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Perioperative Treatment of Resectable Liver Metastases (PERIMAX)

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ClinicalTrials.gov Identifier: NCT01540435
Recruitment Status : Withdrawn (insufficient recruitment)
First Posted : February 28, 2012
Last Update Posted : May 29, 2013
University of Halle Medical Faculty
Information provided by (Responsible Party):
Hans J Schlitt, Prof. MD, University of Regensburg

Brief Summary:
This randomized, controlled, multicenter, non-comparative phase II trial compares an intensified perioperative treatment of patients with resectable synchronous or metachronous colorectal liver metastases to primary surgery and adjuvant systemic chemotherapy.

Condition or disease Intervention/treatment Phase
Colon Cancer Liver Metastasis Drug: Bevacizumab Phase 2

Detailed Description:

Recurrence rates after R0-resection of colorectal liver metastases are still very high (about 60-70 %). Therefore, multidisciplinary treatment of these patients is frequently used in order to achieve a beneficial impact regarding progression-free and overall survival. The point in time of treatment, pre- and/or postoperative, is still a matter of debate. In the EORTC 40983 trial, perioperative chemotherapy with 5-Fluorouracil and oxaliplatin (FOLFOX-Regimen) displayed a non-significant benefit in 3 year disease free survival in the intent to treat population (HR 0.79, 95% CI 0.62 to 1.02) (Nordlinger, Sorbye et al. 2008). The combined analysis of two adjuvant trials, with a (non-contemporary) 5-FU Bolus regimen, showed a non-significant prolongation of median disease free survival (DFS) from 18.8 to 27.9 months (p=0.058) and OS from 47.3 to 62.2 months (p=0.095) (Mitry, Fields et al. 2008). However, postoperative treatment with 6 months of FOLFOX is often used in daily practise. Thus, further investigation is urgently warranted.

This phase II trial evaluates two strategies with intensified perioperative or postoperative treatment regimens. Current studies established the role of the FOLFOXIRI regimen in the metastatic setting (Falcone, Ricci et al. 2007). A further intensification of a three drug regimen with bevacizumab seem to be feasible yielding response rates up to 84% and a disease control rate up to 100% (Falcone 2008; Bruera, Santomaggio et al. 2010; Masi, Loupakis et al. 2010). Regarding the efficacy, evaluation of FOLFOXIRI and bevacizumab in preoperative treatment for resectable CLM seems to be promising. Postoperative treatment with FOLFOX for 6 months was chosen for arm A.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Perioperative FOLFOXIRI and Bevacizumab Compared With Postoperative FOLFOX in Patients With Resectable Liver Metastases From Colorectal Cancer (PERIMAX). A Randomized, Multidisciplinary DGAV(CAO-V/CALGP)/AIO Phase II Trial
Study Start Date : September 2012
Actual Primary Completion Date : May 2013
Actual Study Completion Date : May 2013

Resource links provided by the National Library of Medicine

Drug Information available for: Bevacizumab

Arm Intervention/treatment
No Intervention: Postoperative Arm (Arm A)


Oxaliplatin at a dose of 85 mg/m2 iv over two hours (day 1) I-LV at a dose of 200 mg/m2 iv over two hours (day 1) 5-FU at a dose of 3200 mg/m2 iv over 48 hours (day 1-3)

Duration of treatment:

Treatment will be administered for 12 cycles (6 months) postoperatively starting 6 weeks after surgery.

Experimental: Perioperative Arm (Arm B)

Therapy will be administered in a biweekly schedule. First preoperative cycle will be administered with 75% of dosage for FOLFOXIRI, if no diarrhea ≥ grade 3 occurs, following cycles should be administered in full dosage.

FOLFOXIRI + bevacizumab:

bevacizumab at a dose of 5 mg/kg iv over 30 to 90 min (day 1) irinotecan at a dose of 165 mg/m2 iv over two hours (day 1) oxaliplatin at a dose of 85 mg/m2 iv over two hours (day 1) I-LV at a dose of 200 mg/m2 iv over two hours (day 1) 5-FU at a dose of 3200 mg/m2 iv over 48 hours (day 1-3)

Duration of treatment:

Treatment will be administered for 6 cycles (3 months) preoperatively (last cycle without bevacizumab), after 6 weeks followed by liver surgery, after further 6 weeks followed by 6 cycles (3 months) postoperatively.

Drug: Bevacizumab
Bevacizumab at a dose of 5 mg/kg iv over 30 to 90 min (day 1) + FOLFOXIRI in a biweekly schedule, 6 cycles preoperatively, 6 cycles postoperatively
Other Name: VEGF antibody

Primary Outcome Measures :
  1. Failure-free survival (FFS@18) [ Time Frame: 18 months ]
    Failure will be defined as no R0 resection, local or distant recurrence or death from any cause.

Secondary Outcome Measures :
  1. Disease Free Survival (DFS) [ Time Frame: 5 years ]
  2. Overall survival (OS) [ Time Frame: 5 years ]
  3. Perioperative morbidity [ Time Frame: 30 days (hospital stay) ]
  4. Quality of life [ Time Frame: 12 months ]
  5. Achievability of R0 resection [ Time Frame: intraoperative ]
  6. Overall response rate (Arm B) [ Time Frame: 3 months ]
  7. Pathologic response rate [ Time Frame: 18 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Main selection criteria:

  1. Histological proven CRC with completely resectable metachronous or synchronous liver metastases (as judged by the treating surgeon).
  2. Patients must have undergone complete resection (R0) of the primary tumor at least 4 weeks before randomization. Or in case of synchronous disease with intact primary; the primary tumor have to be R0 resectable together with the liver metastases and the patient has a non-obstructive primary tumor and is able to receive preoperative chemotherapy before surgery. Synchronous rectal primary is not allowed.
  3. Measurable hepatic disease by Response Evaluation Criteria in Solid Tumors (RECIST version 1.1).
  4. No evidence of extra-hepatic metastasis of CRC.
  5. Patients must be from 18 to 75 years.
  6. ECOG Performance status ≤ 1
  7. No previous chemotherapy for metastatic disease. Radiotherapy alone is allowed if given pre or post protocol treatment.
  8. Previous adjuvant chemotherapy for primary CRC is allowed if completed at least 6 months before inclusion in this study.
  9. All the following tests should be done within 4 weeks prior to randomization

    • Absolute neutrophil count > 1.5 x 109/L, platelets > 100 x 109/L, and hemoglobin > 9 g/dL or 5.59 mmol/l.
    • Serum creatinine less than 1.5 times the upper limit of normal (ULN) (to exclude severe renal impairment); no significant proteinuria (urine dipstick for proteinuria ³ 2+. If urine dipstick is ³ 2+, 24-hour urine must demonstrate £ 1 g of protein in 24 hours for patient to be eligible).
    • Absence of major hepatic insufficiency (bilirubin < 1.5 x ULN and aspartate aminotransferase (ASAT)/alanine aminotransferase (ALAT) < 5 x ULN).
    • Patients not receiving therapeutic anticoagulation must have an INR < 1.5 ULN and aPTT < 1.5 ULN within 7 days prior to registration. The use of full dose anticoagulants is allowed as long as the INR or aPTT is within therapeutic limits (according to the medical standard in the institution) and the patient has been on a stable dose for anticoagulants for at least two weeks at the time of registration.
  10. No pregnancy or breast feeding. Negative serum pregnancy test within 7 days of starting study treatment in pre-menopausal women and women < 1 year after the onset of menopause is required before entering in the trial. Note: a negative test has to be reconfirmed by a urine test, should the 7-day window be exceeded.
  11. Adequate contraception is required during and for 3 months after study treatment for both male and female patients if the risk of conception exists.
  12. No major surgical procedure, open biopsy, or significant traumatic injury within 4 weeks prior to randomization.
  13. No previous exposure to VEGF/VEGFR-targeting therapy within the last 12 months.
  14. No thrombosis or severe bleeding within 6 months prior to entry into the study (except for bleeding of the tumor before its surgical resection) and no evidence of bleeding diathesis or coagulopathy.
  15. Absence of peripheral neuropathy NCI CTCAE-grade ≥ 1, active inflammatory bowel disease or other bowel disease causing chronic diarrhea (defined as > 4 loose stools per day), serious wound complications, ulcers, or bone fractures.
  16. No evidence of any other disease, metabolic dysfunction, physical examination finding or laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or puts the patient at high risk for treatment-related complications.
  17. No concomitant treatment with ASS > 325 mg or NSAIDs, known to inhibit platelet function, sorivudin or analog compounds or preparations of St. John's wort.

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 ClinicalTrials.gov identifier (NCT number): NCT01540435

Sponsors and Collaborators
University of Regensburg
University of Halle Medical Faculty
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Study Chair: Hans J. Schlitt, Prof. MD Department of Surgery, University Medical Center Regensburg
Study Director: Hans-Joachim Schmoll, Prof. MD Department of Internal Medicine IV, University Hospital Halle
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Responsible Party: Hans J Schlitt, Prof. MD, Principal Investigator, University of Regensburg
ClinicalTrials.gov Identifier: NCT01540435    
Other Study ID Numbers: KKSH088
2010-023575-25 ( EudraCT Number )
First Posted: February 28, 2012    Key Record Dates
Last Update Posted: May 29, 2013
Last Verified: May 2013
Keywords provided by Hans J Schlitt, Prof. MD, University of Regensburg:
Colorectal cancer
Liver metastases
Perioperative treatment
Liver resection
Additional relevant MeSH terms:
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Neoplasm Metastasis
Liver Neoplasms
Neoplastic Processes
Pathologic Processes
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Liver Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors