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Report for Clinical Trial NCT02316496

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

A Phase II Study of Cetuximab Rechallenge in Combination With Irinotecan in Advanced Metastatic Colorectal Cancer Without KRAS or NRAS or BRAF Mutation (All Wild Type) for Patients Pretreated With FOLFIRI and Cetuximab in First Line With Stopping Cetuximab for Progressive Disease After a Previous Response (Partial Response or Complete Response) and After Treatment With a Fluoropyrimidine, Oxaliplatin Plus Bevacizumab Regimen

The main objective of this study is to evaluate the objective response rate at two months (complete disappearance of the disease and partial disappearance of the disease) obtained after administration of combination therapy with cetuximab and irinotecan in the patients with metastatic colorectal cancer. Secondaries objectives will be assessed progression-free survival, overall survival, toxicity, quality of life.

NCT02316496 Colorectal Cancer Metastatic
MeSH: Colorectal Neoplasms
HPO: Neoplasm of the large intestine

2 Interventions

Name: cetuximab

Description: cetuximab 500mg/m²/ IV infusion, (q2w)

Type: Drug

open label , single arm

Name: Irinotecan

Description: Irinotecan 180mg/m², in 500ml NaCl 0.9% solution, 90 min IV infusion (q2w)

Type: Drug

open label , single arm


Primary Outcomes

Measure: Objective response rate (ORR)

Time: At 2 months

Secondary Outcomes

Description: Best response observed during investigational treatment combination. From the start of treatment until treatment failure

Measure: Objective response rate (ORR)

Time: up to 27 months

Description: The proportion of patients with tumor response (Complete response or partial response) or tumor stabilization as best response during study treamtent

Measure: Disease control rate (DCR)

Time: up to 27 months

Description: Time from the date of inclusion to the date of the first progressive disease (RECIST criteria) or death (any cause)

Measure: Progression-free survival (PFS)

Time: up to 27 months

Description: Only for patients with tumor response (complete reposne or partial response) , from first confirmed response to first observed progression (PD) or death due to PD during study treatment

Measure: Duration of response (DOR)

Time: up to 27 months

Description: Time from the date of inclusion to the date of the first confirmed CR or PR during study treatment

Measure: Time to response (TTR)

Time: up to 27 months

Description: Time from the date of inclusion to the date of the first obseved progression (PD), or death due to progression during the study treatment

Measure: Time to progression (TTP)

Time: up to 27 months

Description: Time from the date of inclusion to the date the decision was made to end the study treatment for any reason

Measure: Time to treatment failure (TTF)

Time: up to 27 months

Description: Only for patient with a stable disease (SD) as best response during the study treatment, from date of inclusion to the first observed progression (PD) or death due to progression

Measure: Duration of stable disease (DoSD)

Time: up to 27 months

Description: From the date of inclusion to the date of patient death, due to any cause, or to the last date the patient was known to be alive

Measure: Overall survival (OS)

Time: up to 27 months

Measure: Adverse Events (CTCAE v.4.03)

Time: Up to 27 months

Description: Using EORTC Quality of Life Questionnaire - C30 (QLQ-C30) and the Dermatology Life Quality Index (DLQI ) questionnaires

