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Correlation Between RECIST, Morphologic Response by CT- Histopathologic Response in Hepatic Metastasis Secondary to Colorectal Cancer (AVAMET)

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: NCT01493713
Recruitment Status : Completed
First Posted : December 16, 2011
Last Update Posted : February 16, 2018
Information provided by (Responsible Party):
Grupo Espanol Multidisciplinario del Cancer Digestivo

Brief Summary:
The purpose of this study is to to evaluate the correlation of overall objective response according to RECIST v1.1. criteria evaluated by conventional imaging techniques, morphologic response by CT, and histopathologic response in patients with resectable hepatic metastasis secondary to colorectal cancer treated with bevacizumab in combination with XELOX.

Condition or disease Intervention/treatment Phase
Colorectal Cancer Hepatic Metastasis Other: Evaluate the correlation of overall different objective response. Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 83 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Phase 4 Study to Evaluate Correlation of Overall Response According to RECIST-conventional Imaging Techniques, Morphologic Response by CT, & Histopathologic Response in Patients With Hepatic Metastasis Secondary to Colorectal Cancer With Bevacizumab in Combination With XELOX
Actual Study Start Date : November 16, 2011
Actual Primary Completion Date : December 8, 2014
Actual Study Completion Date : December 18, 2017

Resource links provided by the National Library of Medicine

Drug Information available for: Bevacizumab

Arm Intervention/treatment
Experimental: Bevacizumab, XELOX
Bevacizumab in combination with XELOX
Other: Evaluate the correlation of overall different objective response.
Evaluate the correlation of overall different objectives response. Chemotherapeutic agents: XELOX scheme (Xeloda; Oxaliplatin) Device: MDCT (MultiDetector Computed Tomography)

Primary Outcome Measures :
  1. Correlation of overall objective responses evaluated by conventional imaging techniques with the morphologic response evaluated by MDCT and the histopathologic response after the resection of hepatic metastases. [ Time Frame: 2016 ]

Secondary Outcome Measures :
  1. R0/R1/R2 resectability rate. [ Time Frame: 2016 ]
  2. Progression-free survival (PFS), only in patients who do not undergo metastasis resection. [ Time Frame: 2016 ]
  3. Recurrence-free survival (RFS) in patients who undergo metastasis resection. [ Time Frame: 2016 ]
  4. Safety and toxicity (surgical and therapeutic) of the therapy graded according to CTC v.4.0 [ Time Frame: 2016 ]
  5. Overall survival (OS) at 2 and 3 years. [ Time Frame: 2016 ]
  6. Examine the influence of a potential predictive and prognostic tumour biomarker -mutations in K-RAS- after start of therapy on overall objective response [ Time Frame: 2016 ]
  7. Examine the influence of a potential predictive and prognostic tumour biomarker -mutations in K-RAS- after start of therapy on surgical resection rate [ Time Frame: 2016 ]
  8. Examine the influence of a potential predictive and prognostic tumour biomarker -mutations in K-RAS- after start of therapy on survival [ Time Frame: 2016 ]
  9. Examine the influence of a potential predictive and prognostic tumour biomarker -mutations in K-RAS- after start of therapy on progression free survival [ Time Frame: 2016 ]

Information from the National Library of Medicine

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

Inclusion Criteria:

  1. Written informed consent.
  2. Age ≥ 18 years.
  3. ECOG 0-1.
  4. Life expectancy of at least 12 weeks.
  5. Histologic confirmation of adenocarcinoma of the colon or rectum, according to the 7th edition of the TNM classification, with evidence of liver metastases according to RECIST v 1.1 criteria (Annex V). Patients with the diagnosis of liver metastasis presenting synchronically or after a disease-free interval. The primary tumor shall have been resected previously although the inverse approach may be acceptable if the tumor is not very symptomatic. Patients in whom combined surgery of the primary tumor and metastases is planned are not eligible.
  6. Availability of a tumor sample for KRAS gene determination.
  7. No prior chemotherapy treatment for metastatic CRC.
  8. Patients with resectable hepatic metastases of colorectal carcinoma who satisfy the following criteria:

    • ≤ 4 metastases
    • Size < 10 cm
    • Technically feasible R0 resection, with a residual liver volume of no less than 30%

    NOTE: Patients with bilateral metastases may be enrolled if they satisfy the above criteria (<4 metastases and size <10 cm).

  9. Adequate bone marrow, liver and kidney function, defined as:

    • Hemoglobin ≥ 9.0 g/dl (a transfusion can be given before treatment).
    • Platelet count ≥ 100 × 109/L.
    • Absolute neutrophil count (ANC) ≥ 1.5 × 109/L.
    • Serum bilirubin ≤ 1.5 times higher than the upper limit of normality (ULN).
    • Alkaline phosphatase, ALT (SGPT) and AST (SGOT) ≤ 5 × ULN.
    • Serum creatinine < 1.5 x ULN or creatinine clearance ≥ 50 ml/min according to Cockcroft and Gault formula (Annex VII).
    • INR < 1.5 within the 7 days prior to the start of study treatment. aPTT < 1.5 × ULN within 7 days prior to the start of study treatment. Exception: Patients treated with complete doses of anticoagulants due to venous thromboembolism usually must have an INR value within the established range (usually 2-3). The patient must be receiving a stable dose of anticoagulant treatment before enrollment in the study.
    • Urine strip for proteinuria < 2+. If the result of the reactive strip in urine is ≥ 2+, the 24-hour urine sample must demonstrate ≤ 1 g protein in 24 hours in order to include the patient.
  10. Women of childbearing potential must have a negative pregnancy test in serum or urine in the 7-day period before entering the study. Postmenopausal women must have been amenorrheic during at least 12 months. Likewise, both the men and the women who participate in this study must use effective contraceptive methods (e.g., abstinence, intrauterine device, oral contraceptives, a double barrier method or surgical sterility), beginning upon signing the informed consent form and for at least 6 months after the end of treatment or the last dose, whichever occurs first.
  11. The subject must have the capacity, in the opinion of the investigator, to comply with all the procedures and examinations of study follow-up.

