Colorectal CancerPhase 3NCT01183780
A Study in Second Line Metastatic Colorectal Cancer
A Phase 3 study testing Ramucirumab, Irinotecan and Folinic Acid in people with Colorectal Cancer, run by Eli Lilly and Company at 213 sites in 26 countries.
Trial summary
The purpose of this study is to compare overall survival in participants with metastatic colorectal cancer treated with either ramucirumab and FOLFIRI or placebo and FOLFIRI. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Colorectal Cancer
- What is being tested?
- Ramucirumab, Irinotecan and Folinic Acid
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 1,072 participants
- Where
- 213 sitesin 26 countries
- Study dates
- 2 Dec 2010to 20 Jun 2016
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histologically or cytologically confirmed colorectal cancer, excluding primary tumors of appendiceal origin (participants are eligible to enroll irrespective of KRAS mutation status)
- Confirmed metastatic colorectal cancer (Stage IV)
- The participant has received first-line combination therapy of bevacizumab, oxaliplatin, and a fluoropyrimidine for metastatic disease and, a) Experienced radiographic disease progression during first-line therapy, or b) Experienced radiographic disease progression ≤6 months after the last dose of first-line therapy, or c) Discontinued part or all of first-line therapy due to toxicity and experienced radiographic disease progression ≤6 months after the last dose of first-line therapy. Note that a participant must have received a minimum of 2 doses of bevacizumab as part of a first-line regimen containing chemotherapy; in addition, a participant must have received at least 1 cycle of first-line therapy that included bevacizumab, oxaliplatin and a fluoropyrimidine in the same cycle. Note that a participant must not have received more than 2 different fluoropyrimidines as part of a first-line regimen; disease progression is not an acceptable reason for discontinuing 1 fluoropyrimidine and starting a second fluoropyrimidine
- Receipt of no more than 2 prior systemic chemotherapy regimens in any setting (only 1 prior regimen for metastatic disease is permitted). For participants with rectal cancer, sequential neoadjuvant and adjuvant therapy will count as a single systemic regimen. Note that rechallenge with oxaliplatin is permitted and will be considered part of the first-line regimen for metastatic disease, both initial oxaliplatin treatment and subsequent rechallenge are considered as 1 regimen
- Measurable or nonmeasurable disease based on the Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1)
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1
Show all 10Show fewer
- Adequate hematologic, renal and hepatic function
- Adequate coagulation function [International Normalized Ratio (INR) ≤1.5 and Partial Thromboplastin Time (PTT) or activated PTT (aPTT) ≤1.5 x upper limit of normal (ULN)). Participants on full-dose anticoagulation must be on a stable dose of anticoagulant therapy and if on oral anticoagulation, must have an INR ≤3 and have no clinically significant active bleeding or pathological condition that carries a high risk of bleeding
- Consent to provide a historical colorectal cancer tissue sample for assessment of biomarkers and the tumor tissue sample is available
- Ability to provide signed informed consent
Who cannot join
- Receipt of bevacizumab ≤28 days prior to randomization
- Receipt of any investigational therapy for non-oncology clinical indication ≤28 days prior to randomization
- Receipt of any previous systemic therapy, other than a combination of bevacizumab, oxaliplatin, and a fluoropyrimidine, for first-line treatment of metastatic colorectal cancer
- Known leptomeningeal disease or brain metastases or uncontrolled spinal cord compression (currently or in the past)
- Experience of any arterial thrombotic or arterial thromboembolic events, including, but not limited to, myocardial infarction, transient ischemic attack, or cerebrovascular accident, ≤12 months prior to randomization
- Pregnant (confirmed by serum beta human chorionic gonadotropin (ß HCG) test ≤7 days prior to randomization) or lactating
Show all 13Show fewer
- History of inflammatory bowel disease or Crohn's disease requiring medical intervention (immunomodulatory or immunosuppressive medications or surgery) ≤12 months prior to randomization
- Acute or subacute bowel obstruction or history of chronic diarrhea which is considered clinically significant in the opinion of the investigator
- Grade 3 or higher bleeding event ≤3 months prior to randomization
- Experience of any of the following during first-line therapy with a bevacizumab-containing regimen: an arterial thrombotic/thromboembolic event, Grade 4 hypertension, Grade 3 proteinuria, a Grade 3-4 bleeding event, or bowel perforation
- Known history or clinical evidence of Gilbert's Syndrome, or is known to have any of the following genotypes: UGT1A1*6/*6, UGT1A1*28/*28, or UGT1A1*6/*28
- Known allergy to any of the study treatment components, including any components used in the preparation of ramucirumab, or other contraindication to receive the study treatments
- Cirrhosis at a level of Child-Pugh B (or worse) or cirrhosis (any degree) and a history of hepatic encephalopathy or clinical meaningful ascites resulting from cirrhosis; Clinically meaningful ascites is defined as ascites resulting from cirrhosis and requiring ongoing treatment with diuretics and/or paracentesis
Trial locations and contacts
213 sites in 26 countries.
