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Study of CS-7017 in Combination With FOLFIRI in Subjects With Metastatic Colorectal Cancer Who Failed First-Line Therapy

Primary Purpose

Colorectal Cancer, Neoplasms, Colorectal

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
CS7017
irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI)
Sponsored by
Daiichi Sankyo, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring metastatic, colon, rectum, combination, chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  • Metastatic CRC that has progressed following first-line therapy.
  • Measurable disease (Response Evaluation Criteria in Solid Tumors [RECIST], Version 1.0.
  • Male or female ≥ 18 years of age.
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.
  • Resolution of any toxic effects of prior therapy (except alopecia) to NCI CTCAE, Version 3.0, grade ≤ 1.
  • Adequate organ and bone marrow function as evidenced by:

    • Hemoglobin ≥ 9 g/dL (transfusion and/or growth factor support allowed)
    • Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L
    • Platelet count ≥ 100 x 10^9/L
    • Serum creatinine ≤ 1.5 x the upper limit of normal (ULN) or creatinine clearance ≥ 60 mL/min
    • Aspartate aminotransferase (AST) and alkaline phosphatase ≤ 2.5 x ULN in participants with no liver metastasis and ≤ 5.0 x ULN in participants with liver metastasis
    • Total bilirubin ≤ 1.5 x ULN
  • Women of childbearing potential must be willing to consent to using effective contraception (eg, hormonal contraceptives, bilateral tubal ligation, barrier with spermicide, intrauterine device) while on treatment and for at least 3 months thereafter. Men who are the partner of a woman of childbearing potential must be willing to consent to using effective contraception (eg, vasectomy or barrier with spermicide) while on treatment and for 3 months thereafter.
  • All female participants of childbearing potential must have a negative pregnancy test (serum or urine) result before initiating study treatment.
  • Participants must be fully informed about their illness and the investigational nature of the study protocol (including foreseeable risks and possible side effects) and must sign and date an Independent Ethics Committee (IEC)- or Institutional Review Board (IRB)-approved informed consent form (ICF) (including HIPAA authorization, if applicable) before performance of any study-specific procedures or tests.
  • Participants must be willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

Exclusion Criteria:

  • First-line treatment with an irinotecan-based regimen (eg, FOLFIRI).
  • Anticipation of need for a major surgical procedure or radiation therapy (RT) during the study.
  • Treatment with chemotherapy, other thiazolidinediones (TZD), RT, surgery, immunotherapy, biological therapy, or any investigational anticancer agent within 4 weeks before start of study treatment.
  • History of any of the following conditions within 6 months before initiating study treatment:

    • Diabetes mellitus requiring treatment with insulin or TZD agents
    • Myocardial infarction with significant impairment of cardiac function (eg, ejection fraction ≤ 50%)
    • Severe/unstable angina pectoris
    • Coronary/peripheral artery bypass graft
    • New York Heart Association (NYHA) class III or IV congestive heart failure
    • Malabsorption syndrome, chronic diarrhea (lasting > 4 weeks), inflammatory bowel disease, or partial bowel obstruction.
  • Participants with clinically active brain metastases (defined as untreated, symptomatic, or requiring therapy with steroids or anticonvulsants to control associated symptoms); uncontrolled seizure disorder; spinal cord compression; or carcinomatous meningitis. Participants with treated brain metastasis will be included in the study if they have recovered from the acute, toxic effects of RT. A minimum of 15 days must have elapsed between the end of RT and enrollment into the study.
  • History of malignancy other than CRC, unless there is an expectation that the malignancy has been cured, and tumor-specific treatment for the malignancy has not been administered within the previous 5 years.
  • Clinically significant, severe, active infection requiring IV antibiotic or antiviral agents.
  • Pericardial or pleural effusion (eg, requiring drainage) or pericardial involvement with the tumor. Participants with minimal pleural effusion may be eligible upon request by Investigator and approval by Sponsor.
  • Need for concomitant use of other TZD agents during the study.
  • Previous administration of CS-7017.
  • Pregnant or breast feeding.
  • Known to be homozygous for the UGT1A1*28 allele.
  • Known history of severe hypersensitivity reactions to any of the components of CS-7017, irinotecan, leucovorin, or 5-FU.
  • Serious intercurrent medical or psychiatric illnesses or any other conditions that in the opinion of the Investigator would impair the ability to give informed consent or unacceptably reduce protocol compliance or safety of the study treatment.