Measure: Quality of life

Time: Up to 27 months

Description: RAS and BRAF status in circulating tumoral DNA

Measure: Respose rate

Time: up to 27 months

Description: RAS and BRAF status in circulating tumoral DNA

Measure: PFS

Time: up to 27 months

Purpose: Treatment

Single Group Assignment


There is one SNP

SNPs


1 V600E

Inclusion Criteria: - Signed and dated informed consent - Histologically confirmed metastatic adenocarcinoma of the colon or rectum - All Wild Type KRAS (exon 2 [codons 12-13], exon 3 [codons - 61]; exon 4 [codon 146]), NRAS (exon 2 [ codons 12-13] and exon 3 [codon 61) and BRAF (V600E) tumor ( local assessment performed either on primary tumor or metastasis) - First line chemotherapy regimen with a fluoropyrimidine and Irinotecan (FOLFIRI) + cetuximab with initial partial or complete response and progressive disease (PD) with PD ≤ 6 weeks after the last administration of cetuximab - Other line(s) of therapy(ies) including the following drugs: second line oxaliplatin based chemotherapy with fluoropyrimidines (5FU or capecitabine) + bevacizumab and eventually regorafenib (possible but not mandatory) and progression or limiting toxicity to the last therapy with a minimum of 4 months between last injection of cetuximab and inclusion in this study - At least one measurable lesion ≥ 10 mm as assessed by CT-scan or MRI (Magnetic Resonance Imaging) according to RECIST v1.1 (All sites must be evaluated ≤ 28 days prior to the enrolment) - Age ≥18 years - World Health Organization (WHO) Performance status (PS) 0-2 - The patient has adequate organ function, defined as : Absolute neutrophil count (ANC) ≥ 1.5 x 109/L, hemoglobin ≥ 9 g/dL, and platelets ≥ 100 x 109/L.Total bilirubin ≤ 1.5 times upper limit of normal value (ULN), serum alkaline phosphatase level < 5 times ULN, Serum creatinine level <150μM/l - For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study drug - Men and women are required to use adequate birth control during the study (when applicable) and until 6 months after the end of study treatment - Registration in a national health care system (CMU included) Exclusion Criteria: - Previous chemotherapy other than adjuvant therapy with different combinations than those scheduled in first and second line treatment - Presence of any KRAS, BRAF or NRAS mutation by allelic discrimination on tumor DNA - Significant cardiovascular disease including unstable angina or myocardial infarction within 12 months before initiation of study treatment or a history of ventricular arrhythmia (treated or not) - History or evidence of central nervous system metastasis (systematic CT-scan or MRI not mandatory if no clinical symptoms) - Known allergy or hypersensitivity to cetuximab - Previous or concurrent malignancy except for basal or squamous cell skin cancer, in situ carcinoma of the cervix, low-risk prostate cancer according to d'Amico classification or other solid tumors treated curatively and without evidence of recurrence for at least 5 years prior to the study - Active or uncontrolled clinically serious infection - Known human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS)-related illness - Other serious and uncontrolled non-malignant disease - Pregnancy - Breast feeding - Treatment with any other investigational medicinal product within 28 days prior to study entry - Known Gilbert's syndrome - Concomitant administration of live, attenuated virus vaccine such as yellow fever vaccine - Concomitant use with St John's Wort - Chronic inflammatory bowel disease and/or Bowel obstruction Inclusion Criteria: - Signed and dated informed consent - Histologically confirmed metastatic adenocarcinoma of the colon or rectum - All Wild Type KRAS (exon 2 [codons 12-13], exon 3 [codons - 61]; exon 4 [codon 146]), NRAS (exon 2 [ codons 12-13] and exon 3 [codon 61) and BRAF (V600E) tumor ( local assessment performed either on primary tumor or metastasis) - First line chemotherapy regimen with a fluoropyrimidine and Irinotecan (FOLFIRI) + cetuximab with initial partial or complete response and progressive disease (PD) with PD ≤ 6 weeks after the last administration of cetuximab - Other line(s) of therapy(ies) including the following drugs: second line oxaliplatin based chemotherapy with fluoropyrimidines (5FU or capecitabine) + bevacizumab and eventually regorafenib (possible but not mandatory) and progression or limiting toxicity to the last therapy with a minimum of 4 months between last injection of cetuximab and inclusion in this study - At least one measurable lesion ≥ 10 mm as assessed by CT-scan or MRI (Magnetic Resonance Imaging) according to RECIST v1.1 (All sites must be evaluated ≤ 28 days prior to the enrolment) - Age ≥18 years - World Health Organization (WHO) Performance status (PS) 0-2 - The patient has adequate organ function, defined as : Absolute neutrophil count (ANC) ≥ 1.5 x 109/L, hemoglobin ≥ 9 g/dL, and platelets ≥ 100 x 109/L.Total bilirubin ≤ 1.5 times upper limit of normal value (ULN), serum alkaline phosphatase level < 5 times ULN, Serum creatinine level <150μM/l - For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study drug - Men and women are required to use adequate birth control during the study (when applicable) and until 6 months after the end of study treatment - Registration in a national health care system (CMU included) Exclusion Criteria: - Previous chemotherapy other than adjuvant therapy with different combinations than those scheduled in first and second line treatment - Presence of any KRAS, BRAF or NRAS mutation by allelic discrimination on tumor DNA - Significant cardiovascular disease including unstable angina or myocardial infarction within 12 months before initiation of study treatment or a history of ventricular arrhythmia (treated or not) - History or evidence of central nervous system metastasis (systematic CT-scan or MRI not mandatory if no clinical symptoms) - Known allergy or hypersensitivity to cetuximab - Previous or concurrent malignancy except for basal or squamous cell skin cancer, in situ carcinoma of the cervix, low-risk prostate cancer according to d'Amico classification or other solid tumors treated curatively and without evidence of recurrence for at least 5 years prior to the study - Active or uncontrolled clinically serious infection - Known human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS)-related illness - Other serious and uncontrolled non-malignant disease - Pregnancy - Breast feeding - Treatment with any other investigational medicinal product within 28 days prior to study entry - Known Gilbert's syndrome - Concomitant administration of live, attenuated virus vaccine such as yellow fever vaccine - Concomitant use with St John's Wort - Chronic inflammatory bowel disease and/or Bowel obstruction Colorectal Cancer Metastatic Colorectal Neoplasms null --- V600E ---

Inclusion Criteria: - Signed and dated informed consent - Histologically confirmed metastatic adenocarcinoma of the colon or rectum - All Wild Type KRAS (exon 2 [codons 12-13], exon 3 [codons - 61]; exon 4 [codon 146]), NRAS (exon 2 [ codons 12-13] and exon 3 [codon 61) and BRAF (V600E) tumor ( local assessment performed either on primary tumor or metastasis) - First line chemotherapy regimen with a fluoropyrimidine and Irinotecan (FOLFIRI) + cetuximab with initial partial or complete response and progressive disease (PD) with PD ≤ 6 weeks after the last administration of cetuximab - Other line(s) of therapy(ies) including the following drugs: second line oxaliplatin based chemotherapy with fluoropyrimidines (5FU or capecitabine) + bevacizumab and eventually regorafenib (possible but not mandatory) and progression or limiting toxicity to the last therapy with a minimum of 4 months between last injection of cetuximab and inclusion in this study - At least one measurable lesion ≥ 10 mm as assessed by CT-scan or MRI (Magnetic Resonance Imaging) according to RECIST v1.1 (All sites must be evaluated ≤ 28 days prior to the enrolment) - Age ≥18 years - World Health Organization (WHO) Performance status (PS) 0-2 - The patient has adequate organ function, defined as : Absolute neutrophil count (ANC) ≥ 1.5 x 109/L, hemoglobin ≥ 9 g/dL, and platelets ≥ 100 x 109/L.Total bilirubin ≤ 1.5 times upper limit of normal value (ULN), serum alkaline phosphatase level < 5 times ULN, Serum creatinine level <150μM/l - For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study drug - Men and women are required to use adequate birth control during the study (when applicable) and until 6 months after the end of study treatment - Registration in a national health care system (CMU included) Exclusion Criteria: - Previous chemotherapy other than adjuvant therapy with different combinations than those scheduled in first and second line treatment - Presence of any KRAS, BRAF or NRAS mutation by allelic discrimination on tumor DNA - Significant cardiovascular disease including unstable angina or myocardial infarction within 12 months before initiation of study treatment or a history of ventricular arrhythmia (treated or not) - History or evidence of central nervous system metastasis (systematic CT-scan or MRI not mandatory if no clinical symptoms) - Known allergy or hypersensitivity to cetuximab - Previous or concurrent malignancy except for basal or squamous cell skin cancer, in situ carcinoma of the cervix, low-risk prostate cancer according to d'Amico classification or other solid tumors treated curatively and without evidence of recurrence for at least 5 years prior to the study - Active or uncontrolled clinically serious infection - Known human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS)-related illness - Other serious and uncontrolled non-malignant disease - Pregnancy - Breast feeding - Treatment with any other investigational medicinal product within 28 days prior to study entry - Known Gilbert's syndrome - Concomitant administration of live, attenuated virus vaccine such as yellow fever vaccine - Concomitant use with St John's Wort - Chronic inflammatory bowel disease and/or Bowel obstruction Inclusion Criteria: - Signed and dated informed consent - Histologically confirmed metastatic adenocarcinoma of the colon or rectum - All Wild Type KRAS (exon 2 [codons 12-13], exon 3 [codons - 61]; exon 4 [codon 146]), NRAS (exon 2 [ codons 12-13] and exon 3 [codon 61) and BRAF (V600E) tumor ( local assessment performed either on primary tumor or metastasis) - First line chemotherapy regimen with a fluoropyrimidine and Irinotecan (FOLFIRI) + cetuximab with initial partial or complete response and progressive disease (PD) with PD ≤ 6 weeks after the last administration of cetuximab - Other line(s) of therapy(ies) including the following drugs: second line oxaliplatin based chemotherapy with fluoropyrimidines (5FU or capecitabine) + bevacizumab and eventually regorafenib (possible but not mandatory) and progression or limiting toxicity to the last therapy with a minimum of 4 months between last injection of cetuximab and inclusion in this study - At least one measurable lesion ≥ 10 mm as assessed by CT-scan or MRI (Magnetic Resonance Imaging) according to RECIST v1.1 (All sites must be evaluated ≤ 28 days prior to the enrolment) - Age ≥18 years - World Health Organization (WHO) Performance status (PS) 0-2 - The patient has adequate organ function, defined as : Absolute neutrophil count (ANC) ≥ 1.5 x 109/L, hemoglobin ≥ 9 g/dL, and platelets ≥ 100 x 109/L.Total bilirubin ≤ 1.5 times upper limit of normal value (ULN), serum alkaline phosphatase level < 5 times ULN, Serum creatinine level <150μM/l - For female patients of childbearing potential, negative pregnancy test within 7 days before starting the study drug - Men and women are required to use adequate birth control during the study (when applicable) and until 6 months after the end of study treatment - Registration in a national health care system (CMU included) Exclusion Criteria: - Previous chemotherapy other than adjuvant therapy with different combinations than those scheduled in first and second line treatment - Presence of any KRAS, BRAF or NRAS mutation by allelic discrimination on tumor DNA - Significant cardiovascular disease including unstable angina or myocardial infarction within 12 months before initiation of study treatment or a history of ventricular arrhythmia (treated or not) - History or evidence of central nervous system metastasis (systematic CT-scan or MRI not mandatory if no clinical symptoms) - Known allergy or hypersensitivity to cetuximab - Previous or concurrent malignancy except for basal or squamous cell skin cancer, in situ carcinoma of the cervix, low-risk prostate cancer according to d'Amico classification or other solid tumors treated curatively and without evidence of recurrence for at least 5 years prior to the study - Active or uncontrolled clinically serious infection - Known human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS)-related illness - Other serious and uncontrolled non-malignant disease - Pregnancy - Breast feeding - Treatment with any other investigational medicinal product within 28 days prior to study entry - Known Gilbert's syndrome - Concomitant administration of live, attenuated virus vaccine such as yellow fever vaccine - Concomitant use with St John's Wort - Chronic inflammatory bowel disease and/or Bowel obstruction Colorectal Cancer Metastatic Colorectal Neoplasms null --- V600E --- --- V600E ---