213 sites in 26 countries
United States92 sites
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Abilene, Texas, 79606
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Albuquerque, New Mexico, 87109
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Arlington, Texas, 76014
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Athens, Georgia, 30607
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Augusta, Georgia, 30901
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Beaumont, Texas, 77702
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Bedford, Texas, 76022
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Bend, Oregon, 97701
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Bethesda, Maryland, 20817
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Billings, Montana, 59101
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Boynton Beach, Florida, 33426
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Cherry Hill, New Jersey, 08003
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Cincinnati, Ohio, 45242
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Columbia, Missouri, 65201
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Columbia, South Carolina, 29210
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Columbus, Ohio, 43219
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Dallas, Texas, 75246
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Denton, Texas, 76210
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Denver, Colorado, 80218
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Duarte, California, 91010
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Escondido, California, 92025
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Fairfax, Virginia, 22031
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Fayetteville, Arkansas, 72703
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Flower Mound, Texas, 75028
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Fort Lauderdale, Florida, 33308
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Fort Myers, Florida, 33916
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Fort Worth, Texas, 76104
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Fresno, California, 93720
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Garland, Texas, 75042
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Goshen, Indiana, 46526
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Greenbrae, California, 94904
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Hackensack, New Jersey, 07601
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Harvey, Illinois, 60426
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Honolulu, Hawaii, 96819
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Hudson, New York, 12534
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Indianapolis, Indiana, 46237
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Jamaica, New York, 11432
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Kennewick, Washington, 99336
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Kingston, Pennsylvania, 18704
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La Jolla, California, 92093
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Las Vegas, Nevada, 89169
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Little Rock, Arkansas, 72205
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Macon, Georgia, 31201
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Marietta, Georgia, 30060
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McAllen, Texas, 78503
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Memphis, Tennessee, 38138
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Miami, Florida, 33176
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Milwaukee, Wisconsin, 53226
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Minneapolis, Minnesota, 55404
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Morristown, New Jersey, 07962
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Muncie, Indiana, 47303
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Nashville, Tennessee, 37203
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New York, New York, 10029
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Newport News, Virginia, 23606
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Ocala, Florida, 34471
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Odessa, Texas, 79761
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Ogden, Utah, 84403
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Paris, Texas, 75460
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Peoria, Illinois, 61615
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Philadelphia, Pennsylvania, 19106
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Port Saint Lucie, Florida, 34952
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Portland, Oregon, 97227
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Raleigh, North Carolina, 27607
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Rancho Cucamonga, California, 91730
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Richmond, Virginia, 23230
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Rome, Georgia, 30165
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Round Rock, Texas, 78665
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Salt Lake City, Utah, 84106
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San Antonio, Texas, 78229
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San Diego, California, 92108
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Seattle, Washington, 98109
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Sedona, Arizona, 86336
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Sherman, Texas, 75090
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Spokane Valley, Washington, 99216
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St Louis, Missouri, 63110
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St. Petersburg, Florida, 33705
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Sugar Land, Texas, 77479
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Temple, Texas, 76508
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The Bronx, New York, 10467
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The Woodlands, Texas, 77380
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Thomasville, Georgia, 31792
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Titusville, Florida, 32796
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Tucson, Arizona, 85715
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Tulsa, Oklahoma, 74136
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Tyler, Texas, 75702
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Waco, Texas, 76712
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Warrenville, Illinois, 60555
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Waterbury, Connecticut, 06708
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Webster, Texas, 77598
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Wichita Falls, Texas, 76310
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Willow Grove, Pennsylvania, 19090
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Winchester, Virginia, 22601
Japan14 sites
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Aichi, 464
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Chiba, 277 8577
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Ehime, 790-0007
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Fukuoka, 811-1395
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Gifu, 501-1194
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Hokkaido, 060-8638
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Hyōgo, 650-0046
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Kanagawa, 216-8511
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Kochi, 781-8555
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Osaka, 569-8686
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Saitama, 362-0806
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Shizuoka, 411-8777
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Tochigi, 329-0498
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Tokyo, 104-0045
Germany11 sites
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Augsburg, 86150
