Vectibix for the Treatment of Anal Cancer (VITAL)
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|ClinicalTrials.gov Identifier: NCT01285778|
Recruitment Status : Completed
First Posted : January 28, 2011
Last Update Posted : May 16, 2018
Chemoradiation with 5-FU and Mitomycin C is the standard treatment in anal canal SCC. Panitumumab has shown efficacy in other tumors and anti-EGFR treatment has shown clinical activity in a single report of a refractory anal canal SCC patient. Based on this background, we propose to conduct a phase II study to investigate the efficacy and toxicity of radiotherapy with the association:
- 5-FU 1000mg/m2 on days 1-4 and 29-32
- Mitomycin C 10mg/m2 on days 1 and 29
- Panitumumab 6 mg/kg on day 1, then every 2 weeks for 8 weeks
|Condition or disease||Intervention/treatment||Phase|
|Anal Squamous Cell Carcinoma||Drug: panitumumab, mytomicin C, 5-FU, radiation||Phase 2|
In the 1980s, the treatment of choice for anal cancer was abdominal-perineal amputation, which included the removal of the anus, rectum and lymphatic drainage areas and a permanent colostomy. With this treatment, 5-year survival rates were 40-70%. In the following years, however, it was shown that anal cancer was a tumor that was sensitive to chemotherapy and radiation, so surgery was not the first choice and was only reserved for resistant cases or relapses. Concomitant chemo and radiotherapy based on the Mitomycin C - 5-FU regimen is currently the standard treatment for localized (except T1N0) and locally advanced cases. This statement is supported by two randomized studies that showed that the administration of chemoradiation with Mitomycin C - 5FU was better than radiation in monotherapy. The trial conducted by the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) randomized 585 patients to receive radiotherapy (45 Gy in 4-5 weeks) or the same radiotherapy regimen coupled with 5-FU (1000 mg/m2 x 4 days or 750 mg/m2 x 5 days), for the first and last week of radiotherapy and Mitomycin C 12 mg/m2 on day 1. The 3-year local failure rate was 39% in the combined arm versus 61% with radiotherapy alone. There were no differences in the 3-year overall survival rate. On the other hand, in the study conducted by EORTC, 110 patients were distributed to receive radiotherapy (45 Gy in 5 weeks, with an overimpression of 15 Gy in the patients with CR and 20 Gy if PR) or radiotherapy plus 5-FU (750 mg/m2 days 1-5 and 29-33) associated to Mitomycin C (15 mg/m2 on day 1). The CR rate was significantly greater in the group treated with chemoradiation (80% vs. 54%). After 5 years of follow-up, there was still an 18% increase in the local control rate in favor of the group treated with chemoradiation.
More recently, the results of a phase II CALGB trial, suggests that the administration of induction treatment with two cycles of cisplatin-5FU (cisplatin 100 mg/m2 on days 1 and 29 and 5FU 1000 mg/m2 days 1-4 and 29-32) followed by chemoradiotherapy with 5-FU and Mitomycin C was very promising, especially in patients with a poor prognosis, with 50% of patients remaining colostomy and disease-free at 48 months. However, in a randomized study by the RTOG group, which included 682 patients, this strategy was compared with the classic concomitant chemoradiation with 5-FU (1000 mg/m2 days 1-4 and 29-32) and Mitomycin C (10 mg/m2 days 1 and 29). No differences in survival were found, but it was also detected that the colostomy rate was greater in the patients treated with the regimen containing Cisplatin (HR, 1.68; 95% CI, 1.07-2.65; P=.02). The authors concluded that induction with cisplatin was not superior to the traditional administration of 5FU-Mitomycin C with RT.
Epidermoid anal cancer is a tumor that often expresses the EGFR receptor. In an initial study with 21 cases, it was reported that there was EGFR expression in all the biopsies. In another study with 38 cases, it was found that 55% of the tumors expressed EGFR. No study has been published, however, which has investigated the efficacy of Panitumumab in this tumor. There is only one report of a refractory case in which cetuximab was administered together with CPT-11 with an excellent response.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||58 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Phase 2 Trial to Assess the Efficacy and Safety of Chemoradiation With 5-fluorouracil, Mytomicin C and Panitumumab as a Treatment for Anal Squamous Cell Carcinoma|
|Actual Study Start Date :||October 2010|
|Actual Primary Completion Date :||March 24, 2017|
|Actual Study Completion Date :||March 24, 2017|
|Experimental: Panitumumab, mytomicin C, 5-FU, radiation||
Drug: panitumumab, mytomicin C, 5-FU, radiation
Radiation therapy will be administered concurrent with chemotherapy and Panitumumab treatment. It will start the day 1 of the systemic treatment. That is, the first day of radiation therapy will be the day of the administration of the first dose of Panitumumab and Mitomycin C, as well as the first day of the first 96-hours course of 5-FU continuous infusion. On day 1, drugs and radiation will be administered in the following order:
Other Name: Vectibix
- Three-year disease-free survival rate [ Time Frame: 3 years ]To estimate the three-year disease-free survival rate in patients treated with 5-FU, mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma
- Disease free survival rate [ Time Frame: 3 years ]To assess disease free survival in patients treated with 5-FU, Mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma.
