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Report for Clinical Trial NCT03992456

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

PULSE: A Randomized, Phase II Open Label Study of PanitUmumab RechaLlenge Versus Standard Therapy After Progression on Anti-EGFR Therapy in Patients With Metastatic and/or Unresectable RAS Wild-Type Colorectal Cancer

This phase II trial studies how well retreatment with panitumumab works compared to standard of care regorafenib or trifluridine and tipiracil hydrochloride (TAS-102) in treating patients with colorectal cancer that is negative for RAS wild-type colorectal cancer has spread to other places in the body, and/or cannot be removed by surgery, and is negative for resistance mutations in blood. Treatment with panitumumab may interfere with the ability of tumor cells to grow and spread. Some tumors need growth factors to keep growing. Growth factor antagonists, such as regorafenib, may interfere with the growth factor and stop the tumor from growing. Drugs used in chemotherapy, such as TAS-102, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving panitumumab may work better in treating patients with colorectal cancer than with the usual treatment of regorafenib or TAS-102.

NCT03992456 BRAF V600 Wild Type KRAS Gene Mutation Negative Metastatic Colon Adenocarcinoma Metastatic Colorectal Carcinoma Metastatic Rectal Adenocarcinoma NRAS Gene Mutation Negative Progressive Disease RAS Wild Type Stage IV Colon Cancer AJCC v8 Stage IV Colorectal Cancer AJCC v8 Stage IV Rectal Cancer AJCC v8 Stage IVA Colon Cancer AJCC v8 Stage IVA Colorectal Cancer AJCC v8 Stage IVA Rectal Cancer AJCC v8 Stage IVB Colon Cancer AJCC v8 Stage IVB Colorectal Cancer AJCC v8 Stage IVB Rectal Cancer AJCC v8 Stage IVC Colon Cancer AJCC v8 Stage IVC Colorectal Cancer AJCC v8 Stage IVC Rectal Cancer AJCC v8
MeSH:Colorectal Neoplasms Adenocarcinoma Rectal Neoplasms Colonic Neoplasms Disease Progression
HPO:Colon cancer Neoplasm of the colon Neoplasm of the large intestine Neoplasm of the rectum

5 Interventions

Name: Panitumumab

Description: Given IV
Type: Biological
Group Labels: 1

Arm A (panitumumab)

Name: Quality-of-Life Assessment

Description: Ancillary studies
Type: Other
Group Labels: 2

Arm A (panitumumab) Arm B (regorafenib, trifluridine and tipiracil hydrochloride)

Name: Questionnaire Administration

Description: Ancillary studies
Type: Other
Group Labels: 2

Arm A (panitumumab) Arm B (regorafenib, trifluridine and tipiracil hydrochloride)

Name: Regorafenib

Description: Given PO
Type: Drug
Group Labels: 1

Arm B (regorafenib, trifluridine and tipiracil hydrochloride)

Name: Trifluridine and Tipiracil Hydrochloride

Description: Given PO
Type: Drug
Group Labels: 1

Arm B (regorafenib, trifluridine and tipiracil hydrochloride)


Primary Outcomes

Description: The distribution of overall survival will be estimated using the method of Kaplan-Meier. Overall survival will be compared between the 2 treatment arms using the unstratified log-rank test.

Measure: Overall survival (OS)

Time: Time from randomization to death from any cause, assessed for up to 3 years

Secondary Outcomes

Description: The distribution of progression free survival will be estimated using the method of Kaplan-Meier. Progression free survival will be compared between the 2 treatment arms using the log-rank test.

Measure: Progression free survival (PFS)

Time: Time from randomization to documentation of disease progression or death due to any cause, whichever is first, assessed for up to 3 years

Description: Defined as the number of patients with a complete response (CR) or partial response (PR) (as defined by the Response Evaluation Criteria in Solid Tumors [RECIST] 1.1) divided by the number of evaluable patients in each arm at 12 months post randomization. ORR will be compared between the 2 treatment arms. Confidence intervals for the true success proportion will be calculated according to the approach of Clopper and Pearson.

Measure: Overall response rate (ORR)

Time: At 12 months

Description: Defined as the number of patients with a complete response (CR), partial response (PR), or stable disease for >= 6 months (as defined by the RECIST 1.1) divided by the number of evaluable patients in each arm. Confidence intervals for the true success proportion will be calculated according to the approach of Clopper and Pearson.

Measure: Clinical benefit rate

Time: At 6 months

Description: The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine adverse event patterns. The overall adverse event rates for grade 3 or higher adverse events will be compared using Chi-Square or Fisher?s Exact tests.

Measure: Incidence of adverse events

Time: Up to 3 years

Description: Patients reported quality of life (QOL) outcomes will be collected using the Linear Analog Self-Assessment (LASA) Questionnaire. Data will be collected each cycle. Mean values of the first question (regarding overall QOL) at each cycle will be plotted, and stratified by arm. Additional analyses using data collected from the LASA questionnaire may be performed.

Measure: Patient-reported quality of life

Time: Up to 3 years

Other Outcomes

Description: A report will be generated for each clinical specimen, which may include (but not limited to) the presence or absence of relevant gene mutations or amplifications, along with the allele frequency. Mutations of interest include KRAS and NRAS exons 2, 3, and 4, BRAF, PIK3CA, EGFR, AKT, PTEN, MAP2K1, and MET. Amplifications of interest include MET, EGFR, KRAS, and ERBB2. Genes and alterations analyzed will be based on best available science at the time of analysis.

Measure: Cell free tumor deoxyribonucleic acid (cfDNA)

Time: Baseline, at restaging, and at disease progression

Description: Plasma samples will be analyzed for multiple soluble protein analytes, which may include (but not limited to) HGF, c-MET, EGF, HBEGF, TGF-alpha, EGFR, HER2, and CD73.

Measure: Circulating protein studies

Time: Up to 3 years

Description: Comprehensive mutational analysis will be performed on archived formalin fixed paraffin embedded (FFPE) tumor samples. This analysis may include, but is not limited to Next Generation Sequencing (NGS) and IHC where appropriate.

Measure: Tumor tissue studies

Time: Up to 3 years

Purpose: Treatment

Allocation: Randomized

Parallel Assignment


There are 2 SNPs

SNPs


1 R451C

Note: EGFR S492R, K467, and R451C mutations are not an exclusion. --- S492R --- --- R451C ---


2 S492R

Note: EGFR S492R, K467, and R451C mutations are not an exclusion. --- S492R ---



HPO Nodes


HPO: