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A Study of Sequential and Concurrent FOLFOXIRI/Avastin (Bevacizumab) Regimens Versus FOLFOX/Avastin in First-Line in Participants With Metastatic Colorectal Cancer (STEAM)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Hoffmann-La Roche
ClinicalTrials.gov Identifier:
NCT01765582
First received: January 9, 2013
Last updated: March 7, 2017
Last verified: January 2017

January 9, 2013
March 7, 2017
January 2013
March 2016   (Final data collection date for primary outcome measure)
  • Percentage of Participants With Overall Response During First-Line Therapy (ORR1), Assessed by Investigator According to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v.1.1) [ Time Frame: Randomization up to disease progression during first-line therapy or death, whichever occurs first (up to approximately 3 years) ]
  • Progression-Free Survival During First-Line Therapy (PFS1), Assessed by Investigator According to RECIST v.1.1 Criteria [ Time Frame: Randomization up to disease progression during first-line therapy or death, whichever occurs first (up to approximately 3 years) ]
  • Overall response rate (ORR1) during first-line therapy, assessed by the investigator according to RECIST v.1.1 criteria [ Time Frame: approximately 5 years ]
  • Progression-free survival (PFS1), defined as time from randomization to first occurrence of disease progression or death, whichever occurs first, during first-line therapy [ Time Frame: approximately 5 years ]
Complete list of historical versions of study NCT01765582 on ClinicalTrials.gov Archive Site
  • Percentage of Participants With Overall Response During Second-Line Therapy (ORR2), Assessed by Investigator According to RECIST v.1.1 [ Time Frame: After initiation of second-line therapy up to disease progression or death, whichever occurs first (up to approximately 3 years) ]
  • Progression-Free Survival During Second-Line Therapy (PFS2) Assessed by Investigator According to RECIST v.1.1 Criteria [ Time Frame: After initiation of second-line therapy up to disease progression or death, whichever occurs first (up to approximately 3 years) ]
  • Time to PFS2, Assessed by Investigator According to RECIST v.1.1 Criteria [ Time Frame: Randomization up to disease progression during second-line therapy or death, whichever occurs first (up to approximately 3 years) ]
  • Overall survival (OS) [ Time Frame: Randomization until death due to any cause (up to approximately 3 years) ]
  • Percentage of Participants who Underwent Liver Metastases Resections [ Time Frame: Randomization up to approximately 3 years ]
  • Percentage of Participants Considered by the Investigator to be Unresectable on Study Enrollment Who Subsequently Undergo Attempted Curative Resections of Metastases [ Time Frame: Randomization up to approximately 3 years ]
  • Percentage of Participants With Adverse Events [ Time Frame: Randomization up to approximately 3 years ]
  • Overall response rate during second-line therapy (ORR2), defined as proportion of patients with complete response or partial response during second-line therapy [ Time Frame: approximately 5 years ]
  • Progression-free survival during second-line therapy (PFS2), defined as time from reinduction of second-line therapy to disease progression or death from any cause, whichever occurs first [ Time Frame: approximately 5 years ]
  • Time to PFS2, defined as time from randomization to first occurrence of disease progression after reintroduction of second-line therapy [ Time Frame: approximately 5 years ]
  • Overall survival, defined as time from randomization to death of any cause [ Time Frame: approximately 5 years ]
  • Liver resection rate: Proportion of patients who undergo liver metastases resections [ Time Frame: approximately 5 years ]
  • Rates of conversion from unresectable to resectable disease (liver-limited and non-liver-limited disease) [ Time Frame: approximately 5 years ]
  • Safety: Incidence of adverse events [ Time Frame: approximately 5 years ]
Not Provided
Not Provided
 
A Study of Sequential and Concurrent FOLFOXIRI/Avastin (Bevacizumab) Regimens Versus FOLFOX/Avastin in First-Line in Participants With Metastatic Colorectal Cancer (STEAM)
Steam (Sequencing Triplet With Avastin and Maintenance): FOLFOXIRI/Bevacizumab Regimens (Concurrent and Sequential) vs. FOLFOX/Bevacizumab in First-Line Metastatic Colorectal Cancer
This randomized, open-label, multicenter study will evaluate the efficacy and safety of folinic acid (leucovorin), 5-fluorouracil (5-FU), oxaliplatin, and irinotecan (FOLFOXIRI) / bevacizumab regimens (concurrent and sequential) versus folinic acid (leucovorin), 5-fluorouracil, and oxaliplatin (FOLFOX) / bevacizumab in first-line in participants with metastatic colorectal cancer. Participants will be randomized to receive bevacizumab 5 milligrams per kilogram (mg/kg) intravenously every 2 weeks with either concurrent or sequential FOLFOXIRI or with FOLFOX for 4 to 6 months of induction therapy, followed by maintenance therapy with bevacizumab plus either leucovorin/5-fluorouracil or capecitabine until disease progression occurs. After disease progression, participants will receive treatment with a fluoropyrimidine-based chemotherapy plus bevacizumab.
Not Provided
Interventional
Phase 2
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Treatment
Colorectal Neoplasm
  • Drug: 5-fluorouracil
    Participants in Arm A will receive 3200 milligrams per square meter (mg/m^2) by 48-hour continuous intravenous (IV) infusion every 2 weeks, during the 4-6 months' induction followed by maintenance therapy including bolus dose of 400 mg/m^2, followed by a 46-hour continuous infusion (2400 mg/m^2) every 2 weeks per investigator's discretion. Participant in Arm B and C will receive a bolus dose of 400 mg/m^2, followed by a 46-hour continuous infusion (2400 mg/m^2) every 2 weeks during the 4-6 months of induction and maintenance per investigator's discretion.
  • Drug: bevacizumab
    Participants will receive 5 mg/kg IV every 2 weeks during the first 4-6 months induction phase, followed by 5 mg/kg IV every 2 weeks or 7.5 mg/kg IV every 3 weeks during maintenance therapy, and 2.5 mg/kg per week reinduction after disease progression.
    Other Name: Avastin
  • Drug: Capecitabine
    Participants will receive 1000 or 850 mg/kg orally twice daily as per investigator's discretion on Day 1 to 14, repeated every 3 weeks in maintenance phase.
    Other Name: Xeloda
  • Drug: Irinotecan
    Participants will receive IV infusion of 165 mg/m^2 over 1 hour every 2 weeks (Arm A) or IV infusion of 180 mg/m^2 over 1 hour in 2 x 2 weeks cycles alternating months (in Arm B), during 4-6 months induction phase.
  • Drug: Leucovorin
    Participants will receive IV infusion of 200 mg/m^² (Arm A) or 400 mg/m^2 (Arm B or C) over 2 hours every 2 weeks, during 4-6 months induction phase followed by IV infusion of 400 mg/m^2 in the maintenance therapy.
  • Drug: Oxaliplatin
    Participants will receive 85 mg/m^2 over 2 hours as IV infusion every 2 weeks (Arm A, C ) or 2 x 2 week cycles alternating months (Arm B), during 4-6 months induction phase .
  • Experimental: Arm A: Concurrent FOLFOXIRI + Bevacizumab
    Participants will receive concurrent FOLFOXIRI along with 5 mg/kg of bevacizumab with treatment cycle of 2 weeks during first 4 month induction phase (plus optional 2 months of induction for participants who exhibit good response and tolerate the regimen) followed by administration of 5-FU with bevacizumab or capecitabine with bevacizumab as per investigator's discretion in maintenance phase. Following progression on first-line therapy (PD1), bevacizumab (dose equivalent, 2.5 mg/kg/week) will be administered as second-line therapy in combination with fluoropyrimidine based chemotherapy at the investigator's discretion.
    Interventions:
    • Drug: 5-fluorouracil
    • Drug: bevacizumab
    • Drug: Capecitabine
    • Drug: Irinotecan
    • Drug: Leucovorin
    • Drug: Oxaliplatin
  • Experimental: Arm B: Sequential FOLFOXIRI + Bevacizumab
    Participants will receive alternating 4-week administrations of FOLFOX/bevacizumab and folinic acid (leucovorin), 5-FU, and irinotecan (FOLFIRI) /Bevacizumab with a treatment cycle of 2 weeks during first 4-month induction phase (plus optional 2 months of induction for participants who exhibit good response and tolerate the regimen) followed by administration of 5-FU with bevacizumab or capecitabine with bevacizumab as per investigator's discretion in maintenance phase. Following progression on first-line therapy (PD1), bevacizumab (dose equivalent, 2.5 mg/kg/week) will be administered as second-line therapy in combination with fluoropyrimidine based chemotherapy at the investigator's discretion.
