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Induction Therapy With Panitumumab + mFOLFOX-6 in Rectal Cancer and Quadruple Wild-type Mutation Before Surgery (PIER)

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ClinicalTrials.gov Identifier: NCT03000374
Recruitment Status : Recruiting
First Posted : December 22, 2016
Last Update Posted : July 23, 2020
Sponsor:
Collaborators:
Pivotal S.L.
Amgen
Information provided by (Responsible Party):
Grupo Espanol Multidisciplinario del Cancer Digestivo

Brief Summary:
Patients with rectal adenocarcinoma of intermediate risk (defined by magnetic resonance imaging [MRI]), without mutations in KRAS, BRAF, NRAS and PI3KCA, who are candidates for preoperative treatment, will receive a preoperative Induction therapy with 12 weeks of panitumumab with mFOLFOX-6 to evaluate the efficacy in terms of pathologic complete response (pCR)

Condition or disease Intervention/treatment Phase
Rectal Cancer Drug: Panitumumab Drug: 5Fluorouracil Drug: Oxaliplatin Drug: Leucovorin Phase 2

Detailed Description:

Phase II, nonrandomized single-arm trial of preoperative treatment with mFOLFOX-6 and panitumumab in an enriched population of patients with rectal adenocarcinoma of intermediate risk, screened by MRI, without mutations in KRAS, BRAF, NRAS and PI3K. All patients enrolled in the study will receive 12 weeks of the investigational product (mFOLFOX-6 with panitumumab) every 14 days for six cycles, unless unacceptable toxicity occurs or progression is detected. After this treatment, response will be evaluated by diffusion-weighted MRI and endoscopy. In the absence of disease progression, patients eligible for R0 resection will undergo total mesorectal excision (TME). After surgery, patients will receive mFOLFOX6 x 6 cycles. In the case of intolerance to FOLFOX-panitumumab, disease progression or ineligibility for R0 resection, patients will receive chemoradiotherapy with capecitabine 825 mg/m2 every 12 hours concomitantly with radiotherapy (RT) with a total dose of 50.4 Gy. At the end of this treatment, patients will undergo TME between 6-8 weeks after finishing the CRT. If a patient has received 4 or more neoadjuvant cycles of FOLFOX-panitumumab before unacceptable toxicity or progression, it will be considered that the neoadjuvant treatment has been completed and the patient will have no additional neoadjuvant treatment but surgery. If the patient has received <4 cycles of neoadjuvant treatment, neoadjuvant CRT will be administered.

If a patient has an acceptable toxicity or disease progression or a R0 surgery is not possible to be performed and the patient received CRT, the patient will be followed up for 24 months, from the enrollment of the last patient in the trial, or until progression occurs, in order to assess progression-free survival and all the data regarding surgery and CRT will be recorded in the eCRF. If a patient withdraws consent and refuses to continue participating in the study, follow-up evaluations must be discontinued.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 47 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Preoperative Induction Therapy With 12 Weeks of Panitumumab in Combination With mFOLFOX-6 in an Enriched Population (Quadruple Wild-Type) of Patients With mrT3 Rectal Cancer of the Middle Third With Clear Mesorectal Fascia
Actual Study Start Date : May 30, 2017
Estimated Primary Completion Date : July 31, 2020
Estimated Study Completion Date : October 31, 2022

Resource links provided by the National Library of Medicine

Drug Information available for: Panitumumab

Arm Intervention/treatment
Experimental: Panitumumab + mFOLFOX-6

- Modified FOLFOX-6 regimen: 5-Fluorouracil (5-FU), oxaliplatin and leucovorin will be administered intravenously once every 14 days, according to the mFOLFOX-6 regimen:

Day 1: Oxaliplatin 85 mg/m² in IV infusion of 250-500 mL and leucovorin 200 mg/m² IV, both injected over two hours, followed by 5-FU 400 mg/m2 in IV bolus and a 46-hour infusion of 5-FU 2400 mg/m².

- Panitumumab will be administered intravenously (IV) in a dose of 6 mg/kg on day 1 every 14 days. Panitumumab will be supplied to sites by the study sponsor in 5-mL and 20-mL vials, at a concentration of 20 mg/mL.

Treatment will continue until 6 cycles have been administered, followed by surgery, 5 weeks +/- 1 week after the last dose of neoadjuvant treatment

Drug: Panitumumab
Panitumumab will be administered intravenously (IV) in a dose of 6 mg/kg on day 1 every 14 days. Panitumumab will be supplied to sites by the study sponsor in 5-mL and 20-mL vials, at a concentration of 20 mg/mL.
Other Name: Vectibix 20 mg/ml

Drug: 5Fluorouracil
Once every 14 days. Day 1: 400 mg/m2 in IV bolus and a 46-hour infusion of 5-FU 2400 mg/m².
Other Name: 5-FU

Drug: Oxaliplatin
Once every 14 days. Day 1: 85 mg/m2 I.V. infusión in 250-500 mL, over two hours, followed by 5-FU
Other Name: Any marketed

Drug: Leucovorin
Once every 14 days. Day 1: 200 mg/m2 I.V., over two hours, followed by 5-FU
Other Name: Any marketed




Primary Outcome Measures :
  1. Pathologic complete response (pCR) [ Time Frame: Up to 16-18 weeks after first treatment administration ]
    Pathologic CR is defined as the absence of viable tumor cells in the primary tumor and lymph nodes (ypT0N0).


Secondary Outcome Measures :
  1. Rates of R0 resection and free mesorectal fascia (or circumferential margin) [ Time Frame: Up to 16-18 weeks after first treatment administration ]
  2. Tumor regression grade (TRG) [ Time Frame: Up to 16-18 weeks after first treatment administration ]
    the residual tumor after preoperative treatment is evaluated semi-quantitatively using the 5-point regression grading scale established by Dworak

  3. Rate of tumor downstaging (mrT versus ypT) [ Time Frame: Up to 16-18 weeks after first treatment administration ]
  4. Quality of surgery [ Time Frame: Up to 16-18 weeks after first treatment administration ]
    According to the histopathology report

  5. Adverse events and changes in laboratory results [ Time Frame: All AEs that occur up until 30 days after the last dose of investigational product will be recorded. Serious and nonserious AEs related with the study treatment that appear up until 30 days after the administration of the last dose should be reported. ]
    The adverse events will be encoded using the Medical Dictionary for Regulatory Activities (MedDRA), version 18.1 or later, and evaluated using the U.S. National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 4.0.

  6. Surgical complications [ Time Frame: Over 30 days after surgery. ]
  7. Rate of local recurrence [ Time Frame: At 3 years after recruitment ]
  8. Distant metastasis rate [ Time Frame: At 3 years after recruitment ]
  9. Disease free survival [ Time Frame: At 3 years after recruitment ]
  10. Overall survival [ Time Frame: At 3 years after recruitment ]


Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 74 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Signed and dated informed consent form, and willingness and ability to comply with the requirements of the protocol;
  2. Men or women with rectal cancer, age ≥ 18 and <75 years;
  3. Histologically documented adenocarcinoma of the rectum. All other histologic types are excluded. A biopsy of the rectal primary tumor must be available (between 1-4), with tumor representation > 50% in each sample. The samples will be sent to Val d'Hebron Institute of Oncology (VHIO) for molecular determination. The blocks of the biopsies will be sent included in paraffin.
  4. Rectal cancer candidate for R0 resection with preservation of the rectal sphincter.
  5. Tumors with the following characteristics on high-resolution thin-slice (3 mm) MRI:

    1. mrT3
    2. Tumors of the middle third, defined as tumors whose distal edge is ≤ 12 cm of the anal verge or below the peritoneal reflection and above ≥ 2 cm of the anorectal junction.
    3. Absence of MRF invasion, defined as a distance ≥ 1 mm between the tumor and the fascia;
  6. Absence of mutations in KRAS (mutations in KRAS exon 2 [codons 12/13], exon 3 [codons 59/61] and exon 4 [codon 117/146], NRAS (NRAS exon 2 [codons 12/13], exon 3 [codons 59/61] and exon 4 [codons 117/146]), BRAF (exon 15 [codon 600] and PI3KCA in exons 9 and 20
  7. ECOG performance status ≤ 2;
  8. Hematological status:

    • Neutrophils (ANC) ≥ 1.5 x 109/L;
    • Platelets ≥ 100 x 109/L;
    • Hemoglobin ≥ 9 g/dL;
  9. Adequate renal function: serum creatinine <1.5 x upper limit of normal (ULN);
  10. Adequate liver function:

    • Serum bilirubin ≤ 1.5 x ULN,
    • Alkaline phosphatase < 5 x ULN,
    • AST/ALT < 3 x ULN;
  11. Regular monitoring feasible;
  12. In women of childbearing potential, a negative serum pregnancy test within 1 week (7 days) before the start of study treatment;
  13. Women must commit to using reliable and appropriate methods of contraception for up to at least six months after the end of the study treatment (when applicable). Men with a partner of childbearing potential must agree to use a method of contraception and their partners must use another contraceptive method for the duration of the trial. Sexual abstinence will be accepted as a contraception method, with the duration and considerations stablished by the investigator

Exclusion Criteria:

  1. Mucinous adenocarcinoma.
  2. N2 lymph node involvement, defined as: 4 or more lymph nodes in the mesorectum showing morphological signs of metastatic involvement on MRI. A lymph node is considered malignant when:

    1. Short axis > 9 mm.
    2. Short axis 5-9 mm and ≥2 of the following criteria:

      i Rounded appearance. ii Heterogeneous margin. iii Heterogeneous signal intensity.

    3. Short axis < 5 mm AND round shape AND heterogeneous margin AND heterogeneous signal intensity.
  3. Extramesorectal lymph node involvement: an involved extramesorectal lymph node is defined as a lymph node in the obturator area with a short axis > 8 mm, round shape and heterogeneous signal..
  4. Prior treatment with panitumumab or cetuximab;
  5. Preexisting permanent neuropathy (grade ≥ 2 NCI-CTCAE);
  6. Concomitant antitumor treatment not foreseen in the protocol (e.g., chemotherapy, targeted molecular therapy, immunotherapy);
  7. Treatment with any other investigational medicinal product within the 28 days prior to study entry;
  8. Other simultaneous or prior malignancy, except: i) properly treated uterine cervix carcinoma in situ, ii) basal or squamous cell skin carcinoma, iii) cancer in complete remission for a period > 5 years;
  9. Evidence of metastatic disease in additional studies or in the physical examination;
  10. Any other severe and uncontrolled nonmalignant disease, major surgery or traumatic injury in the last 28 days;
  11. Pregnant or breastfeeding women;
  12. Patients with known allergy to any excipient of the investigational products;
  13. Clinically significant cardiovascular disease, including myocardial infarction, unstable angina, symptomatic congestive heart failure or cardiac arrhythmia in the year before randomization in the study.
  14. Intestinal occlusion: In the case of intestinal occlusion, patients may be enrolled in the study after performing a derivative stoma.
  15. Interstitial Lung Disease

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): NCT03000374


Contacts
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Contact: Carlos Fernández-Martos, MD +34 96 3690600 ext 21268 carlosfmartos@initiaoncologia.com
Contact: Anna Triginer +34 93 4344412 secretaria@gemcad.org

Locations
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Spain
Hospital General Universitario de Elche Recruiting
Elche, Alicante, Spain, 3203
Contact: Javier Gallego Plazas, MD       j.gallegoplazas@gmail.com   
Hospital de Sabadell Recruiting
Sabadell, Barcelona, Spain, 08208
Contact: Carles Pericay Pijaume, MD       cpericay@gmail.com   
Hospital de Sant Joan Despí Moisés Broggi Recruiting
Sant Joan Despí, Barcelona, Spain, 08970
Contact: Ferrán Losa, MD       ferran.losa@sanitatintegral.org   
Complejo Hospitalario de Navarra Recruiting
Pamplona, Navarra, Spain, 31008
Contact: Ruth Vera Garcia, MD       ruth.vera.garcia@cfnavarra.es   
Hospital de la Santa Creu i Sant Pau Recruiting
Barcelona, Spain, 08025
Contact: Maria Tobeña Puyal, MD       mtobena@santpau.cat   
Hospital Universitari Vall d'Hebrón Recruiting
Barcelona, Spain, 08035
Contact: Jaume Capdevila, MD       jacapdevila@vhebron.net   
Hospital Clinic i Provincial Recruiting
Barcelona, Spain, 08036
Contact: Joan Maurel Santasusana       jmaurel@clinic.ub.es   
Hospital Universitario La Paz Recruiting
Madrid, Spain, 28046
Contact: Nuria Rodríguez Salas, MD       nuria.rodriguez@salud.madrid.org   
Hospital Universitario Virgen del Rocío Recruiting
Sevilla, Spain, 41013
Contact: Manuel Valladares, MD       mvalaye@icloud.com   
Fundación Instituto Valenciano de Oncología Recruiting
Valencia, Spain, 46009
Contact: Ricardo Yaya, MD       ryaya@fivo.org   
Consorcio Hospital General Universitario de Valencia Active, not recruiting
Valencia, Spain, 46014
Hospital Politécnico Universitario La Fe Withdrawn
Valencia, Spain, 46026
Sponsors and Collaborators
Grupo Espanol Multidisciplinario del Cancer Digestivo
Pivotal S.L.
Amgen
Investigators
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Study Director: Carlos Fernández-Martos, MD Initia Centro Oncológico Integral
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Responsible Party: Grupo Espanol Multidisciplinario del Cancer Digestivo
ClinicalTrials.gov Identifier: NCT03000374    
Other Study ID Numbers: GEMCAD-1601
2016-002333-29 ( EudraCT Number )
First Posted: December 22, 2016    Key Record Dates
Last Update Posted: July 23, 2020
Last Verified: July 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Rectal Neoplasms
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Intestinal Diseases
Rectal Diseases
Leucovorin
Fluorouracil
Oxaliplatin
Panitumumab
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antidotes
Protective Agents
Vitamin B Complex
Vitamins
Micronutrients
Nutrients
Growth Substances
Antineoplastic Agents, Immunological