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Bevacizumab, Erlotinib and 5-Fluorouracil With External Beam Radiation Therapy in Locally Advanced Rectal Cancer

This study has been completed.
Sponsor:
Collaborators:
Beth Israel Deaconess Medical Center
Dana-Farber Cancer Institute
Genentech, Inc.
Information provided by (Responsible Party):
Lawrence S. Blaszkowsky, MD, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT00307736
First received: March 24, 2006
Last updated: March 30, 2017
Last verified: March 2017
  Purpose
The purpose of this study is determine the safety of 5-fluorouracil, bevacizumab and erlotinib when administered in combination with external beam radiation therapy(Phase I portion) as well as to begin to collect information about whether this combination treatment is effective in treating(Phase II portion) patients with locally advanced rectal cancer.

Condition Intervention Phase
Rectal Cancer Adenocarcinoma of the Rectum Drug: 5-fluorouracil Drug: bevacizumab Drug: erlotinib Procedure: External beam radiation therapy (EBRT) Phase 1 Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I/II Study of Bevacizumab, Erlotinib and 5-fluorouracil With Concurrent External Beam Radiation Therapy in Locally Advanced Rectal Cancer

Resource links provided by NLM:


Further study details as provided by Lawrence S. Blaszkowsky, MD, Massachusetts General Hospital:

Primary Outcome Measures:
  • Maximum Tolerated Dose (MTD) of Erlotinib When Administered in Combination With 5-fluorouracil (5-FU), Bevacizumab, and External Beam Radiation Therapy [ Time Frame: 3 years ]
    MTD of Erlotinib was determined using a traditional 3 + 3 dose escalation scheme of three dose levels (50,100,150mg). Successive cohorts of 3-6 patients were enrolled into dose escalation cohorts for 14 day cycles. MTD reflects the highest dose of Erlotinib that had ≤1 out of 6 patients with Dose-Limiting Toxicity (DLT) at the highest dose level below the maximally administered dose. The maximally administered dose is the first dose that causes DLT in >33% of patients. DLT was defined as: Any grade 4 neutropenia, Any grade 3 thrombocytopenia, or Any ≥ grade 3 non-hematologic toxicity that results in greater than 7 days interruption in therapy.


Secondary Outcome Measures:
  • Summary of Grade 3 or Greater Toxicity [ Time Frame: 3 years ]

    Summary of grade 3 or greater toxicity by grade and type. All adverse events were evaluated using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.

    Grade 3: Severe or medically significant but not immediately life threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care activities of daily living.

    Grade 4 Life-threatening consequences; urgent intervention indicated.


  • Percentage of Participants With Disease-free Survival [ Time Frame: 1, 2, 3 years ]
    Summary of disease free survival at 1, 2, and 3 years. Disease free survival is the length of time after primary treatment for cancer ends that the participant survives without any clinical signs or symptoms of that cancer. The data is shown of the percentage of participants still in disease free survival at one, two, and three years.

  • Post-operative Complications After Resection of Rectal Cancers Following Preoperative 5-FU, Bevacizumab, Erlotinib, and External Beam Radiation Therapy. [ Time Frame: 3 years ]
    Surgical morbidity following R0 resection with one of the following procedures: abdominal perineal resection, low anterior resection, and low anterior resection with coloanal anastomosis.


Other Outcome Measures:
  • Pathologic Complete Response [ Time Frame: 3 years ]
    The number of subjects who achieved a pathologic complete response as determine by pathologist, following completion of the study therapy. Pathologic complete response represents the absence of residual invasive disease in the rectum and in the regional lymph nodes.


Enrollment: 32
Study Start Date: May 2006
Study Completion Date: July 2011
Primary Completion Date: April 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Chemotherapy and radiation
Continuous infusion 5-fluorouracil 225 mg/M2/d, bevacizumab 5 mg/kg IV q 14 days, erlotinib 50-150 mg orally daily for duration of radiation.
Drug: 5-fluorouracil
Given as a 24-hour infusion on days 1-14 of each 14-day cycle for a total of 3 cycles.
Drug: bevacizumab
Given intravenously on day 1 of each 14-day cycle for a total of 3 cycles.
Drug: erlotinib
Taken orally on days 1-14 of each 14-day cycle for a total of 3 cycles.
Procedure: External beam radiation therapy (EBRT)
Given on days 1-5 and 8-12