    Interventions:
    • Drug: 5-fluorouracil
    • Drug: bevacizumab
    • Drug: Capecitabine
    • Drug: Irinotecan
    • Drug: Leucovorin
    • Drug: Oxaliplatin
  • Experimental: Arm C: FOLFOX + Bevacizumab
    Participants will receive FOLFOX along with 5 mg/kg of bevacizumab with treatment cycle of 2 weeks during first 4-month induction phase (plus optional 2 months of induction for participants who exhibit good response and tolerate the regimen) followed by administration of 5-FU with bevacizumab or capecitabine with bevacizumab as per investigator's discretion in maintenance phase. Following progression on first-line therapy (PD1), bevacizumab (dose equivalent, 2.5 mg/kg/week) will be administered as second-line therapy in combination with fluoropyrimidine based chemotherapy at the investigator's discretion.
    Interventions:
    • Drug: 5-fluorouracil
    • Drug: bevacizumab
    • Drug: Capecitabine
    • Drug: Leucovorin
    • Drug: Oxaliplatin
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
48
March 2016
March 2016   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Histologically confirmed colorectal cancer with at least one measurable metastatic lesion by RECIST v 1.1, that is considered unresectable at baseline
  • Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 if age less than (<) 71 years; ECOG status of 0 if age 71 to 75 years
  • Adequate hematological, renal and liver function
  • Participants with treated brain metastases are eligible for study participation; participants may not receive ongoing treatment with steroids at screening, anticonvulsants (at stable dose) are allowed
  • Females of childbearing potential and males must agree to use effective contraception as defined by protocol during the treatment period and for at least 6 months after the last dose of study drug

Exclusion Criteria:

  • Any prior treatment for metastatic colorectal cancer, except for use of palliative radiosensitizers
  • Adjuvant chemotherapy for colorectal cancer completed < 12 months prior to study consent
  • Sensory peripheral neuropathy greater than or equal to (>/=) Grade 2
  • Evidence of Gilbert's Syndrome or homozygosity for the Uridine 5-diphospho-glucuronosyltransferase (UGT) 1A1*28 allele
  • Positive for human immunodeficiency virus (HIV) infection
  • Malignancies other than metastatic colorectal cancer within 5 years prior to randomization, except for adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated surgically with curative intent, and ductal carcinoma in situ treated surgically with curative intent
  • Radiotherapy to any site for any reason within 28 days prior to randomization, except for palliative radiotherapy to bone lesions within 14 days prior to randomization
  • Clinically significant third-space fluid collections (e.g. ascites or pleural effusion) that cannot be controlled by drainage or other procedures prior to study entry
  • Treatment with any other investigational agent, or participation in another investigational drug trial within 28 days prior to randomization
  • Any disease or condition or laboratory finding giving reasonable suspicion of disease or condition that contraindicates the use of bevacizumab or puts the participant at high risk for treatment-related complications
  • Inadequately controlled hypertension
  • Clinically significant (that is [i.e.] active) cardiovascular disease (For example [e.g.] cerebrovascular accident or myocardial infarction within 6 months prior to randomization), unstable angina, congestive heart failure (New York Heart Association Class >/= II) or serious cardiac arrhythmia that is uncontrolled by medication or may interfere with the administration of the study treatment
  • Known hypersensitivity to bevacizumab or any of its excipients or any other study drug
Sexes Eligible for Study: All
18 Years to 75 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01765582
ML28442
Not Provided
Not Provided
Not Provided
Not Provided
Hoffmann-La Roche
Hoffmann-La Roche
Not Provided
Study Director: Clinical Trials Hoffmann-La Roche
Hoffmann-La Roche
January 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP