Aflibercept and FOLFOX6 Treatment for Previously Untreated Stage IV Colorectal Cancer
This phase II trial studies how well giving aflibercept together with combination chemotherapy works in treating patients with previously untreated colon or rectal cancer that is metastatic or locally advanced and cannot be removed by surgery. Aflibercept may stop the growth of colon or rectal cancer by blocking blood flow to the tumor. Drugs used in chemotherapy, such as leucovorin calcium, fluorouracil, and oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving aflibercept together with combination chemotherapy may kill more tumor cells
Mucinous Adenocarcinoma of the Colon
Mucinous Adenocarcinoma of the Rectum
Signet Ring Adenocarcinoma of the Colon
Signet Ring Adenocarcinoma of the Rectum
Stage IV Colon Cancer
Stage IV Rectal Cancer
Other: Correlative Studies
Procedure: DCE MRI
Procedure: PET (positron emission tomography)
|Study Design:||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase II Study of the Combination of Aflibercept (VEGF-Trap) Plus Modified FOLFOX 6 in Patients With Previously Untreated Metastatic Colorectal Cancer|
- Proportion of patients alive and progression-free [ Time Frame: At 15 months from initiation of therapy ] [ Designated as safety issue: No ]Assuming that the number of treatment successes (alive and progression-free) is binomially distributed, proportion estimates along with their corresponding exact 95% confidence intervals will be calculated.
- Objective response rate (ORR) defined as the proportion of patients who achieve a PR or CR based on RECIST 1.1 criteria divided by the total number of evaluable patients [ Time Frame: Up to 4 weeks post-treatment ] [ Designated as safety issue: No ]Summarized as a proportion with corresponding 95% confidence interval.
- Percentage of patients able to undergo surgery [ Time Frame: Up to 4 weeks post-treatment ] [ Designated as safety issue: No ]Summarized as a proportion with corresponding 95% confidence interval.
- Progression free survival (PFS) [ Time Frame: From study entry to the time of progressive disease and/or death, assessed up to 4 weeks post-treatment ] [ Designated as safety issue: No ]Will be evaluated using the methods of Kaplan and Meier.
- Overall survival [ Time Frame: From study entry to time of death due to any cause, assessed up to 4 weeks post-treatment ] [ Designated as safety issue: No ]Will be evaluated using the methods of Kaplan and Meier.
- Incidence of severe (grade 3+) adverse events or toxicities, assessed using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.0 [ Time Frame: Up to 4 weeks post-treatment ] [ Designated as safety issue: Yes ]
- Tolerability in terms of number of patients who require dose modifications and/or dose delays [ Time Frame: Up to 4 weeks post-treatment ] [ Designated as safety issue: Yes ]
- Proportion of patients who go off treatment due to adverse reactions or even those who refuse further treatment for lesser toxicities that inhibit their willingness to continue participation on the trial [ Time Frame: Up to 4 weeks post-treatment ] [ Designated as safety issue: Yes ]
|Study Start Date:||November 2012|
|Estimated Primary Completion Date:||September 2016 (Final data collection date for primary outcome measure)|
Experimental: Aflibercept (combination chemotherapy)
Patients receive aflibercept and fluorouracil and then continuously over 46 hours on days 1 and 15.If leucovorin is not available due to drug shortages the regimen should be administered with the leucovorin omitted. Correlative Studies are required to be available before enrolling on the study. A fresh biopsy is only required if there is insufficient material for analysis. Repeat tumor biopsies after 8 weeks of therapy are optional and will only be performed at the Ohio State University Medical Center.DCE MRI (dynamic contrast-enhanced magnetic resonance imaging)images at weeks 0, and after 8 weeks +/- 1 week of treatment(after Cycle 2). 18FDG-PET is a functional imaging technique that relies on tumor uptake of radiolabeled tracer 18 fluorodeoxyglucose (18FDG).FDG-PET is a widely-used imaging modality in the detection and monitoring of a variety of metastatic cancers,including colorectal cancer (99-102).
4 mg/kg as a 1-hour IV(intervenous) infusion
Other Names:Drug: oxaliplatin
85 mg/m2 IV infused over 2 hours
Other Names:Drug: leucovorin
200 mg/m2 (Or levoleucovorin 100 mg/m2. If leucovorin is not available due to drug shortages the regimen should be administered with the leucovorin omitted) IV over 2 hours. Alternatively, leucovorin may be administered (via separate infusion lines) concurrently with oxaliplatin
Other Names:Drug: fluorouracil
400 mg/m2 IV bolus over 5-15 minutes, then 2400 mg/m2 continuous IV infusion over 46 hours.
Other Names:Other: Correlative Studies
Patients are required to have tissue available before enrolling on the study. A fresh biopsy is only required if there is insufficient material for analysis. Repeat tumor biopsies after 8 weeks of therapy are optional and will only be performed at the Ohio State University Medical Center.