Detailed Description:
  • All participants will receive the following drugs: 5-fluorouracil (5-FU) given as a continuous 24-hour infusion; Bevacizumab given intravenously; erlotinib given orally at home. In the Phase I portion, we are looking for the highest dose of erlotinib that can be given safely in combination with the 5-FU, bevacizumab and radiation therapy. Therefore the dose of erlotinib may not be the same for each participant. The dose will increase until we find the highest dose without causing serious or unmanageable side effects.
  • Study treatment is given as an outpatient and consists of 14 day cycles with a total of 3 cycles. Patients will be given all three study drugs and radiation therapy on a monday (unless a monday falls on on a holiday). This will be day 1 of the first treatment cycle. 5-FU is given continuously days 1-14. Bevacizumab is given on day 1. Erlotinib will be given on days 1-14. Radiation therapy will be performed on Days 1-5 and 8-12.
  • The following tests and procedures will be performed weekly while participants are receiving study treatment: physical examination, measurement of vital signs, height and weight; performance status; blood work, urine sample.
  • At the end of treatment the following tests will be performed: physical examination and measurement of vital signs; performance status; blood work; CT scans of chest, abdomen and pelvis. Patients will also be evaluated for surgery at this time. Patients will be followed every three months for the first three years after surgery, then every 6 months for the next two years.
  Eligibility

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

Inclusion Criteria:

  • Histologically confirmed primary adenocarcinoma of the rectum that begins within 15cm of the anal verge as determined by sigmoidoscopy or colonoscopy
  • Clinical T3 or T4 tumors as determined by endoscopic ultrasound and/or rectal MRI
  • ECOG performance status of 0-2
  • 18 years of age or older
  • Creatinine of < 2.0
  • Adequate hepatic function
  • Adequate hematopoietic function
  • Use of effective means of contraception in subjects of child-bearing potential

Exclusion Criteria:

  • Evidence of metastatic disease as determined by chest/abdominal/pelvic CT or physical exam
  • Prior chemotherapy or radiation therapy for treatment of colorectal cancer
  • Prior treatment with 5-FU
  • Prior treatment with a tyrosine kinase inhibitor, EGFR inhibitor, or VEGF inhibitor
  • Patients must not be receiving any other investigational agent
  • Prior malignancy within the last 5 years except for completely excised skin cancer, in situ cervical cancer
  • Warfarin anticoagulation
  • Co-existent malignant disease
  • Current or recent participation in a clinical trial (within 4 weeks from the first day of treatment)
  • Pregnancy
  • Blood pressure of >150/100 mmHg
  • Unstable angina
  • NYHA Grade II or greater congestive heart failure
  • History of myocardial infarction within 6 months
  • History of stroke within 6 months
  • Clinically significant peripheral vascular disease
  • Evidence of bleeding diathesis or coagulopathy
  • Presence of central nervous system or brain metastases
  • Major surgical procedure, open biopsy, or significant trauma injury within 28 days prior to day 0, anticipation of need for major surgical procedure during the course of the study
  • Minor surgical procedures, fine needle aspirations or core biopsies within 7 days prior to day 0
  • Pregnant or lactating
  • Urine protein:creatinine ratio > or equal to one at screening
  • History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to day 0]
  • Serious, non-healing wound, ulcer, or bone fracture
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00307736

Locations
United States, Massachusetts
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02115
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02115
Massachusetts General Hospital
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Massachusetts General Hospital
Beth Israel Deaconess Medical Center
Dana-Farber Cancer Institute
Genentech, Inc.
Investigators
Principal Investigator: Lawrence S. Blaszkowsky, MD Massachusetts General Hospital
  More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Lawrence S. Blaszkowsky, MD, Assistant Physician, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT00307736     History of Changes
Other Study ID Numbers: 05-345
Study First Received: March 24, 2006
Results First Received: January 27, 2017
Last Updated: March 30, 2017

Keywords provided by Lawrence S. Blaszkowsky, MD, Massachusetts General Hospital:
Fluorouracil
bevacizumab
erlotinib
external beam radiation therapy
EBRT

Additional relevant MeSH terms:
Adenocarcinoma
Rectal Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Intestinal Diseases
Rectal Diseases
Bevacizumab
Erlotinib Hydrochloride
Fluorouracil
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antimetabolites
Antimetabolites, Antineoplastic
Immunosuppressive Agents

ClinicalTrials.gov processed this record on August 18, 2017