- Three-year free local-regional failure rate [ Time Frame: 3 years ]To assess three-year free local-regional failure rate in patients treated with 5-FU, Mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma.
- Overall survival [ Time Frame: 3 years ]To assess overall survival in patients treated with 5-FU, Mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma.
- Colostomy-free survival rate [ Time Frame: 2 years ]To assess two-year colostomy-free survival rate in patients treated with 5-FU, Mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma.
- Complete response rate [ Time Frame: 3 years ]To assess complete response rate in patients treated with 5-FU, Mytomicin C and Panitumumab concurrently with radiation therapy as treatment for anal squamous cell carcinoma.
- Safety profile [ Time Frame: 3 years ]
- Incidence of adverse events (including all serious, grade 3, grade 4, and treatment related events)
- Changes in laboratory values.
- Predictive potential of different biomarkers [ Time Frame: 3 years ]
To investigate the predictive potential of different biomarkers involved in different pathways on efficacy and/or safety endpoints:
- EGFR pathway
- DNA reparation mechanisms and apoptosis control
- Oxidative stress control mechanism
- Resistance mechanisms to alkylants (mitomycin C) and antimetabolits (5-FU)
- To describe the presence of HPV infection, isotype study and impact of the status on efficacy and/or safety.
- To evaluate the role of magnetic resonance imaging (MRI) in the determination of therapeutic efficacy and follow-up of these patients.
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 ClinicalTrials.gov identifier (NCT number): NCT01285778
|Study Director:||Jaime Feliu, MD||Hospital Universitario La Paz|
|Principal Investigator:||Vicente Alonso, MD||Hospital Miguel Servet|
|Principal Investigator:||Jaume Capdevila, MD||Hospital Universitario Vall Hebron|
|Principal Investigator:||Ruth Vera, MD||Hospital de Navarra|
|Principal Investigator:||Miriam Lopez, MD||Hospital Infanta Sofia|
|Principal Investigator:||Carmen Castañon, MD||Hospital Virgen Blanca (León)|
|Principal Investigator:||Carlos Fernández-Martos, MD||Instituto Valenciano de Oncología|
|Principal Investigator:||Clara Montagut, MD||Hospital del Mar|
|Principal Investigator:||Carlos García Girón, MD||Hospital General Yagüe (Burgos)|
|Principal Investigator:||Ana León, MD||Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz|
|Principal Investigator:||Marta Martín, MD||Hospital de la Santa Creu i Sant Pau de Barcelona|
|Principal Investigator:||Juan Carlos Méndez, MD||Centro Oncológico de Galicia|
|Principal Investigator:||Rocío García Carbonero, MD||Hospital Universitario Virgen del Rocío (Sevilla)|
|Principal Investigator:||Jordi Remon, MD||Hospital de Mataró|
|Principal Investigator:||Fernando Rivera, MD||Hospital Universitario Marqués de Valdecilla (Santander)|
|Principal Investigator:||Laura Cerezo, MD||Hospital Universitario La Princesa (Madrid)|
|Principal Investigator:||Pilar García-Alfonso, MD||Hospital Universitario Gregorio Marañón (Madrid)|
|Principal Investigator:||Emilio Fonseca, MD||University of Salamanca|
|Principal Investigator:||Aleydis Pisa, MD||Corporació Sanitaria Parc Taulí (Sabadell, Barcelona)|
|Principal Investigator:||Mónica Caro, MD||Institut Català d´Oncologia. Hospital Germans Trias i Pujol (Badalona)|
|Principal Investigator:||José María Vicent, MD||Hospital de Manises, Valencia|
|Principal Investigator:||Isabel Sevilla, MD||Hospital Universitario Virgen de la Victoria (Málaga)|
|Principal Investigator:||Joan Maurel, MD||Hospital Clinic of Barcelona|
|Principal Investigator:||I Guasch, MD||Hospital Sant Joan de Deu|
|Principal Investigator:||Jesus Garcia-Foncillas, MD||Clinica Universidad de Navarra|
|Principal Investigator:||Antonio Arrivi, MD||Hospital Son Llatzer|