Sorafenib and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer
Recurrent Colon Cancer, Recurrent Rectal Cancer, Stage IV Colon Cancer
About this trial
This is an interventional treatment trial for Recurrent Colon Cancer
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of stage IV colorectal cancer (histologic proof is not required)
Measurable disease
- Spiral CT scan required for both pre- and post-treatment tumor assessments of lesions measuring 1-2 cm
- Progressive disease during or within 6 months of most recent prior chemotherapy regimen (bevacizumab, fluoropyrimidine, oxaliplatin, or irinotecan-based treatment) OR considered ineligible for standard therapy
- Documentation of submission of tumor material for Kirsten Rat Sarcoma (KRAS) testing available
- Prior anti-epidermal growth factor receptor (EGFR) antibody therapy (e.g., cetuximab or panitumumab) required for patients with wild-type KRAS tumor
No known brain metastasis
- Patients with neurological symptoms must undergo a CT scan or MRI of the brain to exclude brain metastasis
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Life expectancy ≥ 6 months
- Hemoglobin ≥ 9.0 g/dL
- Absolute neutrophil count (ANC) ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- White blood cell count (WBC) ≥ 3,400/mm³
- International normalized ratio (INR) < 1.5 (≤ 3.0 if on anti-coagulation therapy [e.g., warfarin or heparin])
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
- Aspartate aminotransferase (AST) ≤ 2.5 times ULN (≤ 5 times ULN if there is liver involvement)
- Alkaline phosphatase ≤ 3 times ULN
- Creatinine ≤ 1.5 times ULN
- Urine protein:creatinine ratio < 1 OR urine dipstick < 2+ OR urine protein < 1,000 mg by 24-hour urine collection
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment (≥ 2 weeks after completion of treatment with sorafenib tosylate alone)
- Willing to provide mandatory blood samples for translational research studies
- Able to swallow whole pills
- No inadequately controlled hypertension (i.e., systolic BP > 150 mm Hg or diastolic BP > 100 mm Hg on anti-hypertensive medications)
- No prior hypertensive crisis or hypertensive encephalopathy
- No myocardial infarction or unstable angina within the past 6 months
- No congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
- No thrombolic or embolic events (e.g., cerebrovascular accident, including transient ischemic attacks) within the past 6 months
- No hemorrhage or bleeding event > grade 3 within the past 4 weeks
- No evidence or history of bleeding diathesis or coagulopathy (in the absence of therapeutic anticoagulation)
- No greater than normal risk of bleeding
- No active or recent hemoptysis (≥ ½ teaspoon of bright red blood per episode) within the past 30 days
No concurrent uncontrolled illness including, but not limited to, any of the following:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia requiring anti-arrhythmic drugs
- Psychiatric illness or social situations that would limit compliance with study requirements
- No known HIV infection or chronic hepatitis B or C infection
No serious, non-healing wound, active ulcer, or untreated bone fracture
- Patients with fractures secondary to metastatic disease are eligible after appropriate radiotherapy
- No significant traumatic injury within the past 4 weeks
- No known or suspected allergy or hypersensitivity to any component of bevacizumab, sorafenib tosylate, or their excipients or to any other agent given in the course of this study
- No malabsorption problem
None of the following within the past 6 months:
- Significant vascular disease (e.g., aortic aneurysm or aortic dissection)
- Peripheral arterial thrombosis
- Symptomatic peripheral vascular disease
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
No other active malignancy within the past 3 years except non melanoma skin cancer or carcinoma in situ of the cervix
- Prior malignancy allowed provided patient is not receiving other specific treatment for that malignancy (other than hormonal therapy)
- No other concurrent investigational agent for this cancer
- Prior radiotherapy allowed
- No prior sorafenib tosylate
- No prior discontinuation of bevacizumab due to adverse events
- More than 4 weeks since prior and no concurrent participation in any other experimental drug study
- More than 4 weeks since prior St. John's wort or rifampin
- More than 4 weeks since prior and no concurrent major surgical procedure or open biopsy
- More than 7 days since prior core biopsy or minor surgical procedure, including placement of a vascular access device
- No concurrent anticoagulant, except low-dose warfarin or heparin for deep venous thrombosis prophylaxis
Sites / Locations
- Mayo Clinic in Arizona
- The Medical Center of Aurora
- Boulder Community Hospital
- Penrose-Saint Francis Healthcare
- Saint Anthony Central Hospital
- Porter Adventist Hospital
- Exempla Saint Joseph Hospital
- Presbyterian - Saint Lukes Medical Center - Health One
- Rose Medical Center
- Colorado Cancer Research Program CCOP
- Swedish Medical Center
- Saint Mary's Hospital and Regional Medical Center
- North Colorado Medical Center
- Sky Ridge Medical Center
- Longmont United Hospital
- McKee Medical Center
- Saint Mary Corwin Medical Center
- North Suburban Medical Center
- Exempla Lutheran Medical Center
- Mayo Clinic in Florida
- Saint Joseph Medical Center
- Graham Hospital Association
- Memorial Hospital
- Eureka Hospital
- Galesburg Clinic
- Galesburg Cottage Hospital
- Mason District Hospital
- Mcdonough District Hospital
- Garneau, Stewart C MD (UIA Investigator)
- Porubcin, Michael MD (UIA Investigator)
- Sharis, Christine M MD (UIA Investigator)
- Stoffel, Thomas J MD (UIA Investigator)
- Holy Family Medical Center
- Bromenn Regional Medical Center
- Community Cancer Center Foundation
- Illinois CancerCare-Ottawa Clinic
- Ottawa Regional Hospital and Healthcare Center
- Pekin Cancer Treatment Center
- Pekin Hospital
- Methodist Medical Center of Illinois
- Proctor Hospital
- Illinois CancerCare-Peoria
- Illinois Oncology Research Association CCOP
- OSF Saint Francis Medical Center
- Illinois Valley Hospital
- Perry Memorial Hospital
- Saint Margaret's Hospital
- Saint Francis Hospital and Health Centers
- Elkhart General Hospital
- Community Howard Regional Health
- Indiana University Health La Porte Hospital
- Saint Joseph Regional Medical Center-Mishawaka
- Reid Hospital and Health Care Services
- Memorial Hospital of South Bend
- Northern Indiana Cancer Research Consortium
- South Bend Clinic
- Constantinou, Costas L MD (UIA Investigator)
- Cedar Rapids Oncology Association
- Mercy Hospital
- Oncology Associates at Mercy Medical Center
- Medical Oncology and Hematology Associates-West Des Moines
- Mercy Capitol
- Iowa Methodist Medical Center
- Iowa Oncology Research Association CCOP
- Medical Oncology and Hematology Associates-Des Moines
- Medical Oncology and Hematology Associates
- Mercy Medical Center - Des Moines
- Iowa Lutheran Hospital
- Mercy Medical Center - North Iowa
- Siouxland Hematology Oncology Associates
- Mercy Medical Center-Sioux City
- Saint Luke's Regional Medical Center
- Hospital District Sixth of Harper County
- Cancer Center of Kansas - Chanute
- Cancer Center of Kansas - Dodge City
- Cancer Center of Kansas - El Dorado
- Cancer Center of Kansas - Fort Scott
- Cancer Center of Kansas-Independence
- Cancer Center of Kansas-Kingman
- Lawrence Memorial Hospital
- Cancer Center of Kansas - Newton
- Cancer Center of Kansas - Parsons
- Cancer Center of Kansas - Pratt
- Cancer Center of Kansas - Salina
- Cancer Center of Kansas - Wellington
- Associates In Womens Health
- Cancer Center of Kansas-Wichita Medical Arts Tower
- Cancer Center of Kansas - Main Office
- Via Christi Regional Medical Center
- Wichita CCOP
- Cancer Center of Kansas - Winfield
- Bixby Medical Center
- Hickman Cancer Center
- Saint Joseph Mercy Hospital
- Michigan Cancer Research Consortium Community Clinical Oncology Program
- Oakwood Hospital
- Saint John Hospital and Medical Center
