Metastatic Colorectal CancerPROSPECT-RNCT03010722
Prospective Translational Study Investigating Molecular Predictors of Resistance and Response to Regorafenib Monotherapy
An observational study of Metastatic Colorectal Cancer, run by Royal Marsden NHS Foundation Trust at 1 site in United Kingdom.
Trial summary
This is a single centre prospective biological translational research study involving the collection of tumour tissue, blood samples and clinical data from patients being treated with regorafenib for metastatic Colorectal Cancer (mCRC) at the Royal Marsden Hospital. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Metastatic Colorectal Cancer
- What is being tested?
- Regorafenib
- Type of treatment
- Pill or oral medicine
- How many people
- 49 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- Jan 2015to Jul 2017
- Phase
- Observational
- Are there results?
- None posted in the registry
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
Study population: Patients will be selected from the clinics and multi-disciplinary meetings, so long that they meet all the inclusion criteria and no exclusion criteria.
Who may be able to join
- Patients with RAS mutant (MT) metastatic colorectal cancer (mCRC) who have been at least once treated with available therapies including fluoropyrimidine-based chemotherapy, oxaliplatin, irinotecan and an anti-angiogenic agent, except for patients who have not been treated with oxaliplatin due to previous documented peripheral neuropathy in an adjuvant setting or in those patients where disease has progressed within a short time from receiving adjuvant treatment (<12 months).
- Eligible to receive regorafenib within the context of PROSPECT-R trial at the Royal Marsden Hospital
Who cannot join
- A patient who meets any of the exclusion criteria will NOT be eligible for randomization.
- A patient must NOT
- have had prior treatment with regorafenib or any other VEGF-targeting kinase inhibitor
- have had previous or concurrent cancer that is distinct in primary site or histology from colorectal cancer within 5 years prior to randomization EXCEPT for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors [Ta (Noninvasive tumor), Tis (Carcinoma in situ) and T1 (Tumor invades lamina propria)].
- Patients that are participating in another clinical trial involving an investigational medicinal product, unless it is more than 14 days after they have ceased the investigational medicinal product
- Patients that are participating in another research study involving tumour tissue biopsies planned to take place during the time that the patient is participating in this study
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- Have had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to initiation of study treatment
- If female and of childbearing potential, be engaged in breast feeding
- Be unable to swallow oral tablets (crushing of study treatment tablets is not allowed)
- Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 month before the start of study medication (except for adequately treated catheter-related venous thrombosis occurring more than one month before the start of study medication)
- Interstitial lung disease with ongoing signs and symptoms at the time of informed consent.
- Ongoing infection > Grade 2 NCI Common Toxicity Criterial for Adverse Effects (CTCAE).
- Uncontrolled hypertension (Systolic blood pressure > 140 mmHg or diastolic pressure > 90 mmHg) despite optimal medical management
- Have congestive heart failure classified as New York Heart Association Class 2 or higher
- Have had unstable angina (angina symptoms at rest) or new-onset angina < 3 months prior to screening
- Have had a myocardial infarction < 6 months prior to initiation of study treatment
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
The Royal Marsden NHS Foundation Trust London and Surrey
Carshalton, Surrey, SM2 5PT
About this study
Official title: A Prospective Translational Study Investigating Molecular Predictors of Resistance and Response to Regorafenib Monotherapy in RAS Mutant Metastatic Colorectal Cancer
This is a single centre prospective biological translational research study involving the collection of tumour tissue, blood samples and clinical data from patients being treated with regorafenib for metastatic Colorectal Cancer (mCRC) at the Royal Marsden Hospital. Patients will be eligible for the study if they have a histological diagnosis of CRC, are refractory to standard available therapies with palliative intent for mCRC, have received prior treatment with at least one anti-VEGF antibody and chemotherapy drugs including fluorouracil (5FU) or capecitabine, oxaliplatin and irinotecan, and patients have RAS mutant tumours.
Read the detailed description
This is an exploratory translational research study to obtain research biopsies of RAS mutant metastatic colorectal cancer (mCRC) tumour tissue prior to commencement of regorafenib multi-tyrosine kinase inhibitor (MKI) treatment targeting vascular endothelial growth factor receptor (VEGFR), tumour microenvironment and oncogenic driver alterations, and again at development of resistance. Candidate markers of resistance will be identified in tissue biopsies through genetic and other molecular analysis and parallel collection of serial blood specimens will facilitate the identification of resistance markers and the tracking of resistance evolution in circulating nucleic acids. Early dynamic contrast enhanced MRI (DCE-MRI) along with diffusion weighted (DW)-MRI imaging at the beginning, and on day 15+/-7 post treatment will be performed. Additionally, dual contrast enhanced CT (DECT) will be performed according to routine clinical evaluation time points before drug administration and at 8 weeks after drug administration. Disease will be monitored with serial CT scans of the chest abdomen and pelvis (CT-CAP) every eight weeks, until progression. The aim of the study is to identify novel predictive biomarkers of resistance and response to this targeted therapy in mCRC previously treated with oxaliplatin, fluoropyrimidines and irinotecan, using genetic, epigenetic, transcriptomics, proteomic and live tissue culture methods. These molecular analyses will be performed on metastatic tumour tissue samples taken firstly before commencement of regorafenib, and secondly on progression of disease, and thirdly from archival primary or metastatic tumour tissue. There is an additional biopsy at 8 weeks in patients with response or stable disease, as determined by Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 criteria.
- Conditions
- Metastatic Colorectal Cancer
- Being tested
- Regorafenib
- Medical subject headings
- Colorectal Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
RegorafenibDrug
Also called Stivarga
Patients meeting all of the inclusion criteria and none of the exclusion criteria will receive regorafenib 160 mg orally (po) od for 3 weeks of every 4-week cycle. Each cycle will comprise 3 weeks of treatment followed by 1 week without treatment, hereafter described as "3 weeks on/1 week off". Each 160-mg dose will include four regorafenib 40-mg tablets.
| Study group | Role | What they receive |
|---|---|---|
| Regorafenib | 160 mg orally (po) od for 3 weeks of every 4-week cycle
All patients will be required to have pre-treatment dynamic contrast enhance computed tomography (DECT) scan pre-treatment and at 8 weeks. Suitable patients will also be required to have dynamic contrast enhanced magnetic resonance imaging (DEC-MRI) and diffusion weighted (DW)-MRI, pre-treatment and at 2 weeks. All patients will also be required to have an Ultrasound (USS) or CT-guided biopsy of suitable metastatic lesion. Receives: Drug: Regorafenib |
What is being measured
The primary outcome is the main question the study is designed to answer.
disease control rate (DCR), measured in months
DCR will be defined as complete response (CR)/partial response (PR)/ stable disease (SD) using RECIST v1.1. Chi2 or Fisher's exact tests will be employed to explore whether there is an association between low or high mutations and DCR. Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs).
Measured: 12 months
Secondary outcomes (3)
progression free survival (PFS), measured in months
PFS will be measured from start of treatment to date of progression or death from any cause.Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs). The PFS will be estimated using the Kaplan-Meier method and survival curves will be generated for each group. The log-rank test will be used to compare the survival curves and a Cox proportional hazards model will be fitted to obtain hazard ratios (HRs) and 95% CIs. The proportional hazards assumption will be tested with the use of Schoenfeld residuals
Measured: 12 months
overall survival (OS), measured in months
OS will be defined as time from start of treatment to death of any cause. Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs). The OS will be estimated using the Kaplan-Meier method and survival curves will be generated for each group. The log-rank test will be used to compare the survival curves and a Cox proportional hazards model will be fitted to obtain hazard ratios (HRs) and 95% CIs. The proportional hazards assumption will be tested with the use of Schoenfeld residuals
Measured: 12 months
Median values of volume transfer constant (Ktrans) and enhancing fraction (EF) and their product KEF (product of summarised median values of Ktrans x EF/100) will be compared at baseline and on day 15
Dynamic contrast enhance magnetic resonance imaging (DCE-MRI) will be performed pre-treatment and at day 15. KEF changes of more than 70% between the two time points will be considered significant and patients will be thus stratified in two groups, i.e. A) drop in KEF of >70% and B) less than 70% drop in KEF.
Measured: 15 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Jan 2017 (estimated)
- Study startJan 2015
- Primary completionJan 2017
- Study completionJul 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Metastatic Colorectal CancerStudies of the same condition, open and under way.
