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Colorectal CancerPhase 3RAMTASNCT03520946

RAMucirumab in Combination Wth TAS102 vs. TAS102 Alone in Chemotherapy Refractory Metastatic Colorectal Cancer Patients

A Phase 3 study testing Ramucirumab and TAS 102 in people with Colorectal Cancer, run by Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest at 28 sites in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Interventional, prospective, randomized (1:1), controlled, open label, multicenter phase IIb study in patients with advanced metastatic colorectal cancer. The scope of the trial is to evaluate overall survival of either regimen (TAS102 +/- Ramucirumab) and evaluate safety and tolerability. 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 and TAS 102
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
430 participants
Where
28 sitesGermany
Study dates
24 Jan 2019to 30 Jul 2024
Phase
Phase 3
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

Who may be able to join

  • Metastatic and inoperable, colorectal cancer who has progressed on/after, or did not tolerate, refuse or have contraindications to: fluoropyrimidines, oxaliplatin, irinotecan, anti-angiogenic therapies (bevacizumab, aflibercept, regorafenib or ramucirumab) and if indicated anti-EGFR antibodies (cetuximab or panitumumab).
  • Intolerance is defined as a permanent discontinuation of the respective treatment resulting from toxicity
  • Signed informed consent before start of specific protocol procedure
  • Histologically or cytologically documented diagnosis of adenocarcinoma of the colon or rectum
  • Presence of at least one measurable site of disease following RECIST 1.1 criteria
  • ECOG (Eastern Cooperative Oncology Group) performance 0-1
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  • Known RAS and BRAF V600E mutational status
  • Life expectancy of at least 3 months
  • Adequate hematological, hepatic and renal function parameters:
  • Leukocytes ≥3000/mm³, platelets ≥100,000/mm³, neutrophil count (ANC) ≥1500/μL, hemoglobin ≥9 g/dL (5.58 mmol/L)
  • Adequate coagulation function as defined by International Normalized Ratio (INR) ≤1.5, and a partial thromboplastin time (PTT) ≤5 seconds above the ULN (upper limit of normal) (unless receiving anticoagulation therapy). Patients receiving warfarin/phenprocoumon must be switched to low molecular weight heparin and have achieved a stable coagulation profile prior to first dose of protocol therapy
  • Serum creatinine ≤1.5 x upper limit of normal or creatinine clearance (measured via 24-hour urine collection) ≥40 mL/minute (that is, if serum creatinine is >1.5 times the ULN, a 24-hour urine collection to calculate creatinine clearance must be performed)
  • Urinary protein ≤1+ on dipstick or routine urinalysis (UA; if urine dipstick or routine analysis is ≥2+, a 24-hour urine collection for protein must demonstrate <1000 mg of protein in 24 hours to allow participation in this protocol)
  • Bilirubin ≤1.5 x upper limit of normal, AST and ALT ≤3.0 x upper limit of normal, ≤5xULN if liver metastasis present, alkaline phosphatase ≤6 x upper limit of normal
  • Patient able and willing to provide written informed consent and to comply with the study protocol
  • Female and male patients ≥18. Patients in reproductive age must be willing to use adequate contraception during the study and for 7 months after the end of ramucirumab treatment (appropriate contraception is defined as surgical sterilization (e.g., bilateral tubal ligation, vasectomy) or hormonal contraception (implantable, patch, oral). Women who use a hormonal contraception method should use an additional barrier method like IUD, male or female condom with spermicidal gel, diaphragm, sponge, cervical cap). Female patients with childbearing potential need to have a negative pregnancy test within 7 days before study start (There are no data that indicate special gender distribution. Therefore, patients will be enrolled in the study gender-independently.)