Sites / Locations

  • Beverly Hills Cancer Center
  • St. Jude Heritage Medical Group
  • John Marshall
  • Georgia Cancer Specialists
  • Victor Priego
  • Gabrail Cancer Center
  • Instituto FIDES Oncologia y Especialidades Medicas
  • CAIPO Centro para la Atencion Integral del Paciente Oncologico
  • Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul - PUC-RS
  • Instituto Nacional de Cancer INCA
  • ICAVC
  • Fundacion Arturo Lopez Perez
  • Instituto Nacional del Cancer
  • Instituto Oncologico Clinica Renaca
  • Hospital Nacional Alberto Sabogai Sologuren
  • Hospital Nacional Dos de Mayo
  • Oncosalud SAC
  • Hospital Nacional Dos de Mayo

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

FOLFIRI

CS7017+FOLFIRI

Arm Description

Participants who received irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI). FOLFIRI was administered by intravenous (IV) injection once every 2 weeks. The FOLFIRI regimen consisted of: Irinotecan, 180 mg/m^2 IV infusion over 30 to 120 minutes Leucovorin, 400 mg/m^2 IV infusion to match the duration of the irinotecan infusion 5-FU, 1200 mg/m^2/day x 2 days (total 2400 mg/m^2 over 46 to 48 hours continuous infusion)

Participants who received CS7017 plus irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI). Two CS-7017 tablets were administered by mouth (PO) twice a day (BID) every 12 hours. FOLFIRI was administered IV once every 2 weeks. The FOLFIRI regimen consisted of: Irinotecan, 180 mg/m^2 IV infusion over 30 to 120 minutes Leucovorin, 400 mg/m^2 IV infusion to match the duration of the irinotecan infusion 5-FU, 1200 mg/m^2/day x 2 days (total 2400 mg/m^2 over 46 to 48 hours continuous infusion)

Outcomes

Primary Outcome Measures

Percentage of Participants With Progression-Free Survival at 16 Weeks After Administration of CS-7017 Combined With Irinotecan, Leucovorin, and 5-Fluorouracil (5-FU) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Progression-free survival (PFS) was defined as the time from randomization until the first objective evidence of disease progression or death from any cause.

Secondary Outcome Measures

Median Overall Progression-Free Survival Following Administration of CS-7017 in Combination With Irinotecan, Leucovorin, and 5-Fluorouracil (5-FU) (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Progression-free survival (PFS) was defined as the time from randomization until the first objective evidence of disease progression or death from any cause.
Median Overall Progression-Free Survival: Sensitivity Analysis Including Clinical Progression After Administration of CS-7017 and Irinotecan, Leucovorin, and 5-Fluorouracil After Failure of First-line Therapy of Metastatic Colorectal Cancer
Progression-free survival (PFS) was defined as the time from randomization to the date of the first objective documentation of progressive disease (PD) or death resulting from any cause, whichever came first. The sensitivity analysis included clinical progression as an event.
Best Overall Response and Objective Response Rate Following Administration of CS-7017 in Combination With Irinotecan, Leucovorin, and 5-Fluorouracil (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
As per Response Evaluation Criteria for Solid Tumors v1.0, best overall response was characterized as confirmed complete response (CR) defined as disappearance of all target lesions, confirmed partial response (PR) defined as ≥30% decrease from baseline, stable disease (SD) defined as neither progressive disease (PD) nor PR, and PD defined as ≥20% increase from smallest sum of longest diameter recorded since treatment started. Objective response rate (ORR) was defined as CR + PR. If there is no tumor assessment after the first dose of study drug, the best overall response is classified as Inevaluable.
Treatment-Emergent Adverse Events Occurring in ≥10% of Participants Following Administration of CS-7017 Combined With Irinotecan, Leucovorin, and 5-Fluorouracil (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
An adverse event (AE) >30 days after last dose of study drug was not included as a treatment-emergent adverse events (TEAE) unless considered related to treatment.