Exclusion Criteria:

  1. Patients with non-resectable hepatic metastases at the time of enrollment.
  2. Previous systemic or local treatment of metastatic disease.
  3. Presence of metastatic extrahepatic disease.
  4. Neo-adjuvant or adjuvant chemotherapy/radiotherapy in the 6 months prior to entering the study.
  5. Use of any investigational drug in the 4 weeks before starting the study treatment.
  6. Current or recent (in the 10 days prior to the first administration of the study treatment) use of acetylsalicylic acid (> 325 mg/day) or clopidogrel (75 mg/day).
  7. Current presence of peripheral neuropathy = 1 (CTCAE).
  8. Hypertension not properly controlled (defined as systolic pressure > 150 mm Hg and/or diastolic pressure > 100 mm Hg in repeated measurements), despite optimal medical management.
  9. Previous history of hypertensive episodes or hypertensive encephalopathy.
  10. CHF class II or higher of the NYHA classification.
  11. History of myocardial infarction or unstable angina within the 6 months prior to starting the study treatment.
  12. Significant vascular disease (e.g., aortic aneurysm requiring surgery, pulmonary embolism or recent peripheral arterial thrombosis) in the 6 months prior to the start of the study treatment.
  13. History of hemoptysis (equivalent to = ½ teaspoon of red-colored blood per episode) in the month prior to the study treatment.
  14. Major surgery, open surgical biopsy or significant trauma in the 4 weeks prior to the start of study treatment. Thick-needle biopsy of a major organ in the 7 days prior to entering the study. Insertion of a vascular access > 3 days before entering the study is allowed.
  15. Tests or history of significant hemorrhagic diathesis or coagulation disorder (in the absence of anticoagulation).
  16. History of abdominal fistula or gastrointestinal perforation in the 6 months prior to the start of study treatment.
  17. Intra-abdominal acute inflammatory process.
  18. Serious unhealed wounds, active ulcer or untreated bone fracture.
  19. History of another neoplastic disease aside from colorectal cancer in the last 2 years prior to the start of study treatment, with the exception of basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix treated curatively.
  20. Human immunodeficiency virus infection or chronic infection by the hepatitis B or C virus or presence of uncontrolled intercurrent infections, or other severe uncontrolled concomitant diseases.
  21. Current grade ≥ 2 infection (CTCAE).
  22. Pregnant or breast-feeding women.
  23. Known allergy, suspicion of allergy, or hypersensitivity to any of the study drugs (bevacizumab, oxaliplatin, capecitabine) and/or iodide contrast agents.
  24. Incapacity for oral intake.
  25. Any important and uncontrolled medical, psychological, psychiatric or social problem that can interfere in the subject's participation in the study or the evaluation of the study results or represents and increased risk of complications related to the patient's treatment.
  26. Patients in whom combined surgery of the primary tumor and metastases is planned are not eligible.
  27. Venous Cava invasion and 2 or more hepatic venous invasion Both portal venous invasion Remanent future minor to 40% Use of portal embolization previous to hepatectomy.

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): NCT01493713

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Hospital de Donostia
San Sebastián, Guipúzcoa, Spain, 20014
Hospital Universitario Fundación Alcorcón
Alcorcón, Madrid, Spain, 28922
Hospital Universitario Puerta de Hierro de Majadahonda
Majadahonda, Madrid, Spain, 28222
Hospital Son Llatzer
Palma de Mallorca, Mallorca, Spain, 07198
Hospital Universitario Virgen de la Arrixaca
El Palmar, Murcia, Spain, 30120
Hospital de Navarra
Pamplona, Navarra, Spain, 31008
Hospital del Mar
Barcelona, Spain, 08003
Hospital de la Santa Creu i Sant Pau
Barcelona, Spain, 08025
Hospital Clìnic
Barcelona, Spain, 08036
Complejo Hospitalario Xeral Calde
Lugo, Spain, 27004
Hospital Universitario Arnau de Vilanova de Lleida
Lérida, Spain, 25198
Hospital General Universitario Gregorio Marañón
Madrid, Spain, 28009
Hospital Universitario La Paz
Madrid, Spain, 28046
Complejo Hospitalario Universitario de Ourense
Orense, Spain, 32005
Hospital Universitario Central de Asturias
Oviedo, Spain, 33006
Hospital de Sabadell
Sabadell, Spain, 08208
Hospital General Universitario de Valencia
Valencia, Spain, 46014
Hospital Arnau de Vilanova de Valencia
Valencia, Spain, 46015
Hospital Universitario y Politécnico La Fe
Valencia, Spain, 46026
Complejo Hospitalario Universitario de Vigo
Vigo, Spain, 36036
Hospital Universitario Miguel Servet
Zaragoza, Spain, 50009
Sponsors and Collaborators
Grupo Espanol Multidisciplinario del Cancer Digestivo
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Study Director: Ruth Vera, Dr Hospital de Navarra

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Responsible Party: Grupo Espanol Multidisciplinario del Cancer Digestivo Identifier: NCT01493713     History of Changes
Other Study ID Numbers: GEMCAD-10-06
First Posted: December 16, 2011    Key Record Dates
Last Update Posted: February 16, 2018
Last Verified: February 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Colorectal Neoplasms
Neoplasm Metastasis
Liver Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Neoplastic Processes
Pathologic Processes
Liver Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors