Bevacizumab With Capecitabine and Oxaliplatin in Advanced Adenocarcinoma of the Small Bowel or Ampulla of Vater

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01208103
Recruitment Status : Completed
First Posted : September 23, 2010
Last Update Posted : March 15, 2018
Genentech, Inc.
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
The goal of this clinical research study is to learn if the combination of capecitabine, oxaliplatin, and bevacizumab can help to control cancer of the small bowel or ampulla of Vater. The safety of this drug combination will also be studied.

Condition or disease Intervention/treatment Phase
Gastrointestinal Cancers Drug: Capecitabine Drug: Oxaliplatin Drug: Bevacizumab Phase 2

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Study of Bevacizumab Combined With Capecitabine and Oxaliplatin (CAPOX) in Patients With Advanced Adenocarcinoma of the Small Bowel or Ampulla of Vater
Actual Study Start Date : May 6, 2011
Actual Primary Completion Date : March 7, 2018
Actual Study Completion Date : March 7, 2018

Arm Intervention/treatment
Experimental: Bevacizumab, Capecitabine, Oxaliplatin
Bevacizumab 7.5 mg/kg by vein on day 1 over 90 minutes of 21 day cycle. Capecitabine 750 mg/m2 by mouth twice a day beginning on day 1-14 of 21 day cycle. Oxaliplatin 130 mg/m2 by vein on day 1 over 2 hours of 21 day cycle.
Drug: Capecitabine
750 mg/m2 by mouth twice a day beginning on day 1-14 of 21 day cycle.
Other Name: Xeloda
Drug: Oxaliplatin
130 mg/m2 by vein on day 1 over 2 hours of 21 day cycle.
Other Name: Eloxatin
Drug: Bevacizumab
7.5 mg/kg by vein on day 1 over 90 minutes of 21 day cycle.
Other Names:
  • Avastin
  • Anti-VEGF monoclonal antibody
  • rhuMab-VEGF

Primary Outcome Measures :
  1. Number of Patients with Progression-Free Survival (PFS) [ Time Frame: 6 months ]
    PFS defined as from date of treatment start to date of first documentation of progression or symptomatic deterioration or death due to any cause.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients must have histologically confirmed adenocarcinoma of the small bowel or ampulla of Vater.
  2. Prior adjuvant chemotherapy (including 5-FU, capecitabine, and oxaliplatin) for the treatment of adenocarcinoma of the small bowel or ampulla of Vater is allowed if completed >/= 52 weeks prior to first dose of study treatment.
  3. Prior capecitabine or 5-FU administered as a radiosensitizing agent concurrently with external beam radiotherapy is allowed.
  4. Patients must have metastatic disease
  5. A minimum of 4 weeks must have elapsed from completion of any prior chemotherapy or radiotherapy or surgery and the start date of study therapy.
  6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2.
  7. Adequate organ function including: Absolute neutrophil count (ANC) >/= 1,500/ul; platelets >/= 100,000/ul; total bilirubin </= 1.5 x upper limit of normal (ULN)*; AST (SGOT) and ALT (SGPT) < 3 x ULN; calculated creatinine clearance (CrCl) > 50 cc/min (calculated using the Cockcroft and Gault formula). *In patients with known Gilbert's syndrome direct bilirubin </= 1.5 x ULN will be used as organ function criteria, instead of total bilirubin.
  8. Negative serum or urine pregnancy test in women with childbearing potential (defined as not post-menopausal for 12 months or no previous surgical sterilization), within one week prior to initiation of treatment.
  9. Patients must sign an Informed Consent and Authorization indicating that they are aware of the investigational nature of this study and the known risks involved.
  10. The effects of the combination of CAPOX and bevacizumab on the developing fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control) prior to study entry, for the duration of study participation, and for six months following the completion of therapy. Should a woman become pregnant while participating in this study, she should inform her treating physician immediately.
  11. (continued from # 8). Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with oxaliplatin or capecitabine or bevacizumab, breast feeding must be discontinued.

Exclusion Criteria:

  1. Patients who have received prior chemotherapy for their metastatic disease are excluded. Chemotherapy if given as a radiation-sensitizer is allowed.
  2. Patients may not be receiving any other investigational agents nor have received any investigational drug 28 days prior to enrollment.
  3. Known history of dihydropyrimidine (DPD) deficiency.
  4. Peripheral neuropathy of grade 3 or greater by Common Terminology Criteria for Adverse Events (CTCAE) 4.0.
  5. Gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation.
  6. Because of the interaction between coumadin and capecitabine, patients taking therapeutic doses of coumarin-derivative anticoagulants are not eligible. Low-dose Coumadin (e.g. 1 mg PO per day) in patients with in-dwelling venous access devices is allowed but increased frequency of INR monitoring is recommended.
  7. Prior treatment with bevacizumab or known hypersensitivity to any component of bevacizumab.
  8. Inadequately controlled hypertension (defined as systolic blood pressure >140 mmHg and/or diastolic blood pressure > 90 mmHg).
  9. Prior history of hypertensive crisis or hypertensive encephalopathy.
  10. Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation).
  11. New York Heart Association (NYHA) Grade II or greater congestive heart failure.
  12. History of myocardial infarction or unstable angina within 6 months prior to Day 1.
  13. History of stroke or transient ischemic attack within 6 months prior to Day 1.
  14. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Day 1.
  15. History of hemoptysis (>/= 1/2 teaspoon of bright red blood per episode) within 1 month prior to Day 1.
  16. History of abdominal fistula or gastrointestinal perforation which must have resolved at least 6 months prior to Day 1.
  17. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 1 or anticipation of need for major surgical procedure during the course of the study.
  18. Core biopsy or other minor surgical procedure excluding placement of a vascular access device, within 7 days prior to Day 1.
  19. Serious, non-healing wound, active ulcer, or untreated bone fracture.
  20. Proteinuria at screening as demonstrated by either (1) urine protein:creatinine (UPC) ratio of >/= 1.0 or (2) urine dipstick for proteinuria >/= 2+ (patients discovered to have >/= 2+ proteinuria on dipstick urinalysis should undergo a 24 hour urine collection and must demonstrate </= 1g of protein in 24 hours to be eligible).
  21. Known CNS disease, except for treated brain metastasis. Treated brain metastases are defined as having no evidence of progression or hemorrhage after treatment and no ongoing requirement for dexamethasone, as ascertained by clinical examination and brain imaging (MRI or CT) during the screening period. Anticonvulsants (stable dose) are allowed. Treatment for brain metastases may include whole brain radiotherapy (WBRT), radiosurgery (RS; Gamma Knife, LINAC, or equivalent) or a combination as deemed appropriate by the treating physician.
  22. (continued from # 21) Patients with CNS metastases treated by neurosurgical resection or brain biopsy performed within 3 months prior to Day 1 will be excluded.
  23. Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study other than this study.
  24. Pregnancy (positive pregnancy test) or lactation.
  25. Active malignancy, other than superficial basal cell and superficial squamous (skin) cell, or carcinoma in situ of the cervix, within last five years.
  26. Inability to comply with study and/or follow-up procedures.
  27. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, or psychiatric illness/social situations that would limit adherence with study requirements.
  28. Age <18 years. Because no dosing or adverse event data are currently available on the use of CAPOX and bevacizumab in patients <18 years of age, children are excluded from this study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01208103

United States, Texas
University of Texas MD Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Genentech, Inc.
Principal Investigator: Michael Overman, MD M.D. Anderson Cancer Center

Additional Information:
Responsible Party: M.D. Anderson Cancer Center Identifier: NCT01208103     History of Changes
Other Study ID Numbers: 2009-0626
NCI-2011-00470 ( Registry Identifier: NCI CTRP )
First Posted: September 23, 2010    Key Record Dates
Last Update Posted: March 15, 2018
Last Verified: March 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by M.D. Anderson Cancer Center:
Small bowel
Ampulla of Vater
CAPOX Chemotherapy
Anti-VEGF monoclonal antibody

Additional relevant MeSH terms:
Gastrointestinal Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Antibodies, Monoclonal
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Antineoplastic Agents
Immunologic Factors
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action