HPO Nodes


HPO:
Neoplasm of the large intestine
Genes 120
FLCN SDHC MLH1 PMS2 APC EPCAM SDHC PALLD SRC BUB1 APC GREM1 NTHL1 PMS1 PTEN SDHB MSH6 APC KIT SDHD KRAS BMPR1A FAN1 CTNNB1 MSH3 POLD1 KRAS RNF43 KEAP1 DICER1 DLC1 BMPR1A MSH2 MSH6 PIK3CA CDKN2A FGFR3 BMPR1A MUTYH PIK3CA BMPR1A EP300 FOXE1 ENG SMAD7 AXIN2 CHEK2 MLH1 RPS20 BRCA1 RPS19 PRKAR1A APC GPR35 MLH1 AKT1 POLE SMAD4 KIT TP53 TRIP13 COL14A1 MDM2 SMAD4 POLE BRCA2 AKT1 MSH6 HABP2 NRAS MUTYH BUB1B DOCK8 TGFBR2 STK11 AXIN2 EPCAM BUB3 DCC AXIN2 TCF4 KLLN MSH2 APC TP53 SEC23B PTEN TGFBR2 SEMA4A POLD1 PIK3CA PDGFRA MINPP1 APC SH3KBP1 BMPR1A TP53 BUB1 AAGAB SMAD4 BMPR1A MST1 MLH3 MSH2 PALB2 FLCN SDHA PMS2 SDHB BUB1B MSH2 MLH1 CEP57 MLH3 TP53 PTPRJ PMS1 APC CDKN2A APC