tumours (MACRO-2)

Primary Purpose

Metastatic Colorectal Cancer

Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
mFOLFOX-6 + cetuximab until disease progression or early withdrawal.
8 cycles of mFOLFOX-6 + cetuximab, followed by cetuximab alone until disease progression or early withdrawal.
Sponsored by
Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Colorectal Cancer focused on measuring metastatic colorectal cancer, wild-type KRAS tumours, cetuximab, mFOLFOX-6

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written informed consent.
  • Patients of an age ≥ 18 years and < 71
  • Patients with an ECOG performance status ≤ 2
  • Confirmed histological diagnosis of colorectal carcinoma with metastatic disease and wild-type KRAS.
  • Presence of at least one target lesion that is measurable one-dimensionally (not located in an irradiated region).
  • Life expectancy greater than 12 weeks.
  • First evidence of chemotherapy-naïve metastatic disease. Adjuvant chemotherapy is allowed if it has been more than 6 months since the treatment was finished and there have been no signs of disease progression, neither during treatment nor during the 6 months following its completion.
  • Adequate medullar reserve:
  • Absolute neutrophil count ≥ 1.5 x 109/L
  • Platelet count ≥ 100 x 109/L
  • Haemoglobin ≥ 9 g/dL
  • Adequate renal function: Creatinine clearance > 30 mL/min, calculated using the Cockroff-Gault formula, or a serum creatinine < 2 mg/dL or 177 umol/L
  • An adequate liver function: ASAT (SGOT) and ALAT (SGPT) ≤ 2.5 x ULN (≤ 5 x ULN if there are liver metastases). Total bilirubin < 1.5 x ULN. Alkaline phosphatase ≤ 2.5 x ULN ( ≤ 5 x ULN in the case of liver metastases or ≤ 10 x ULN in the case of bone metastases)

Exclusion Criteria:

  • To have received prior systemic treatment for the metastatic disease
  • Diagnosis or suspicion of brain or leptomeningeal metastases
  • Major surgery or radiotherapy (except for antalgic surgery that does not include measurable target lesions) during the 4 weeks prior to inclusion in the study.
  • Previous administration of monoclonal antibodies, agents inhibiting EGFR signal transduction or EGFR-targeted treatment.
  • Participation in another clinical trial with drugs within the previous 30 days.
  • Neoplasm in the 2 years prior to entering the study, except for non-melanoma skin carcinoma or in situ cervix carcinoma.
  • Evidence of previous acute hypersensitivity reaction of any degree to any of the treatment's components.
  • Clinically relevant peripheral neuropathy.
  • Signs and symptoms, at the moment of entering the study, of acute or subacute bowel obstruction.
  • A history of an acute episode of ischemic heart disease (angina or acute myocardial infarction) within the previous 12 months or an elevated risk of heart failure decompensation or uncontrolled arrhythmia.
  • Serious active infection, including active tuberculosis and HIV diagnosis.
  • Chronic immunological or hormonal treatment, except for hormone replacement treatment at physiological doses.
  • Known drug or alcohol abuse.
  • Legal incapacity or limited legal capacity.
  • Pregnancy or breastfeeding. Premenopausal women must have a negative pregnancy test in urine or blood before entering the trial. Patients and their partners must take contraceptive measures (hormonal, barrier, or abstinence) if the possibility of conception exists, during the study and for 3 months after the end of the treatment thereof.
  • Any geographical or social circumstance or any medical or psychological alteration that, in the investigator's opinion, will not allow the patient to conclude the study.

Sites / Locations

  • Spanish Cooperative Group for Gastrointestinal Tumour Therapy

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Control

Experimental

Arm Description

mFOLFOX-6 + cetuximab until disease progression or early withdrawal.

8 cycles of mFOLFOX-6 + cetuximab, followed by cetuximab alone until disease progression or early withdrawal.

Outcomes

Primary Outcome Measures

progression-free survival

Secondary Outcome Measures

overall survival
rate of objective responses
disease's resectability (R0)
evaluate hypomagnesaemia as a predictive factor in the treatment's efficacy
Adverse events

Full Information

First Posted
July 12, 2010
Last Updated
July 24, 2015
Sponsor
Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD)
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1. Study Identification

Unique Protocol Identification Number
NCT01161316
Brief Title
Safety and Efficacy Study of mFOLFOX-6 Plus Cetuximab for 8 Cycles Followed by mFOLFOX-6 Plus Cetuximab or Single Agent Cetuximab as Maintenance Therapy in Patients With Metastatic Colorectal Cancer and WT KRAS Tumours
Acronym
MACRO-2
Official Title
Phase-II, Randomized, Multicentre Pilot Study to Evaluate the Safety and Efficacy of the Treatment With mFOLFOX-6 Plus Cetuximab Versus Initial Treatment With mFOLFOX-6 Plus Cetuximab (for 8 Cycles), Followed by Maintenance With Cetuximab Alone as First-line Treatment in Patients With Metastatic Colorectal Cancer (mCRC) and Wild-type KRAS Tumours
Study Type
Interventional

2. Study Status

Record Verification Date
July 2015
Overall Recruitment Status
Completed
Study Start Date
August 2010 (undefined)
Primary Completion Date
June 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to evaluate the efficacy and safety of the combination of mFOLFOX-6 plus cetuximab for 8 cycles followed by mFOLFOX-6 plus cetuximab or single agent (s/a) cetuximab as maintenance therapy in patients (pts) with metastatic colorectal cancer (mCRC).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Cancer
Keywords
metastatic colorectal cancer, wild-type KRAS tumours, cetuximab, mFOLFOX-6

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Control
Arm Type
Active Comparator
Arm Description
mFOLFOX-6 + cetuximab until disease progression or early withdrawal.
Arm Title
Experimental
Arm Type
Experimental
Arm Description
8 cycles of mFOLFOX-6 + cetuximab, followed by cetuximab alone until disease progression or early withdrawal.
Intervention Type
Drug
Intervention Name(s)
mFOLFOX-6 + cetuximab until disease progression or early withdrawal.
Intervention Description
Treatment regimen: mFOLFOX-6, day 1, every two weeks; OXALIPLATIN 85 mg/m2; FOLINIC ACID 400 mg/m2; 5-FU 400 mg/m2 IV bolus; 5-FU 2400 mg/m2 continuous infusion for 46 hours Cetuximab weekly. Cetuximab 400 mg/m2 the first time the treatment is administered; 250 mg/m2 for subsequent administrations.
Intervention Type
Drug
Intervention Name(s)
8 cycles of mFOLFOX-6 + cetuximab, followed by cetuximab alone until disease progression or early withdrawal.
Intervention Description
Treatment regimen. mFOLFOX-6. day 1 every two weeks. OXALIPLATIN 85 mg/m2; FOLINIC ACID 400 mg/m2; 5-FU 400 mg/m2 IV bolus; 5-FU 2400 mg/m2 continuous infusion for 46 hours Cetuximab weekly. Cetuximab 400 mg/m2 the first time the treatment is administered; 250 mg/m2 for subsequent administrations.
Primary Outcome Measure Information:
Title
progression-free survival
Time Frame
2010-2014
Secondary Outcome Measure Information:
Title
overall survival
Time Frame
2010-2014
Title
rate of objective responses
Time Frame
2010-2014
Title
disease's resectability (R0)
Time Frame
2010-2014
Title
evaluate hypomagnesaemia as a predictive factor in the treatment's efficacy
Time Frame
2010-2014
Title
Adverse events
Time Frame
2010-2014

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent. Patients of an age ≥ 18 years and < 71 Patients with an ECOG performance status ≤ 2 Confirmed histological diagnosis of colorectal carcinoma with metastatic disease and wild-type KRAS. Presence of at least one target lesion that is measurable one-dimensionally (not located in an irradiated region). Life expectancy greater than 12 weeks. First evidence of chemotherapy-naïve metastatic disease. Adjuvant chemotherapy is allowed if it has been more than 6 months since the treatment was finished and there have been no signs of disease progression, neither during treatment nor during the 6 months following its completion. Adequate medullar reserve: Absolute neutrophil count ≥ 1.5 x 109/L Platelet count ≥ 100 x 109/L Haemoglobin ≥ 9 g/dL Adequate renal function: Creatinine clearance > 30 mL/min, calculated using the Cockroff-Gault formula, or a serum creatinine < 2 mg/dL or 177 umol/L An adequate liver function: ASAT (SGOT) and ALAT (SGPT) ≤ 2.5 x ULN (≤ 5 x ULN if there are liver metastases). Total bilirubin < 1.5 x ULN. Alkaline phosphatase ≤ 2.5 x ULN ( ≤ 5 x ULN in the case of liver metastases or ≤ 10 x ULN in the case of bone metastases) Exclusion Criteria: To have received prior systemic treatment for the metastatic disease Diagnosis or suspicion of brain or leptomeningeal metastases Major surgery or radiotherapy (except for antalgic surgery that does not include measurable target lesions) during the 4 weeks prior to inclusion in the study. Previous administration of monoclonal antibodies, agents inhibiting EGFR signal transduction or EGFR-targeted treatment. Participation in another clinical trial with drugs within the previous 30 days. Neoplasm in the 2 years prior to entering the study, except for non-melanoma skin carcinoma or in situ cervix carcinoma. Evidence of previous acute hypersensitivity reaction of any degree to any of the treatment's components. Clinically relevant peripheral neuropathy. Signs and symptoms, at the moment of entering the study, of acute or subacute bowel obstruction. A history of an acute episode of ischemic heart disease (angina or acute myocardial infarction) within the previous 12 months or an elevated risk of heart failure decompensation or uncontrolled arrhythmia. Serious active infection, including active tuberculosis and HIV diagnosis. Chronic immunological or hormonal treatment, except for hormone replacement treatment at physiological doses. Known drug or alcohol abuse. Legal incapacity or limited legal capacity. Pregnancy or breastfeeding. Premenopausal women must have a negative pregnancy test in urine or blood before entering the trial. Patients and their partners must take contraceptive measures (hormonal, barrier, or abstinence) if the possibility of conception exists, during the study and for 3 months after the end of the treatment thereof. Any geographical or social circumstance or any medical or psychological alteration that, in the investigator's opinion, will not allow the patient to conclude the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Enrique Aranda
Organizational Affiliation
Hospital Reina Sofia. Córdoba. Spain
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Eduardo Díaz-Rubio
Organizational Affiliation
Hospital Clínico San Carlos. Madrid. Spain
Official's Role
Study Chair
Facility Information:
Facility Name
Spanish Cooperative Group for Gastrointestinal Tumour Therapy
City
Madrid
ZIP/Postal Code
28046
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
31803504
Citation
Benavides M, Diaz-Rubio E, Carrato A, Abad A, Guillen C, Garcia-Alfonso P, Gil S, Cano MT, Safont MJ, Gravalos C, Manzano JL, Sanchez A, Alcaide J, Lopez R, Massuti B, Sastre J, Martinez E, Escudero P, Mendez M, Aranda E. Tumour location and efficacy of first-line EGFR inhibitors in KRAS/RAS wild-type metastatic colorectal cancer: retrospective analyses of two phase II randomised Spanish TTD trials. ESMO Open. 2019 Dec 1;4(6):e000599. doi: 10.1136/esmoopen-2019-000599. eCollection 2019. Erratum In: ESMO Open. 2020 Jan;5(1):
Results Reference
derived
PubMed Identifier
30054049
Citation
Aranda E, Garcia-Alfonso P, Benavides M, Sanchez Ruiz A, Guillen-Ponce C, Safont MJ, Alcaide J, Gomez A, Lopez R, Manzano JL, Mendez Urena M, Sastre J, Rivera F, Gravalos C, Garcia T, Martin-Valades JI, Falco E, Navalon M, Gonzalez Flores E, Ma Garcia Tapiador A, Ma Lopez Munoz A, Barrajon E, Reboredo M, Garcia Teijido P, Viudez A, Cardenas N, Diaz-Rubio E; Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD). First-line mFOLFOX plus cetuximab followed by mFOLFOX plus cetuximab or single-agent cetuximab as maintenance therapy in patients with metastatic colorectal cancer: Phase II randomised MACRO2 TTD study. Eur J Cancer. 2018 Sep;101:263-272. doi: 10.1016/j.ejca.2018.06.024. Epub 2018 Jul 24.
Results Reference
derived
Links:
URL
http://www.ttdgroup.org
Description
Related Info

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Safety and Efficacy Study of mFOLFOX-6 Plus Cetuximab for 8 Cycles Followed by mFOLFOX-6 Plus Cetuximab or Single Agent Cetuximab as Maintenance Therapy in Patients With Metastatic Colorectal Cancer and WT KRAS Tumours

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