- More trials run by Royal Marsden NHS Foundation TrustThe 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
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 49 participants (actual)
Sponsor and investigators
- Lead sponsor
- Royal Marsden NHS Foundation Trust
- Sponsor type
- University, hospital or other
- Collaborators
- Bayer
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03010722
- Sponsor's protocol ID
- 4164
- Acronym
- PROSPECT-R
- Status last verified
- Jan 2017
- First submitted
- 6 Jan 2015
- Last updated
- 3 May 2021
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Rata M, Khan K, Collins DJ, Orton MR, d'Arcy J, Tunariu N, Bali MA, Chau I, Valeri N, Cunningham D, Koh DM. Apparent diffusion coefficient and kurtosis parameters show early response to anti-angiogenic therapy in patients with colorectal liver metastases. Cancer Imaging. 2026 Jun 4;26(1):101. doi: 10.1186/s40644-026-01063-3.
PubMed 42243941Rata M, Khan K, Collins DJ, Koh DM, Tunariu N, Bali MA, d'Arcy J, Winfield JM, Picchia S, Valeri N, Chau I, Cunningham D, Fassan M, Leach MO, Orton MR. DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases. Cancer Imaging. 2021 Dec 19;21(1):67. doi: 10.1186/s40644-021-00436-0.
PubMed 34924031
Study at a glance
From the registry record, last updated by the sponsor on 3 May 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Prospective Translational Study Investigating Molecular Predictors of Resistance and Response to Regorafenib Monotherapy in RAS Mutant Metastatic Colorectal Cancer
- ClinicalTrials.gov ID
- NCT03010722
- Acronym / sponsor ID
- PROSPECT-R / 4164
- Conditions
- Metastatic Colorectal Cancer
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 49 participants (actual)
- Lead sponsor
- Royal Marsden NHS Foundation TrustUniversity, hospital or other
- Collaborators
- Bayer
- Study start
- Jan 2015
- Primary completion
- Jan 2017 (actual)
- Study completion
- Jul 2017 (actual)
- First posted
- 5 Jan 2017 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a single centre prospective biological translational research study involving the collection of tumour tissue, blood samples and clinical data from patients being treated with regorafenib for metastatic Colorectal Cancer (mCRC) at the Royal Marsden Hospital. Patients will be eligible for the study if they have a histological diagnosis of CRC, are refractory to standard available therapies with palliative intent for mCRC, have received prior treatment with at least one anti-VEGF antibody and chemotherapy drugs including fluorouracil (5FU) or capecitabine, oxaliplatin and irinotecan, and patients have RAS mutant tumours.
Detailed description
This is an exploratory translational research study to obtain research biopsies of RAS mutant metastatic colorectal cancer (mCRC) tumour tissue prior to commencement of regorafenib multi-tyrosine kinase inhibitor (MKI) treatment targeting vascular endothelial growth factor receptor (VEGFR), tumour microenvironment and oncogenic driver alterations, and again at development of resistance. Candidate markers of resistance will be identified in tissue biopsies through genetic and other molecular analysis and parallel collection of serial blood specimens will facilitate the identification of resistance markers and the tracking of resistance evolution in circulating nucleic acids. Early dynamic contrast enhanced MRI (DCE-MRI) along with diffusion weighted (DW)-MRI imaging at the beginning, and on day 15+/-7 post treatment will be performed. Additionally, dual contrast enhanced CT (DECT) will be performed according to routine clinical evaluation time points before drug administration and at 8 weeks after drug administration. Disease will be monitored with serial CT scans of the chest abdomen and pelvis (CT-CAP) every eight weeks, until progression. The aim of the study is to identify novel predictive biomarkers of resistance and response to this targeted therapy in mCRC previously treated with oxaliplatin, fluoropyrimidines and irinotecan, using genetic, epigenetic, transcriptomics, proteomic and live tissue culture methods. These molecular analyses will be performed on metastatic tumour tissue samples taken firstly before commencement of regorafenib, and secondly on progression of disease, and thirdly from archival primary or metastatic tumour tissue. There is an additional biopsy at 8 weeks in patients with response or stable disease, as determined by Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 criteria.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Regorafenib | – | Drug: Regorafenib160 mg orally (po) od for 3 weeks of every 4-week cycle All patients will be required to have pre-treatment dynamic contrast enhance computed tomography (DECT) scan pre-treatment and at 8 weeks. Suitable patients will also be required to have dynamic contrast enhanced magnetic resonance imaging (DEC-MRI) and diffusion weighted (DW)-MRI, pre-treatment and at 2 weeks. All patients will also be required to have an Ultrasound (USS) or CT-guided biopsy of suitable metastatic lesion. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients will be selected from the clinics and multi-disciplinary meetings, so long that they meet all the inclusion criteria and no exclusion criteria.
Key inclusion criteria (2 listed)
- Patients with RAS mutant (MT) metastatic colorectal cancer (mCRC) who have been at least once treated with available therapies including fluoropyrimidine-based chemotherapy, oxaliplatin, irinotecan and an anti-angiogenic agent, except for patients who have not been treated with oxaliplatin due to previous documented peripheral neuropathy in an adjuvant setting or in those patients where disease has progressed within a short time from receiving adjuvant treatment (<12 months).
- Eligible to receive regorafenib within the context of PROSPECT-R trial at the Royal Marsden Hospital
Key exclusion criteria (16 listed)
- A patient who meets any of the exclusion criteria will NOT be eligible for randomization.
- A patient must NOT
- have had prior treatment with regorafenib or any other VEGF-targeting kinase inhibitor
- have had previous or concurrent cancer that is distinct in primary site or histology from colorectal cancer within 5 years prior to randomization EXCEPT for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors [Ta (Noninvasive tumor), Tis (Carcinoma in situ) and T1 (Tumor invades lamina propria)].
- Patients that are participating in another clinical trial involving an investigational medicinal product, unless it is more than 14 days after they have ceased the investigational medicinal product
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 |
|---|---|---|
| RegorafenibAlso: StivargaPatients meeting all of the inclusion criteria and none of the exclusion criteria will receive regorafenib 160 mg orally (po) od for 3 weeks of every 4-week cycle. Each cycle will comprise 3 weeks of treatment followed by 1 week without treatment, hereafter described as "3 weeks on/1 week off". Each 160-mg dose will include four regorafenib 40-mg tablets. | Drug | Regorafenib |
Primary outcome
disease control rate (DCR), measured in months
Time frame: 12 months
DCR will be defined as complete response (CR)/partial response (PR)/ stable disease (SD) using RECIST v1.1. Chi2 or Fisher's exact tests will be employed to explore whether there is an association between low or high mutations and DCR. Logistic regression will be employed to produce odds ratios (ORs) and 95% confidence intervals (CIs).
3 secondary outcomes
progression free survival (PFS), measured in months
Time frame: 12 months
overall survival (OS), measured in months
Time frame: 12 months
Median values of volume transfer constant (Ktrans) and enhancing fraction (EF) and their product KEF (product of summarised median values of Ktrans x EF/100) will be compared at baseline and on day 15
Time frame: 15 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 May 2021.
- Derived from this study: PubMed 42243941Rata M, Khan K, Collins DJ, Orton MR, d'Arcy J, Tunariu N, Bali MA, Chau I, Valeri N, Cunningham D, Koh DM. Apparent diffusion coefficient and kurtosis parameters show early response to anti-angiogenic therapy in patients with colorectal liver metastases. Cancer Imaging. 2026 Jun 4;26(1):101. doi: 10.1186/s40644-026-01063-3.
- Derived from this study: PubMed 34924031Rata M, Khan K, Collins DJ, Koh DM, Tunariu N, Bali MA, d'Arcy J, Winfield JM, Picchia S, Valeri N, Chau I, Cunningham D, Fassan M, Leach MO, Orton MR. DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases. Cancer Imaging. 2021 Dec 19;21(1):67. doi: 10.1186/s40644-021-00436-0.
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CRC
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.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Metastatic Colorectal Cancer, run by Royal Marsden NHS Foundation Trust at 1 site in United Kingdom.
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 2 inclusion and 16 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 3 May 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
disease control rate (DCR), measured in months (time frame: 12 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 NCT03010722, which also lists 2 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 3 May 2021.