- Green Bay Oncology - Escanaba
- Hurley Medical Center
- Genesys Regional Medical Center-West Flint Campus
- Green Bay Oncology - Iron Mountain
- Allegiance Health
- Sparrow Hospital
- Saint Mary Mercy Hospital
- Community Cancer Center of Monroe
- Mercy Memorial Hospital
- Saint Joseph Mercy Oakland
- Saint Joseph Mercy Port Huron
- Saint Mary's of Michigan
- Lakeland Hospital
- Saint John Macomb-Oakland Hospital
- Sanford Clinic North-Bemidgi
- Fairview Ridges Hospital
- Mercy Hospital
- Essentia Health Duluth Clinic CCOP
- Essentia Health Saint Mary's Medical Center
- Miller-Dwan Hospital
- Fairview-Southdale Hospital
- Unity Hospital
- Hutchinson Area Health Care
- Immanuel-Saint Joseph Hospital-Mayo Health System
- Minnesota Oncology Hematology PA-Maplewood
- Saint John's Hospital - Healtheast
- Abbott-Northwestern Hospital
- Virginia Piper Cancer Institute
- Hennepin County Medical Center
- North Memorial Medical Health Center
- Mayo Clinic
- Metro-Minnesota CCOP
- Park Nicollet Clinic - Saint Louis Park
- Regions Hospital
- United Hospital
- Saint Francis Regional Medical Center
- Ridgeview Medical Center
- Minnesota Oncology and Hematology PA-Woodbury
- Missouri Baptist Medical Center
- Center for Cancer Care and Research
- Saint John's Hospital
- Montana Cancer Consortium CCOP
- Northern Rockies Radiation Oncology Center
- Saint Vincent Healthcare
- Hematology-Oncology Centers of the Northern Rockies PC
- Billings Clinic
- Bozeman Deaconess Cancer Center
- Saint James Community Hospital and Cancer Treatment Center
- Berdeaux, Donald MD (UIA Investigator)
- Great Falls Clinic
- Northern Montana Hospital
- Saint Peter's Community Hospital
- Glacier Oncology PLLC
- Kalispell Medical Oncology
- Kalispell Regional Medical Center
- Community Medical Hospital
- Montana Cancer Specialists
- Saint Patrick Hospital - Community Hospital
- Guardian Oncology and Center for Wellness
- Bismarck Cancer Center
- Mid Dakota Clinic
- Saint Alexius Medical Center
- Sanford Bismarck Medical Center
- Sanford Clinic North-Fargo
- Sanford Medical Center-Fargo
- Altru Cancer Center
- Toledo Clinic Cancer Centers-Bowling Green
- North Coast Cancer Care-Clyde
- Grandview Hospital
- Good Samaritan Hospital - Dayton
- Miami Valley Hospital
- Samaritan North Health Center
- Dayton CCOP
- Hematology Oncology Center Incorporated
- Blanchard Valley Hospital
- Atrium Medical Center-Middletown Regional Hospital
- Wayne Hospital
- Kettering Medical Center
- Lima Memorial Hospital
- Toledo Clinic Cancer Centers-Maumee
- Saint Luke's Hospital
- Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
- Saint Charles Hospital
- Toledo Clinic Cancer Centers-Oregon
- North Coast Cancer Care
- Flower Hospital
- Mercy Hospital of Tiffin
- The Toledo Hospital/Toledo Children's Hospital
- Saint Vincent Mercy Medical Center
- University of Toledo
- Toledo Community Hospital Oncology Program CCOP
- Mercy Cancer Center at Saint Anne Mercy Hospital
- Toledo Clinic Cancer Centers-Toledo
- Upper Valley Medical Center
- Fulton County Health Center
- Clinton Memorial Hospital
- Greene Memorial Hospital
- Adventist Medical Center
- Geisinger Medical Center
- Geisinger Medical Center-Cancer Center Hazelton
- Geisinger Medical Group
- Geisinger Wyoming Valley
- Fredericksburg Oncology Inc
- Midelfort Clinic-Clairemont Campus
- Mayo Clinic Health System Eau Claire Hospital - Luther Campus
- Green Bay Oncology at Saint Vincent Hospital
- Saint Vincent Hospital
- Green Bay Oncology Limited at Saint Mary's Hospital
- Saint Mary's Hospital
- Holy Family Memorial Hospital
- Bay Area Medical Center
- Green Bay Oncology - Oconto Falls
- Green Bay Oncology - Sturgeon Bay
- Welch Cancer Center
Arms of the Study
Arm 1
Experimental
Treatment (sorafenib tosylate and bevacizumab)
Patients receive sorafenib tosylate orally twice daily on days 1-5 and 8-12 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. Blood samples are collected at baseline and then periodically during study treatment for laboratory biomarker and pharmacogenetic studies