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Metastatic Colorectal CancerPhase 2AIO-KRK-0116NCT04034459

FOLFOXIRI Plus Cetuximab vs. FOLFOXIRI Plus Bevacizumab 1st-line in BRAF-mutated mCRC

A Phase 2 study testing Bevacizumab, Irinotecan and Folinic acid in people with Metastatic Colorectal Cancer, run by Ludwig-Maximilians - University of Munich at 1 site in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Once randomisation has been completed, the study treatment should be started preferably immediately; at the latest within one week following randomisation. The patients will be randomised in a ratio of 1:2 to the following two treatment arms. 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?
Bevacizumab, Irinotecan and Folinic acid
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
109 participants
Where
1 siteGermany
Study dates
25 Nov 2016to 31 Dec 2023
Phase
Phase 2
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

  • Histologically confirmed UICC stage IV adenocarcinoma of the colon or rectum with metastases (metastatic colorectal cancer [mCRC]); metastases primarily non-resectable or surgery refused by the patient
  • RAS wild-type tumour status (KRAS and NRAS exons 2, 3, 4) (proven in the primary tumour or metastasis)
  • BRAF-mutant (V600E) tumour (proven in the primary tumour or metastasis)
  • Age ≥18 years
  • ECOG performance status 0-1
  • Patients suitable for chemotherapy administration
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  • Patient's written declaration of consent obtained
  • Estimated life expectancy > 3 months
  • Presence of at least one measurable lesion according to the RECIST 1.1 - criteria (chest X-ray in two planes or chest CT and abdominal CT 4 weeks or less before randomisation)
  • Primary tumour tissue available and patient consents to storage and molecular and genetic profiling of the tumour material. Molecular profiling of blood samples is optionally performed.
  • Females of childbearing potential (FCBP) and men must agree to use effective contraceptive measures (Pearl index <1) for the duration of the study treatment and for at least 6 months after last administration of the study medication. A female subject will be considered to be of child-bearing potential unless she is ≥ 50 years of age as well as has had a natural menopause for at least 2 years or has been surgically sterilised.
  • Adequate bone marrow function:
  • Leukocytes ≥ 3.0 x 109/L with neutrophils ≥ 1.5 x 109/L
  • Thrombocytes ≥ 100 x 109/L,
  • Haemoglobin ≥ 5.6 mmol/L (equivalent to 9 g/dL)
  • Adequate hepatic function:
  • Serum bilirubin ≤ 1.5 x upper limit of normal (ULN),
  • ALAT and ASAT ≤ 2.5 x ULN (in case of hepatic metastasis, ALAT and ASAT ≤ 5 x ULN)
  • INR < 1.5 and aPTT < 1.5 x ULN (patients without anticoagulation). Therapeutic anticoagulation is allowed if INR and aPTT have remained stable within the therapeutic range for at least 2 weeks.
  • Adequate renal function:
  • Serum creatinine ≤ 1.5 x ULN or creatinine clearance (calculated according to Cockcroft and Gault) ≥ 50mL/min.
  • Adequate cardiac function: ECG and echocardiogram with a LVEF of ≥ 55%
  • No previous chemotherapy for metastatic disease (prior radiotherapy of metastasis/metastases without application of chemotherapy permitted provided that no irradiated metastasis is selected as target lesion)
  • Time interval since last administration of any previous neoadjuvant/adjuvant chemotherapy or radiochemotherapy ≥6 months
  • Any relevant toxicities of previous treatments must have subsided to grade 0