Full Information

First Posted
August 27, 2009
Last Updated
April 22, 2020
Sponsor
Daiichi Sankyo, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00967616
Brief Title
Study of CS-7017 in Combination With FOLFIRI in Subjects With Metastatic Colorectal Cancer Who Failed First-Line Therapy
Official Title
Randomized, Active-Controlled, Open-Label Phase 2 Study of CS-7017 in Combination With FOLFIRI in Subjects With Metastatic Colorectal Cancer Who Failed First-Line Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
April 2013 (Actual)
Study Completion Date
April 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Daiichi Sankyo, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This phase 2, randomized, active-controlled, open-label, parallel group, multicenter study will be conducted at up to 18 study centers in the US, Central America, and South America. Adult subjects with metastatic colorectal cancer (CRC) who failed first-line chemotherapy will participate in the study, which will be conducted on an outpatient basis. It is anticipated that 100 subjects will be enrolled to obtain approximately 90 evaluable subjects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Neoplasms, Colorectal
Keywords
metastatic, colon, rectum, combination, chemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
FOLFIRI
Arm Type
Active Comparator
Arm Description
Participants who received irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI). FOLFIRI was administered by intravenous (IV) injection once every 2 weeks. The FOLFIRI regimen consisted of: Irinotecan, 180 mg/m^2 IV infusion over 30 to 120 minutes Leucovorin, 400 mg/m^2 IV infusion to match the duration of the irinotecan infusion 5-FU, 1200 mg/m^2/day x 2 days (total 2400 mg/m^2 over 46 to 48 hours continuous infusion)
Arm Title
CS7017+FOLFIRI
Arm Type
Experimental
Arm Description
Participants who received CS7017 plus irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI). Two CS-7017 tablets were administered by mouth (PO) twice a day (BID) every 12 hours. FOLFIRI was administered IV once every 2 weeks. The FOLFIRI regimen consisted of: Irinotecan, 180 mg/m^2 IV infusion over 30 to 120 minutes Leucovorin, 400 mg/m^2 IV infusion to match the duration of the irinotecan infusion 5-FU, 1200 mg/m^2/day x 2 days (total 2400 mg/m^2 over 46 to 48 hours continuous infusion)
Intervention Type
Drug
Intervention Name(s)
CS7017
Intervention Description
CS-7017 (0.25mg tablet) Two CS-7017 tablets will be administered by mouth (PO) BID every 12 hours. FOLFIRI will be administered IV once every 2 weeks.
Intervention Type
Drug
Intervention Name(s)
irinotecan, leucovorin, and 5-fluorouracil (5-FU) (FOLFIRI)
Other Intervention Name(s)
Irinotecan, Leucovorin, 5-FU, 5-fluorouracil
Intervention Description
FOLFIRI will be administered IV once every 2 weeks. The FOLFIRI regimen consists of: Irinotecan, 180 mg/m^2 IV infusion over 30 to 120 minutes Leucovorin, 400 mg/m^2 IV infusion to match the duration of the irinotecan infusion 5-FU, 1200 mg/m^2/day x 2 days (total 2400 mg/m^2 over 46 to 48 hours continuous infusion)
Primary Outcome Measure Information:
Title
Percentage of Participants With Progression-Free Survival at 16 Weeks After Administration of CS-7017 Combined With Irinotecan, Leucovorin, and 5-Fluorouracil (5-FU) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Description
Progression-free survival (PFS) was defined as the time from randomization until the first objective evidence of disease progression or death from any cause.
Time Frame
Baseline to 16 weeks postdose
Secondary Outcome Measure Information:
Title
Median Overall Progression-Free Survival Following Administration of CS-7017 in Combination With Irinotecan, Leucovorin, and 5-Fluorouracil (5-FU) (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Description
Progression-free survival (PFS) was defined as the time from randomization until the first objective evidence of disease progression or death from any cause.
Time Frame
Baseline to approximately 3 years postdose
Title
Median Overall Progression-Free Survival: Sensitivity Analysis Including Clinical Progression After Administration of CS-7017 and Irinotecan, Leucovorin, and 5-Fluorouracil After Failure of First-line Therapy of Metastatic Colorectal Cancer
Description
Progression-free survival (PFS) was defined as the time from randomization to the date of the first objective documentation of progressive disease (PD) or death resulting from any cause, whichever came first. The sensitivity analysis included clinical progression as an event.
Time Frame
Baseline to approximately 3 years postdose
Title
Best Overall Response and Objective Response Rate Following Administration of CS-7017 in Combination With Irinotecan, Leucovorin, and 5-Fluorouracil (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Description
As per Response Evaluation Criteria for Solid Tumors v1.0, best overall response was characterized as confirmed complete response (CR) defined as disappearance of all target lesions, confirmed partial response (PR) defined as ≥30% decrease from baseline, stable disease (SD) defined as neither progressive disease (PD) nor PR, and PD defined as ≥20% increase from smallest sum of longest diameter recorded since treatment started. Objective response rate (ORR) was defined as CR + PR. If there is no tumor assessment after the first dose of study drug, the best overall response is classified as Inevaluable.
Time Frame
Baseline to approximately 3 years postdose
Title
Treatment-Emergent Adverse Events Occurring in ≥10% of Participants Following Administration of CS-7017 Combined With Irinotecan, Leucovorin, and 5-Fluorouracil (FOLFIRI) After Failure of First-line Therapy in Treatment of Metastatic Colorectal Cancer
Description
An adverse event (AE) >30 days after last dose of study drug was not included as a treatment-emergent adverse events (TEAE) unless considered related to treatment.
Time Frame
Baseline to 30 days post last dose, up to approximately 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Metastatic CRC that has progressed following first-line therapy. Measurable disease (Response Evaluation Criteria in Solid Tumors [RECIST], Version 1.0. Male or female ≥ 18 years of age. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Resolution of any toxic effects of prior therapy (except alopecia) to NCI CTCAE, Version 3.0, grade ≤ 1. Adequate organ and bone marrow function as evidenced by: Hemoglobin ≥ 9 g/dL (transfusion and/or growth factor support allowed) Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L Platelet count ≥ 100 x 10^9/L Serum creatinine ≤ 1.5 x the upper limit of normal (ULN) or creatinine clearance ≥ 60 mL/min Aspartate aminotransferase (AST) and alkaline phosphatase ≤ 2.5 x ULN in participants with no liver metastasis and ≤ 5.0 x ULN in participants with liver metastasis Total bilirubin ≤ 1.5 x ULN Women of childbearing potential must be willing to consent to using effective contraception (eg, hormonal contraceptives, bilateral tubal ligation, barrier with spermicide, intrauterine device) while on treatment and for at least 3 months thereafter. Men who are the partner of a woman of childbearing potential must be willing to consent to using effective contraception (eg, vasectomy or barrier with spermicide) while on treatment and for 3 months thereafter. All female participants of childbearing potential must have a negative pregnancy test (serum or urine) result before initiating study treatment. Participants must be fully informed about their illness and the investigational nature of the study protocol (including foreseeable risks and possible side effects) and must sign and date an Independent Ethics Committee (IEC)- or Institutional Review Board (IRB)-approved informed consent form (ICF) (including HIPAA authorization, if applicable) before performance of any study-specific procedures or tests. Participants must be willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures. Exclusion Criteria: First-line treatment with an irinotecan-based regimen (eg, FOLFIRI). Anticipation of need for a major surgical procedure or radiation therapy (RT) during the study. Treatment with chemotherapy, other thiazolidinediones (TZD), RT, surgery, immunotherapy, biological therapy, or any investigational anticancer agent within 4 weeks before start of study treatment. History of any of the following conditions within 6 months before initiating study treatment: Diabetes mellitus requiring treatment with insulin or TZD agents Myocardial infarction with significant impairment of cardiac function (eg, ejection fraction ≤ 50%) Severe/unstable angina pectoris Coronary/peripheral artery bypass graft New York Heart Association (NYHA) class III or IV congestive heart failure Malabsorption syndrome, chronic diarrhea (lasting > 4 weeks), inflammatory bowel disease, or partial bowel obstruction. Participants with clinically active brain metastases (defined as untreated, symptomatic, or requiring therapy with steroids or anticonvulsants to control associated symptoms); uncontrolled seizure disorder; spinal cord compression; or carcinomatous meningitis. Participants with treated brain metastasis will be included in the study if they have recovered from the acute, toxic effects of RT. A minimum of 15 days must have elapsed between the end of RT and enrollment into the study. History of malignancy other than CRC, unless there is an expectation that the malignancy has been cured, and tumor-specific treatment for the malignancy has not been administered within the previous 5 years. Clinically significant, severe, active infection requiring IV antibiotic or antiviral agents. Pericardial or pleural effusion (eg, requiring drainage) or pericardial involvement with the tumor. Participants with minimal pleural effusion may be eligible upon request by Investigator and approval by Sponsor. Need for concomitant use of other TZD agents during the study. Previous administration of CS-7017. Pregnant or breast feeding. Known to be homozygous for the UGT1A1*28 allele. Known history of severe hypersensitivity reactions to any of the components of CS-7017, irinotecan, leucovorin, or 5-FU. Serious intercurrent medical or psychiatric illnesses or any other conditions that in the opinion of the Investigator would impair the ability to give informed consent or unacceptably reduce protocol compliance or safety of the study treatment.
Facility Information:
Facility Name
Beverly Hills Cancer Center
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Facility Name
St. Jude Heritage Medical Group
City
Fullerton
State/Province
California
ZIP/Postal Code
92835
Country
United States
Facility Name
John Marshall
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States
Facility Name
Georgia Cancer Specialists
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30341
Country
United States
Facility Name
Victor Priego
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20817
Country
United States
Facility Name
Gabrail Cancer Center
City
Canton
State/Province
Ohio
ZIP/Postal Code
44718
Country
United States
Facility Name
Instituto FIDES Oncologia y Especialidades Medicas
City
Buenos Aires
ZIP/Postal Code
B1900BAJ
Country
Argentina
Facility Name
CAIPO Centro para la Atencion Integral del Paciente Oncologico
City
Tucuman
ZIP/Postal Code
T4000GTB
Country
Argentina
Facility Name
Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul - PUC-RS
City
Porto Alegre
ZIP/Postal Code
90610-000
Country
Brazil
Facility Name
Instituto Nacional de Cancer INCA
City
Rio de Janeiro
ZIP/Postal Code
20231-050
Country
Brazil
Facility Name
ICAVC
City
Sao Paulo
ZIP/Postal Code
01209-000
Country
Brazil
Facility Name
Fundacion Arturo Lopez Perez
City
Santiago
ZIP/Postal Code
8320000
Country
Chile
Facility Name
Instituto Nacional del Cancer
City
Santiago
ZIP/Postal Code
8380455
Country
Chile
Facility Name
Instituto Oncologico Clinica Renaca
City
Vina del Mar
ZIP/Postal Code
2540364
Country
Chile
Facility Name
Hospital Nacional Alberto Sabogai Sologuren
City
Callao
Country
Peru
Facility Name
Hospital Nacional Dos de Mayo
City
Lima
ZIP/Postal Code
01
Country
Peru
Facility Name
Oncosalud SAC
City
Lima
ZIP/Postal Code
41
Country
Peru
Facility Name
Hospital Nacional Dos de Mayo
City
Lima
Country
Peru

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
De-identified individual participant data (IPD) and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/
IPD Sharing Time Frame
Studies for which the medicine and indication have received European Union (EU) and United States (US), and/or Japan (JP) marketing approval on or after 01 January 2014 or by the US or EU or JP Health Authorities when regulatory submissions in all regions are not planned and after the primary study results have been accepted for publication.
IPD Sharing Access Criteria
Formal request from qualified scientific and medical researchers on IPD and clinical study documents from clinical trials supporting products submitted and licensed in the United States, the European Union and/or Japan from 01 January 2014 and beyond for the purpose of conducting legitimate research. This must be consistent with the principle of safeguarding study participants' privacy and consistent with provision of informed consent.
IPD Sharing URL
https://vivli.org/ourmember/daiichi-sankyo/

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Study of CS-7017 in Combination With FOLFIRI in Subjects With Metastatic Colorectal Cancer Who Failed First-Line Therapy

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