Who cannot join

  • Known hypersensitivity against ramucirumab or TAS102
  • Other known contraindications against ramucirumab, TAS102, or other anti-angiogenic therapies
  • Prior therapy with TAS102
  • Drug-related severe adverse events upon pretreatment with antiangiogenic drugs that would require permanent discontinuation and not allow re-challenge with the same class of drug (i.e. ramucirumab) such as noncontrollable severe hypertension or thromboembolic events
  • Any antineoplastic treatment including irradiation within 14 days (42 days for mitomycin c) prior to start of therapy.
  • Major surgery within 4 weeks of starting therapy within this study, or minor surgery/subcutaneous venous access device placement within 7 days prior to first dose of protocol therapy. The patient has elective or planned major surgery to be performed during the course of the clinical trial.
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  • Symptomatic brain metastasis
  • Clinically significant cardiovascular disease
  • NYHA>II°, myocardial infarction within 6 months prior study entry
  • Known clinically significant valvular defect
  • Uncontrolled or poorly-controlled hypertension (>160 mmHg systolic or >100 mmHg diastolic for >4 weeks) despite standard medical management
  • Any arterial thromboembolic events, including but not limited to myocardial infarction, transient ischemic attack, cerebrovascular accident, or unstable angina, within 6 months prior to first dose of protocol therapy
  • History of deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE), or any other significant thromboembolism (venous port or catheter thrombosis or superficial venous thrombosis are not considered "significant") during the 3 months prior to first dose of protocol therapy
  • Active clinically serious infections (> grade 2 NCI-CTC version 4.0)
  • Chronic inflammatory bowel disease
  • History of uncontrolled HIV infection or chronic hepatitis B or C
  • Patients with evidence of bleeding diathesis
  • Grade 3-4 GI bleeding within 3 months prior to first dose of protocol therapy
  • Receiving chronic antiplatelet therapy, including aspirin (once daily aspirin use (maximum dose 325 mg/day) is permitted), nonsteroidal anti-inflammatory drugs (including ibuprofen, naproxen, and others), dipyridamole or clopidogrel, or similar agents
  • History of gastrointestinal perforation or fistulae in past 6 months or risk factors for perforation
  • Serious or nonhealing wound, ulcer, or bone fracture within 28 days prior to first dose of protocol therapy
  • Past or current history of other malignancies not curatively treated and without evidence of disease for more than 5 years, except for curatively treated basal cell carcinoma of the skin and in situ carcinoma of the cervix or bladder, or low/intermediate risk prostate cancer (Gleason score ≤7) with normal PSA levels
  • Any condition that could jeopardize the safety of the patient and their compliance of the study
  • Medical, psychological or social conditions that may interfere with the participation in the study
  • Cirrhosis at a level of Child-Pugh B (or worse) or cirrhosis (any degree) and a history of hepatic encephalopathy or ascites.
  • Clinically meaningful ascites is defined as ascites from cirrhosis requiring diuretics or paracentesis
  • On-treatment participation in another clinical study or received investigational drug therapy in the period 30 days prior to inclusion and during the study
  • Subject pregnant or breast feeding, or planning to become pregnant within 7 months after the end of treatment
  • Patients in a closed institution according to an authority or court decision (AMG § 40, Abs. 1 No. 4)
  • Any other concurrent antineoplastic treatment including irradiation

Trial locations and contacts

28 sites in 1 country.

28 sites in 1 country

Germany28 sites
  • MVZ Gesundheitszentrum St. Marien GmbH

    Amberg, 922241

  • HELIOS Klinikum Bad Saarow

    Bad Saarow, 15526

  • Charité - Universitätsmedizin Berlin Campus Mitte

    Berlin, 10115

  • MVZ Seestrasse

    Berlin, 13347

  • St.-Johannes-Hospital

    Dortmund, 44137

  • Universitätsklinikum Düsseldorf

    Düsseldorf, 40225

  • Universitätsklinikum Essen

    Essen, 45147

  • Krankenhaus Nordwest GmbH

    Frankfurt, 60488

  • Universitätsklinikum Hamburg-Eppendorf

    Hamburg, 20246

  • Asklepios Klinik Hamburg Barmbek

    Hamburg, 22307

  • Medizinische Hochschule Hannover

    Hanover, 30625

  • Marien Hospital Herne

    Herne, 44625

  • Vincentius-Diakonissen-Kliniken gAG

    Karlsruhe, 76137

  • Universitätsklinikum Leipzig

    Leipzig, 04103

  • Klinikum Ludwigsburg

    Ludwigsburg, 71640

  • Tagestherapiezentrum am ITM Universitätsmedizin Mannheim

    Mannheim, 68167

  • Johannes Wesling Klinikum Minden

    Minden, 32429

  • Kliniken Maria Hilf GmbH

    Mönchengladbach, 41063

  • Klinikum der Universität München-Großhadern

    München, 81377

  • Unversitätsklinikum Münster

    Münster, 48149

  • Klinikum Nürnberg

    Nuremberg, 90419

  • Studienzentrum Onkologie Ravensburg

    Ravensburg, 88212

  • MedCenter Nordsachsen

    Schkeuditz, 04435

  • Leopoldina Krankenhaus

    Schweinfurt, 97422

  • MVZ Klinik Dr. Hancken GmbH

    Stade, 21680

  • Universitätsklinikum Ulm

    Ulm, 89081

  • Klinikum Wilhelmshaven

    Wilhelmshaven, 26389

  • Hämatologisch-Onkologische Praxis

    Würselen, 52146

Other trials in Germany

About this study

Official title: A Phase III Study of RAMucirumab in Combination With TAS102 vs. TAS102 Monotherapy in Chemotherapy Refractory Metastatic Colorectal Cancer Patients

Interventional, prospective, randomized (1:1), controlled, open label, multicenter phase IIb study in patients with advanced metastatic colorectal cancer. The scope of the trial is to evaluate overall survival of either regimen (TAS102 +/- Ramucirumab) and evaluate safety and tolerability.

Read the detailed description

This is an interventional, prospective, randomized (1:1), controlled, open label, multicenter phase IIb study in patients with advanced metastatic colorectal cancer. The scope of the trial is to evaluate overall survival of either regimen and evaluate safety and tolerability.

Patients with advanced metastatic and inoperable, colorectal cancer who have progressed on/after or did not tolerate: fluoropyrimidines, oxaliplatin, irinotecan, anti-angiogenic therapies (bevacizumab, aflibercept, regorafenib or ramucirumab) and when indicated anti-EGFR (epidermal growth factor receptor) antibodies (cetuximab or panitumumab) will be included in this trial.

Patients will be stratified by the duration of previous anti-angiogenic therapy ≥ or <12 months in total, BRAF V600E mutation status (mutation vs. wildtype), RAS mutation status (mutation vs. wildtype), and randomized 1:1 to receive either ramucirumab/TAS102 (arm A) or TAS102 (arm B). Concurrent use of other chemotherapy is not allowed.

Two interim safety analyses will be conducted when 10 and 40 patients are fully documented in arm A after receiving 2 cycles (one 4-week cycle comprises ramucirumab 8mg/kg administered at d1 and d15 and TAS102 35mg/m2 p.o. twice daily administered on d1-5 and d8-12). The analysis will be reviewed by the lead coordinating investigator (Prof. Dr. Kasper) and members of the steering committee and then by the data safety monitoring board. It is not planned to discontinue recruitment for the interim safety analyses.

Arm A (ramucirumab/TAS102) Patients randomized to arm A will receive ramucirumab 8 mg/kg iv over 60 min on d1+15, q4w and TAS102 35mg/m2 p.o. twice daily (BID) d1-5 and 8-12, q4w until progression or intolerance or completion of 6 cycles.

Arm B (TAS102) Patients randomized to arm B will receive TAS102 35mg/m2 p.o. twice daily (BID) d1-5 and 8-12, q4w until progression, intolerance or completion of 6 cycles.

In both arms, tumor assessments (CT or MRI) are performed before enrollment/randomization and then every 8 weeks (every 2nd cycle) during therapy and every 12 weeks during follow-up until progression/relapse, death or end of follow-up. A change from CT into MRI in the follow-up period is possible at any time.

During treatment, clinical visits (blood cell counts, detection of toxicity) will be performed prior to every treatment dose of ramucirumab or every two weeks in arm B or if ramucirumab was discontinued in arm A. Safety of TAS102 +/- ramucirumab will be monitored continuously by careful monitoring of all adverse events (AEs) and serious adverse events (SAEs) reported. Every 4 weeks during therapy Quality of life (QoL) will be assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30) and the EuroQol 5 dimensions 5-level version (EQ-5D-5L).

Being tested
Ramucirumab, TAS 102
Keywords
colorectal cancer, ramucirumab, tas102
Medical subject headings
Colorectal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RamucirumabDrug

    8 mg/kg iv over 60 min on d1+15, q4w

  • TAS 102Drug

    35mg/m2 p.o. twice daily (BID) d1-5 and d8-12, q4w

Study groups in NCT03520946
Study groupRoleWhat they receive
Arm A (ramucirumab + TAS102)ExperimentalPatients randomized to arm A will receive ramucirumab 8 mg/kg iv over 60 min on d1+15, q4w and TAS102 35mg/m2 p.o. twice daily (BID) d1-5 and 8-12, q4w until progression or intolerance or completion of 6 cycles.
Receives: Drug: Ramucirumab; Drug: TAS 102
Arm B (TAS102 only)Active comparatorPatients randomized to arm B will receive TAS102 35mg/m2 p.o. twice daily (BID) d1-5 and 8-12, q4w until progression, intolerance or completion of 6 cycles.
Receives: Drug: TAS 102

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Overall survival

    Overall survival according to Kaplan-Meier

    Measured: Up to 4 years

Secondary outcomes (9)
  1. Overall response rate (ORR)

    ORR defined as the proportion of patients with complete or partial remission according to RECIST 1.1

    Measured: Up to 4 years

  2. Disease control rate (DCR)

    DCR defined as the proportion of patients with complete or partial remission and stable disease according to RECIST 1.1

    Measured: Up to 4 years

  3. Progression-free survival (PFS)

    PFS, defined as the time from enrollment/randomization to the first occurrence of progression, as determined by the investigator using CT criteria, or death from any cause

    Measured: Up to 4 years

  4. Overall survival (OS) rate at different time points

    OS rate at 6 and 12 months, defined as patients who are alive after at 6 and 12 months, respectively

    Measured: 6 months and 1 year

  5. Efficacy (ORR) subgroup

    Efficacy (ORR) in patients who develop neutropenia grade ≥2 (ANC ≤1500/μl) in cycle 1

    Measured: Up to 4 years

  6. Efficacy (PFS) subgroup

    Efficacy (PFS) in patients who develop neutropenia grade ≥2 (ANC ≤1500/μl) in cycle 1

    Measured: Up to 4 years

  7. Efficacy (OS) subgroup

    Efficacy (OS) in patients who develop neutropenia grade ≥2 (ANC ≤1500/μl) in cycle 1

    Measured: Up to 4 years

  8. Quality of life I (QoL)

    Quality of life (QoL) as measured by EORTC-QLQ-C30 at d1 of each cycle and on EOT (end of treatment).

    Measured: Up to 1 year

  9. Quality of life II (QoL)

    Quality of life (QoL) as measured by EQ-5D-5L at d1 of each cycle and on EOT.

    Measured: Up to 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 May 2018
  2. Study start24 Jan 2019
  3. Primary completion30 Jul 2024
  4. Study completion30 Jul 2024

Resources

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
None (open label)
Enrolment
430 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03520946
Sponsor's protocol ID
RAMTAS
Other IDs
2017-004162-99, 2017
Acronym
RAMTAS
Status last verified
Aug 2024
First submitted
17 Apr 2018
Last updated
9 Aug 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No IPD will be shared

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Ramucirumab and TAS 102 in people with Colorectal Cancer, run by Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest at 28 sites in Germany.

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 16 inclusion and 30 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 9 Aug 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 28 sites in Germany. 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.

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?

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?

Overall survival (time frame: Up to 4 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 9 Aug 2024.

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