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Balingen, 72336
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Bamberg, 96049
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Dresden, 01307
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Frankfurt, 60488
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Halle, 06120
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Hamburg, 20249
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Lübeck, 23562
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Mönchengladbach, 41063
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Munich, 81925
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Weiden, 92637
Australia8 sites
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Bedford Park, South Australia, 5042
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Elizabeth Vale, South Australia, 5112
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Liverpool, New South Wales, 2170
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Randwick, New South Wales, 2031
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St Leonards, New South Wales, 2065
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Wodonga, New South Wales, 3690
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Wollongong, New South Wales, 2500
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Woolloongabba, Queensland, 4102
Belgium7 sites
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Bonheiden, 2820
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Brussels, 1070
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Charleroi, 6000
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Edegem, 2650
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Haine-St.- Paul, 7100
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Leuven, 3000
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Liège, 4000
France7 sites
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Bordeaux, 33076
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La Chaussée-Saint-Victor, 41260
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Le Mans, 72000
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Nantes, 44202
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Paris, 75015
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Poitiers, 86021
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Strasbourg, 67000
Spain7 sites
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Barcelona, 08035
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Madrid, 28097
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Oviedo, 33006
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Pamplona, 31008
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Sabadell, 08208
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Seville, 41013
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Valencia, 46014
Argentina6 sites
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Buenos Aires, B8000FJI
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Caba, C1180AAX
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Rosario, 2000
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Santa Fe, 3000
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Tucumain, 4000
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Viedma, 8500
Brazil6 sites
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Ijuí, 98700 000
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Itajaí, 88301-220
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Rio de Janeiro, 20231-050
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Salvador, 41823-010
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São José do Rio Preto, 15025-100
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São Paulo, 01308-050
Italy6 sites
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Genova, 16132
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Livorno, 57124
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Padova, 35128
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Province of Macerata, 62100
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Reggio Emilia, 42100
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Rome, 00168
India5 sites
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Bangalore, 560027
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Kochi, 628040
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Kolkata, 700053
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New Delhi, 110 060
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Trivandrum, 695 011
Netherlands5 sites
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Breda, 4819 EV
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Deventer, 7416 SE
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Eindhoven, 5623 EJ
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Groningen, 9728 NT
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Sittard - Geleen, 6162 BG
South Korea5 sites
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Anyang, 431-070
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Goyang-si, 411-764
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Incheon, 405-760
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Seoul, 134-791
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Suwon, 442-721
Taiwan5 sites
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Kaohsiung City, 807
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Kuei Shan Hsiang, 33305
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Taichung, 40705
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Tainan, 70403
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Taipei, 100
Israel4 sites
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Beersheba, 84101
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Haifa, 31096
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Tel Aviv, 64239
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Tel HaShomer, 52621
Romania4 sites
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Bucharest, 022328
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Cluj-Napoca, 400015
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Iași, 700106
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Oradea, 410469
Austria3 sites
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Innsbruck, 6020
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Krems, 3500
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Vienna, A1090
Czechia3 sites
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Brno, 656 53
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Pardubice, 532 03
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Prague, 150 06
Greece3 sites
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Athens, 10676
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Chania, 73300
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Ioannina, 45500
Denmark2 sites
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Copenhagen, 2100
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Odense, 5000
Finland2 sites
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Helsinki, 00029 HUS
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Tampere, 33521
Hungary2 sites
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Budapest, 1115
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Kecskemét, 6000
Portugal2 sites
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Coimbra, 3000-075
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Porto, 4200-072
Sweden2 sites
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Stockholm, 17176
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Uppsala, 75185
Puerto Rico1 site
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Bayamón, 00959
Slovenia1 site
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Ljubljana, 1001
About this study
Official title: A Randomized, Double-blind, Multicenter Phase 3 Study of Irinotecan, Folinic Acid, and 5-Fluorouracil (FOLFIRI) Plus Ramucirumab or Placebo in Patients With Metastatic Colorectal Carcinoma Progressive During or Following First-Line Combination Therapy With Bevacizumab, Oxaliplatin, and a Fluoropyrimidine
The purpose of this study is to compare overall survival in participants with metastatic colorectal cancer treated with either ramucirumab and FOLFIRI or placebo and FOLFIRI.
- Conditions
- Colorectal Cancer
- Being tested
- Ramucirumab, Placebo, Irinotecan, Folinic Acid, 5-Fluorouracil
- Keywords
- second line, metastatic colorectal cancer, FOLFIRI, ramucirumab, CRC, mCRC
- Medical subject headings
- Colorectal Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
RamucirumabBiological
Also called LY3009806, IMC-1121B
8 milligrams / kilogram (mg/kg) administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision
PlaceboBiological
Administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision
IrinotecanDrug
180 milligrams/square meter (mg/m^2) administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision
Folinic AcidDrug
Also called leucovorin
400 mg/m^2 administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision
5-FluorouracilDrug
400 mg/m^2 bolus immediately followed by 2400 mg/m^2 continuous infusion every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision
| Study group | Role | What they receive |
|---|---|---|
| FOLFIRI + Ramucirumab | Experimental | Not described Receives: Biological: Ramucirumab; Drug: Irinotecan; Drug: Folinic Acid; Drug: 5-Fluorouracil |
| FOLFIRI + Placebo | Placebo comparator | Not described Receives: Biological: Placebo; Drug: Irinotecan; Drug: Folinic Acid; Drug: 5-Fluorouracil |
What is being measured
The primary outcome is the main question the study is designed to answer.
Overall Survival (OS)
OS was defined as the time in months from the date of randomization to the date of death from any cause. For participants not known to have died as of the cut-off date, OS was censored at the last known date alive.
Measured: Randomization to Date of Death from Any Cause Up to 39.36 Months
Secondary outcomes (6)
Progression-free Survival (PFS) Time
PFS was defined as the time from the date of randomization until the date of objectively determined progressive disease (PD) [according to Response Evaluation Criteria in Solid Tumors (RECIST) version (v). 1.1] or death due to any cause, whichever was first. PD is at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeters (mm). Participants who died without a reported prior progression were considered to have progressed on the day of their death. Participants who did not progress or were lost to follow-up were censored at the day of their last radiographic tumor assessment.
Measured: Randomization to Measured PD or Date of Death from Any Cause Up to 38.01 Months
Percentage of Participants Achieving an Objective Response (Objective Response Rate)
The objective response rate is equal to the proportion of participants achieving a best overall response of partial response or complete response (PR + CR). Response was defined using RECIST, v. 1.1 criteria. CR was defined as the disappearance of all target and non-target lesions and any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm and normalization of tumor marker level of non-target lesions; PR was defined as having at least a 30% decrease in sum of longest diameter of target lesions taking as reference the baseline sum diameter.
Measured: Randomization until Disease Progression Up to 38.01 Months
Change From Baseline in European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 Global Health Status
The EORTC QLQ-C30 (v. 3.0) is a self-administered, cancer-specific questionnaire with multidimensional scales assessing 15 domains (5 functional domains, 9 symptoms, and global health status). A linear transformation was applied to standardize the raw scores to range between 0 and 100 per developer guidelines. For the functional domains and global health status scale, higher scores represent a better level of functioning. For symptom scales, higher scores represent a greater degree of symptoms. Maximum improvement is the best post-baseline change.
Measured: Baseline Up to 171 Weeks
Change From Baseline in EuroQol- 5D (EQ-5D)
The EQ-5D is a generic, multidimensional, health status instrument. The profile allows participants to rate their health state in 5 health domains: mobility, self-care, usual activities, pain/discomfort, and mood using a 3-level scale (no problem, some problems, and major problems). These combinations of attributes were converted into a weighted health-state Index Score according to the United Kingdom (UK) population-based algorithm. The possible values for the Index Score ranged from -0.59 (severe problems in all 5 dimensions) to 1.0 (no problem in any dimension). A negative change indicated a worsening of the participant's health status.