Other Name: laboratory biomarker analysisProcedure: DCE MRI
Images at weeks 0, and after 8 weeks +/- 1 week of treatment (after Cycle 2).
Other Name: Dynamic contrast-enhanced magnetic resonance imagingRadiation: f18FDG-PET
18FDG-PET is a functional imaging technique that relies on tumor uptake of radiolabeled tracer 18 fluorodeoxyglucose (18FDG). FDG-PET is a widely-used imaging modality in the detection and monitoring of a variety of metastatic cancers, including colorectal cancer (99-102).
Other Names:Procedure: PET (positron emission tomography)
I. To evaluate the progression free survival (PFS) of patients with untreated metastatic colorectal cancer (mCRC) receiving the combination of modified leucovorin calcium, fluorouracil, oxaliplatin (FOLFOX6) (mFOLFOX6) and aflibercept.
I. To evaluate the objective response rate (complete response [CR] + partial response [PR]) and the disease control rate (CR + PR + stable disease [SD]), as determined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, of patients with untreated mCRC receiving the combination of mFOLFOX6 and aflibercept.
II. To evaluate overall survival of patients with untreated mCRC receiving the combination of mFOLFOX6 and aflibercept.
III. To further characterize the safety and toxicity of the combination of mFOLFOX6 and aflibercept, including 60 day all-cause mortality.
IV. To describe patients with mCRC whose disease is rendered resectable as a consequence of therapy with the combination of mFOLFOX 6 and aflibercept.
I. To assess the use of dynamic imaging modalities including dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) to evaluate changes in vascular permeability and FDG avidity and correlate with clinical efficacy (PFS, overall survival [OS], and response by RECIST 1.1).
II. To evaluate circulating levels of vascular endothelial growth factor A (VEGFA), phosphatidylinositol glycan anchor biosynthesis, class F (PlGF), soluble vascular endothelial growth factor receptor 2 (VEGF-R2), chemokine (C-X-C motif) ligand 12 (CXCL12) and chemokine (C-X-C motif) receptor 4 (CXCR4) as potential biomarkers for efficacy of aflibercept.
III. To evaluate for the presence of VEGF single nucleotide polymorphisms (SNPs) and whether any SNP(s), when detected, may be predictive of efficacy and/or toxicity of aflibercept.
IV. To assess microvessel density/tumor blood flow, capillary permeability and vessel normalization by tumor biopsy pre and post treatment with aflibercept.
V. To evaluate the presence of hypertension as a predictive biomarker for clinical efficacy of aflibercept.
Patients receive aflibercept intravenously (IV) over 1 hour followed by oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV over 5-15 minutes and then continuously over 46 hours on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 4 weeks.
|Contact: Ohio State University Comprehensive Cancer Center||1-800-293-5066||Jamesline@osumc.edu|
|Contact: Richard Goldberg, MD||614-366-6355||Richard.Goldberg@osumc.edu|
|United States, Alabama|
|Clearview Cancer Institute||Recruiting|
|Huntsville, Alabama, United States, 35805|
|Contact: Avitra Bone 256-705-4283 firstname.lastname@example.org|
|Principal Investigator: Clint D Kingsley, MD|
|United States, Michigan|
|University of Michigan||Recruiting|
|Ann Arbor, Michigan, United States, 48109|
|Contact: John Krauss, MD 734-615-3969 email@example.com|
|Principal Investigator: John Krauss, MD|
|United States, New York|
|Montefiore Medical Center||Not yet recruiting|
|Bronx, New York, United States, 10461|
|Contact: Sanjay Goel, MD 719-904-2488 SGOEL@montifiore.org|
|Principal Investigator: Sanjay Goel, MD|
|Roswell Park Cancer Institute||Recruiting|
|Buffalo, New York, United States, 14263|
|Contact: Wen W. Ma 716-845-3851 firstname.lastname@example.org|
|Principal Investigator: Wen W. Ma|
|United States, North Carolina|
|University of North Carolina||Recruiting|
|Chapel Hill, North Carolina, United States, 27599|
|Contact: Autumn McRee, MD 919-843-6286 email@example.com|
|Contact: Melissa Haines 919-843-7719 Melissa_haines@med.unc.edu|
|Principal Investigator: Autumn McRee, MD|
|United States, Ohio|
|Ohio State University Medical Center||Recruiting|
|Columbus, Ohio, United States, 43210|
|Contact: Goldberg Richard 614-366-6355 Richard.Goldberg@osumc.edu|
|Principal Investigator: Goldberg Richard, MD|
|United States, Virginia|
|Virginia Commonwealth University||Not yet recruiting|
|Richmond, Virginia, United States, 23298|
|Contact: Khalid Martin, MD 804-628-2945 firstname.lastname@example.org|
|Principal Investigator: Khalid Martin, MD|
|Principal Investigator:||Goldberg Richard, MD||Ohio State University Comprehensive Cancer Center|