Who cannot join

  • Grade III or IV heart failure (NYHA classification)
  • Myocardial infarction, unstable angina pectoris, balloon angioplasty (PTCA) with or without stenting within the past 12 months before randomisation
  • Pregnancy (absence of pregnancy has to be ascertained by a beta hCG test) or breast feeding
  • Medical or psychological impairments associated with restricted ability to give consent or not allowing conduct of the study
  • Additional cancer treatment (chemotherapy, radiation, immune therapy or hormone treatment) during the study treatment. Treatments that are conducted as part of an anthroposophical or homeopathic treatment approach, e.g. mistletoe therapy, do not represent an exclusion criterion.
  • Previous chemotherapy for the colorectal cancer with exception of chemotherapy or radiochemotherapy given as neoadjuvant or adjuvant treatment with curative intent, completed ≥6 months before entering the study.
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  • Participation in a clinical study or experimental drug treatment within 30 days prior to study inclusion or within a period of 5 half-lives of the substances administered in a clinical study or during an experimental drug treatment prior to inclusion in the study, depending on which period is longest, or simultaneous participation in another clinical study while taking part in the study
  • Known hypersensitivity or allergic reaction to any of the following substances: 5-fluorouracil, folinic acid, cetuximab, irinotecan, bevacizumab, oxaliplatin and chemically related substances and/or hypersensitivity to any of the excipients of any of the aforementioned substances
  • Known hypersensitivity to CHO (Chinese hamster ovary cells) - cell products or other recombinant human or humanised antibodies
  • Patients with confirmed cerebral metastases. In case of clinical suspicion of brain metastases, a cranial CT or MRI must be performed to rule out brain metastases before study inclusion.
  • History of acute or subacute intestinal occlusion or chronic inflammatory bowel disease or chronic diarrhoea.
  • Symptomatic peritoneal carcinosis
  • Severe, non-healing wounds, ulcers or bone fractures
  • Patients with active infection (including confirmed HIV and/or HBV/HCV infection). In case of clinical suspicion of the presence of HIV or HBV/HCV infection, the latter should be ruled out before study inclusion.
  • Requirement for immunisation with live vaccine during the study treatment.
  • Uncontrolled hypertension
  • Marked proteinuria (nephrotic syndrome)
  • Arterial thromboembolism or severe haemorrhage within 6 months prior to randomisation (with the exception of tumour bleeding before tumour resection surgery)
  • Haemorrhagic diathesis or tendency towards thrombosis
  • Known DPD deficiency (specific screening not required)
  • Known glucuronidation deficiency (Gilbert's syndrome) (specific screening not required)
  • History of a second malignancy during the 5 years before inclusion in the study or during participation in the study, with the exception of a basal cell or squamous cell carcinoma of the skin or cervical carcinoma in situ, if these were treated curatively.
  • Known history of alcohol or drug abuse
  • A significant concomitant disease, in particular chronic hepatic or renal disease, chronic inflammatory or autoimmune diseases, ruling out the patient's participation in the study according to investigator's judgement.
  • Absent or restricted legal capacity

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Klinikum der Universitaet Muenchen

    Munich, 81377 München

Other trials in Germany

About this study

Official title: Randomised Study to Investigate FOLFOXIRI Plus Cetuximab vs. FOLFOXIRI Plus Bevacizumab as First-line Treatment of BRAF-mutated Metastatic Colorectal Cancer

Once randomisation has been completed, the study treatment should be started preferably immediately; at the latest within one week following randomisation.

The patients will be randomised in a ratio of 1:2 to the following two treatment arms.

Read more

Patients in both treatment arms will receive standard chemotherapy with FOLFOXIRI as background treatment, which can be de-escalated to FOLFIRI in case of toxicity.

Standard arm A:

The patient will be treated with FOLFOXIRI plus bevacizumab for up to 12 cycles (24 weeks) or until progression (if the latter occurs before completing the 12 cycles). Within the 12 cycles, the FOLFOXIRI plus bevacizumab regimen may be de-escalated, owing to toxicity, to FOLFIRI and bevacizumab at the treating physician's discretion.

After 12 cycles of the study treatment, a switch to a maintenance regimen with a fluoropyrimidine (5-FU infusion or capecitabine) plus bevacizumab, administered until progression occurs, is recommended. The recommended maintenance phase of the study is not part of the study treatment. However, maintenance therapy will be counted as first-line therapy.

Experimental arm B:

The patient will be treated with FOLFOXIRI plus weekly administration of cetuximab for up to 12 cycles (24 weeks) or until progression (if the latter occurs before completing the 12 cycles). Within the 12 cycles, the FOLFOXIRI plus cetuximab regimen may be de-escalated owing to toxicity, to FOLFIRI and cetuximab at the treating physician's discretion.

After 12 cycles, a switch to a maintenance regimen with 5-FU and cetuximab or with irinotecan and cetuximab, administered until progression occurs, is recommended. The recommended maintenance phase of the study is not part of the study treatment. However, maintenance therapy will be counted as first-line therapy.

Being tested
Bevacizumab, Irinotecan, Folinic acid, Oxaliplatin, 5-FU
Keywords
FIRE, mCRC, AIO, BRAF, FOLFOXIRI, Cetuximab, Bevacizumab
Medical subject headings
Colorectal Neoplasms

What participants receive

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

  • BevacizumabDrug

    Bevacizumab 5 mg/kg BW iv over 30 to 90* min day 1

  • IrinotecanDrug

    Irinotecan 150 mg/m² iv, 30 - 90 min. day 1

  • Folinic acidDrug

    Folinic acid (racemic) 400 mg/m² iv, 120 min. day 1

  • OxaliplatinDrug

    Oxaliplatin 85mg/m² day 1

  • 5-FUDrug

    5-FU 3000 mg/m² iv over 48 h days 1-2

  • CetuximabDrug

    Cetuximab initially 400 mg/m² with infusion rate of ≤5 mg/min., subsequently 250 mg/m² iv with infusion rate of ≤10 mg/min. days 1+8

Study groups in NCT04034459
Study groupRoleWhat they receive
FOLFOXIRI plus bevacizumabActive comparatorOne cycle (cycle duration 14 days) consists of: * Irinotecan 150 mg/m² iv, 30 - 90 min. day 1 * Folinic acid (racemic) 400 mg/m² iv, 120 min. day 1 * Oxaliplatin 85mg/m² day 1 * 5-FU 3000 mg/m² iv over 48 h days 1-2 * Bevacizumab 5 mg/kg BW iv over 30 to 90* min day 1 *1st administration 90 min.; in case of good tolerability, second administration 60 min.; further administrations 30 min. Repeat administration every 2 weeks for a maximum of 12 cycles * Dose adaptation at the treating physician's discretion. * Switch to the recommended maintenance treatment with fluoropyrimidine and bevacizumab after the 8th cycle (following 2nd staging after baseline) is possible at the treating physician's discretion if response according to RECIST 1.1 (CR or PR) has been achieved.
Receives: Drug: Bevacizumab; Drug: Irinotecan; Drug: Folinic acid; Drug: Oxaliplatin; Drug: 5-FU
FOLFOXIRI plus cetuximabExperimentalOne cycle (cycle duration 14 days) consists of: * Irinotecan 150 mg/m² iv, 30 - 90 min. day 1 * Folinic acid (racemic) 400 mg/m² iv, 120 min. day 1 * Oxaliplatin 85mg/m² day 1 * 5-FU 3000 mg/m² iv over 48 h days 1-2 * Cetuximab initially 400 mg/m² with infusion rate of ≤5 mg/min., subsequently 250 mg/m² iv with infusion rate of ≤10 mg/min. days 1+8 Repeat administration every two weeks up to a maximum of 12 cycles. * Dose adaptation at the treating physician's discretion. * Switch to the recommended maintenance treatment with 5-FU and cetuximab or irinotecan and cetuximab after the 8th cycle (following 2nd staging after baseline) is possible at the treating physician's discretion if response according to RECIST 1.1 (CR or PR) has been achieved.
Receives: Drug: Irinotecan; Drug: Folinic acid; Drug: Oxaliplatin; Drug: 5-FU; Drug: Cetuximab

What is being measured

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

  1. Overall Response Rate (ORR)

    (overall response rate) measured in percentage of all treated patients according to RECIST 1.1 criteria

    Measured: up to 48 months

Secondary outcomes (7)
  1. Progression Free Survival (PFS)

    Investigation of progression-free survival (PFS) from randomisation

    Measured: up to 60 months

  2. Overall Survival (OS)

    Investigation of overall survival (OS) from randomisation

    Measured: up to 60 months

  3. Investigation of Early Tumour Shrinkage (ETS) as early-on-Treatment predictor for treatment

    Investigation of early tumour shrinkage (ETS)

    Measured: up to 48 months

  4. Investigation of Depth of Response (DpR) to define nadir for tumour response.

    Investigation of depth of response (DpR)

    Measured: up to 48 months

  5. Investigation of Molecular Biomarkers for Prediction of an Anti-EGFR Treatment

    Investigation of molecular biomarkers for prediction of sensitivity and secondary resistance of an anti-EGFR treatment with cetuximab (including tumour biopsies and liquid biopsies from blood samples)

    Measured: up to 48 months

  6. Prospective Analysis of Tumour Marker Level Evolution (CEA and CA 19-9)

    Investigation of prospective analysis of tumour marker level evolution (CEA and CA 19-9)

    Measured: up to 48 months

  7. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]

    Recording of the safety and tolerability (NCI-CTCAE version 4.03 criteria) of the treatment

    Measured: up to 48 months

Timeline

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

  1. First posted26 Jul 2019
  2. Study start25 Nov 2016
  3. Primary completion1 Nov 2023
  4. Study completion31 Dec 2023 (estimated)

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
109 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04034459
Sponsor's protocol ID
FIRE-4.5
Acronym
AIO-KRK-0116
Status last verified
Nov 2023
First submitted
22 Dec 2017
Last updated
14 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Bevacizumab, Irinotecan and Folinic acid in people with Metastatic Colorectal Cancer, run by Ludwig-Maximilians - University of Munich at 1 site 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 25 inclusion and 25 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: status not confirmed, as of the sponsor's last update on 14 Nov 2023. 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 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

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 Response Rate (ORR) (time frame: up to 48 months). 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 14 Nov 2023.

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