Measured: Baseline and 30-Day Follow-Up (FU) up to 171 Weeks
Percentage of Participants With Treatment-Emergent Anti-Ramucirumab Antibodies
Blood samples were tested to determine if a participant reacted to ramucirumab by producing anti-ramucirumab antibodies. Samples were identified as treatment emergent anti-drug antibody (TE ADA) if the post-treatment sample had an increase of at least 4 fold in titer from pre-treatment values. If the pre-treatment value was not detected or was not present, a 1:20 post-treatment titer was required to indicate treatment emergence. The percentage of participants with TE ADA was calculated as: (the number of participants with TE ADA / total number of participants with at least 1 post-treatment immunogenicity sample analyzed)*100.
Measured: Cycles 1, 3, 5, and 30-Day FU
Observed Maximum Concentration (Cmax) and Observed Minimum Concentration (Cmin) of Ramucirumab
Measured: Preinfusion and 1 hour postinfusion in Cycles 3, 5, 9, 13, and 17
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted18 Aug 2010 (estimated)
- Study start2 Dec 2010
- Primary completion17 Jul 2014
- Study completion20 Jun 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Colorectal CancerStudies of the same condition, open and under way.
- More trials run by Eli Lilly and CompanyThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 1,072 participants (actual)
Sponsor and investigators
- Lead sponsor
- Eli Lilly and Company
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST), Study director, Eli Lilly and Company
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01183780
- Sponsor's protocol ID
- 13856
- Other IDs
- I4T-MC-JVBB, CP12-0920, 2010-021037-32, CTRI/2011/07/001900
- Status last verified
- Sep 2019
- First submitted
- 4 Aug 2010
- Last updated
- 25 Sep 2019
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- Individual data sharing
- Yes: Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.
Publications
Mitani S, Chen Y, Inoue K, Mori J, Gao L, Long A, Wakabayashi S. Clinical Impact of a Shortened Infusion Duration of Ramucirumab in Japanese Patients -A Model-Based Approach. Gan To Kagaku Ryoho. 2021 Nov;48(11):1381-1387.
PubMed 34795131Taniguchi H, Yoshino T, Yamaguchi K, Yamazaki K, Nixon AB, Tabernero J, Van Cutsem E, Robling KR, Abada PB, Hozak RR, Siegel R, Fill JA, Wijayawardana S, Walgren RA, Giles B, Jones A, Pitts KR, Drove N, Muro K. Clinical development and evaluation of a VEGF-D assay in plasma from patients with metastatic colorectal cancer in the RAISE study. Curr Med Res Opin. 2021 Oct;37(10):1769-1778. doi: 10.1080/03007995.2021.1940908. Epub 2021 Jul 28.
PubMed 34229554Lim HH, Hopkins AM, Rowland A, Yuen HY, Karapetis CS, Sorich MJ. Effect of Early Adverse Events on Survival Outcomes of Patients with Metastatic Colorectal Cancer Treated with Ramucirumab. Target Oncol. 2019 Dec;14(6):743-748. doi: 10.1007/s11523-019-00683-z.
PubMed 31676953Yoshino T, Portnoy DC, Obermannova R, Bodoky G, Prausova J, Garcia-Carbonero R, Ciuleanu T, Garcia-Alfonso P, Cohn AL, Van Cutsem E, Yamazaki K, Lonardi S, Muro K, Kim TW, Yamaguchi K, Grothey A, O'Connor J, Taieb J, Wijayawardana SR, Hozak RR, Nasroulah F, Tabernero J. Biomarker analysis beyond angiogenesis: RAS/RAF mutation status, tumour sidedness, and second-line ramucirumab efficacy in patients with metastatic colorectal carcinoma from RAISE-a global phase III study. Ann Oncol. 2019 Jan 1;30(1):124-131. doi: 10.1093/annonc/mdy461.
PubMed 30339194Grothey A, Yoshino T, Bodoky G, Ciuleanu T, Garcia-Carbonero R, Garcia-Alfonso P, Van Cutsem E, Muro K, Mytelka DS, Li L, Lipkovich O, Hsu Y, Sashegyi A, Ferry D, Nasroulah F, Tabernero J. Association of baseline absolute neutrophil counts and survival in patients with metastatic colorectal cancer treated with second-line antiangiogenic therapies: exploratory analyses of the RAISE trial and validation in an electronic medical record data set. ESMO Open. 2018 Apr 24;3(3):e000347. doi: 10.1136/esmoopen-2018-000347. eCollection 2018.
PubMed 29713498Tabernero J, Hozak RR, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy DC, Prausova J, Muro K, Siegel RW, Konrad RJ, Ouyang H, Melemed SA, Ferry D, Nasroulah F, Van Cutsem E. Analysis of angiogenesis biomarkers for ramucirumab efficacy in patients with metastatic colorectal cancer from RAISE, a global, randomized, double-blind, phase III study. Ann Oncol. 2018 Mar 1;29(3):602-609. doi: 10.1093/annonc/mdx767.
PubMed 29228087Obermannova R, Van Cutsem E, Yoshino T, Bodoky G, Prausova J, Garcia-Carbonero R, Ciuleanu T, Garcia Alfonso P, Portnoy D, Cohn A, Yamazaki K, Clingan P, Lonardi S, Kim TW, Yang L, Nasroulah F, Tabernero J. Subgroup analysis in RAISE: a randomized, double-blind phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab or placebo in patients with metastatic colorectal carcinoma progression. Ann Oncol. 2016 Nov;27(11):2082-2090. doi: 10.1093/annonc/mdw402. Epub 2016 Aug 29.
PubMed 27573561Tabernero J, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy DC, Van Cutsem E, Grothey A, Prausova J, Garcia-Alfonso P, Yamazaki K, Clingan PR, Lonardi S, Kim TW, Simms L, Chang SC, Nasroulah F; RAISE Study Investigators. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015 May;16(5):499-508. doi: 10.1016/S1470-2045(15)70127-0. Epub 2015 Apr 12.
PubMed 25877855
Study at a glance
From the registry record, last updated by the sponsor on 25 Sep 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-blind, Multicenter Phase 3 Study of Irinotecan, Folinic Acid, and 5-Fluorouracil (FOLFIRI) Plus Ramucirumab or Placebo in Patients With Metastatic Colorectal Carcinoma Progressive During or Following First-Line Combination Therapy With Bevacizumab, Oxaliplatin, and a Fluoropyrimidine
- ClinicalTrials.gov ID
- NCT01183780
- Acronym / sponsor ID
- 13856
- Conditions
- Colorectal Cancer
- Keywords
- second line, metastatic colorectal cancer, FOLFIRI, ramucirumab, CRC, mCRC
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 1,072 participants (actual)
- Lead sponsor
- Eli Lilly and CompanyIndustry (pharma, biotech, devices)
- Study start
- 2 Dec 2010 (actual)
- Primary completion
- 17 Jul 2014 (actual)
- Study completion
- 20 Jun 2016 (actual)
- First posted
- 18 Aug 2010 (estimated)
- Results
- Posted 15 Jul 2015
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to compare overall survival in participants with metastatic colorectal cancer treated with either ramucirumab and FOLFIRI or placebo and FOLFIRI.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| FOLFIRI + Ramucirumab | Experimental | Biological: Ramucirumab, Drug: Irinotecan, Drug: Folinic Acid, Drug: 5-Fluorouracil |
| FOLFIRI + Placebo | Placebo comparator | Biological: Placebo, Drug: Irinotecan, Drug: Folinic Acid, Drug: 5-Fluorouracil |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Histologically or cytologically confirmed colorectal cancer, excluding primary tumors of appendiceal origin (participants are eligible to enroll irrespective of KRAS mutation status)
- Confirmed metastatic colorectal cancer (Stage IV)
- The participant has received first-line combination therapy of bevacizumab, oxaliplatin, and a fluoropyrimidine for metastatic disease and, a) Experienced radiographic disease progression during first-line therapy, or b) Experienced radiographic disease progression ≤6 months after the last dose of first-line therapy, or c) Discontinued part or all of first-line therapy due to toxicity and experienced radiographic disease progression ≤6 months after the last dose of first-line therapy. Note that a participant must have received a minimum of 2 doses of bevacizumab as part of a first-line regimen containing chemotherapy; in addition, a participant must have received at least 1 cycle of first-line therapy that included bevacizumab, oxaliplatin and a fluoropyrimidine in the same cycle. Note that a participant must not have received more than 2 different fluoropyrimidines as part of a first-line regimen; disease progression is not an acceptable reason for discontinuing 1 fluoropyrimidine and starting a second fluoropyrimidine
- Receipt of no more than 2 prior systemic chemotherapy regimens in any setting (only 1 prior regimen for metastatic disease is permitted). For participants with rectal cancer, sequential neoadjuvant and adjuvant therapy will count as a single systemic regimen. Note that rechallenge with oxaliplatin is permitted and will be considered part of the first-line regimen for metastatic disease, both initial oxaliplatin treatment and subsequent rechallenge are considered as 1 regimen
- Measurable or nonmeasurable disease based on the Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1)
Key exclusion criteria (13 listed)
- Receipt of bevacizumab ≤28 days prior to randomization
- Receipt of any investigational therapy for non-oncology clinical indication ≤28 days prior to randomization
- Receipt of any previous systemic therapy, other than a combination of bevacizumab, oxaliplatin, and a fluoropyrimidine, for first-line treatment of metastatic colorectal cancer
- Known leptomeningeal disease or brain metastases or uncontrolled spinal cord compression (currently or in the past)
- Experience of any arterial thrombotic or arterial thromboembolic events, including, but not limited to, myocardial infarction, transient ischemic attack, or cerebrovascular accident, ≤12 months prior to randomization
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| RamucirumabAlso: LY3009806, IMC-1121B8 milligrams / kilogram (mg/kg) administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision | Biological | FOLFIRI + Ramucirumab |
| PlaceboAdministered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision | Biological | FOLFIRI + Placebo |
| Irinotecan180 milligrams/square meter (mg/m^2) administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision | Drug | FOLFIRI + Placebo, FOLFIRI + Ramucirumab |
| Folinic AcidAlso: leucovorin400 mg/m^2 administered intravenously every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision | Drug | FOLFIRI + Placebo, FOLFIRI + Ramucirumab |
| 5-Fluorouracil400 mg/m^2 bolus immediately followed by 2400 mg/m^2 continuous infusion every 2 weeks until disease progression, unacceptable toxicity, noncompliance or withdrawal of consent by the participant or investigator decision | Drug | FOLFIRI + Placebo, FOLFIRI + Ramucirumab |
Primary outcome
Overall Survival (OS)
Time frame: Randomization to Date of Death from Any Cause Up to 39.36 Months
OS was defined as the time in months from the date of randomization to the date of death from any cause. For participants not known to have died as of the cut-off date, OS was censored at the last known date alive.
6 secondary outcomes
Progression-free Survival (PFS) Time
Time frame: Randomization to Measured PD or Date of Death from Any Cause Up to 38.01 Months
Percentage of Participants Achieving an Objective Response (Objective Response Rate)
Time frame: Randomization until Disease Progression Up to 38.01 Months
Change From Baseline in European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 Global Health Status
Time frame: Baseline Up to 171 Weeks
Change From Baseline in EuroQol- 5D (EQ-5D)
Time frame: Baseline and 30-Day Follow-Up (FU) up to 171 Weeks
Percentage of Participants With Treatment-Emergent Anti-Ramucirumab Antibodies
Time frame: Cycles 1, 3, 5, and 30-Day FU
Observed Maximum Concentration (Cmax) and Observed Minimum Concentration (Cmin) of Ramucirumab
Time frame: Preinfusion and 1 hour postinfusion in Cycles 3, 5, 9, 13, and 17
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Sep 2019.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 34795131Mitani S, Chen Y, Inoue K, Mori J, Gao L, Long A, Wakabayashi S. Clinical Impact of a Shortened Infusion Duration of Ramucirumab in Japanese Patients -A Model-Based Approach. Gan To Kagaku Ryoho. 2021 Nov;48(11):1381-1387.
- Derived from this study: PubMed 34229554Taniguchi H, Yoshino T, Yamaguchi K, Yamazaki K, Nixon AB, Tabernero J, Van Cutsem E, Robling KR, Abada PB, Hozak RR, Siegel R, Fill JA, Wijayawardana S, Walgren RA, Giles B, Jones A, Pitts KR, Drove N, Muro K. Clinical development and evaluation of a VEGF-D assay in plasma from patients with metastatic colorectal cancer in the RAISE study. Curr Med Res Opin. 2021 Oct;37(10):1769-1778. doi: 10.1080/03007995.2021.1940908. Epub 2021 Jul 28.
- Derived from this study: PubMed 31676953Lim HH, Hopkins AM, Rowland A, Yuen HY, Karapetis CS, Sorich MJ. Effect of Early Adverse Events on Survival Outcomes of Patients with Metastatic Colorectal Cancer Treated with Ramucirumab. Target Oncol. 2019 Dec;14(6):743-748. doi: 10.1007/s11523-019-00683-z.
- Derived from this study: PubMed 30339194Yoshino T, Portnoy DC, Obermannova R, Bodoky G, Prausova J, Garcia-Carbonero R, Ciuleanu T, Garcia-Alfonso P, Cohn AL, Van Cutsem E, Yamazaki K, Lonardi S, Muro K, Kim TW, Yamaguchi K, Grothey A, O'Connor J, Taieb J, Wijayawardana SR, Hozak RR, Nasroulah F, Tabernero J. Biomarker analysis beyond angiogenesis: RAS/RAF mutation status, tumour sidedness, and second-line ramucirumab efficacy in patients with metastatic colorectal carcinoma from RAISE-a global phase III study. Ann Oncol. 2019 Jan 1;30(1):124-131. doi: 10.1093/annonc/mdy461.
- Derived from this study: PubMed 29713498Grothey A, Yoshino T, Bodoky G, Ciuleanu T, Garcia-Carbonero R, Garcia-Alfonso P, Van Cutsem E, Muro K, Mytelka DS, Li L, Lipkovich O, Hsu Y, Sashegyi A, Ferry D, Nasroulah F, Tabernero J. Association of baseline absolute neutrophil counts and survival in patients with metastatic colorectal cancer treated with second-line antiangiogenic therapies: exploratory analyses of the RAISE trial and validation in an electronic medical record data set. ESMO Open. 2018 Apr 24;3(3):e000347. doi: 10.1136/esmoopen-2018-000347. eCollection 2018.
- Derived from this study: PubMed 29228087Tabernero J, Hozak RR, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy DC, Prausova J, Muro K, Siegel RW, Konrad RJ, Ouyang H, Melemed SA, Ferry D, Nasroulah F, Van Cutsem E. Analysis of angiogenesis biomarkers for ramucirumab efficacy in patients with metastatic colorectal cancer from RAISE, a global, randomized, double-blind, phase III study. Ann Oncol. 2018 Mar 1;29(3):602-609. doi: 10.1093/annonc/mdx767.
- Derived from this study: PubMed 27573561Obermannova R, Van Cutsem E, Yoshino T, Bodoky G, Prausova J, Garcia-Carbonero R, Ciuleanu T, Garcia Alfonso P, Portnoy D, Cohn A, Yamazaki K, Clingan P, Lonardi S, Kim TW, Yang L, Nasroulah F, Tabernero J. Subgroup analysis in RAISE: a randomized, double-blind phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab or placebo in patients with metastatic colorectal carcinoma progression. Ann Oncol. 2016 Nov;27(11):2082-2090. doi: 10.1093/annonc/mdw402. Epub 2016 Aug 29.
- Derived from this study: PubMed 25877855Tabernero J, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy DC, Van Cutsem E, Grothey A, Prausova J, Garcia-Alfonso P, Yamazaki K, Clingan PR, Lonardi S, Kim TW, Simms L, Chang SC, Nasroulah F; RAISE Study Investigators. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015 May;16(5):499-508. doi: 10.1016/S1470-2045(15)70127-0. Epub 2015 Apr 12.
- Individual participant dataSharing planned: Yes. Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST) study director
Eli Lilly and Company
213 sites in 26 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Ramucirumab, Irinotecan and Folinic Acid in people with Colorectal Cancer, run by Eli Lilly and Company at 213 sites in 26 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 25 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 213 sites in United States, Japan, Germany, Australia, Belgium and 21 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 15 Jul 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Overall Survival (OS) (time frame: Randomization to Date of Death from Any Cause Up to 39.36 Months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01183780, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Sep 2019.