Personalized Marker-driven Early Switch to Aflibercept in Patients With Metastatic Colorectal Cancer (PERMAD-Trial) - a Multicenter, Multinational, Two Part, Phase II Trial
Overview
- Phase
- Phase 2
- Intervention
- Not specified
- Conditions
- Metastatic Colorectal Cancer
- Sponsor
- University of Ulm
- Enrollment
- 150
- Locations
- 3
- Primary Endpoint
- Randomized part: PFS rate at 6 months after first cycle after randomization
- Last Updated
- 6 years ago
Overview
Brief Summary
The primary objective of the two phase PERMAD trial is the evaluation of the impact of a personalized marker-driven treatment approach with early detection of progression and modification of treatment on cytokines and angiogenic factors (CAF) and efficacy.
In regard of the two parts, the primary objective of the run-in phase (n=50 patients) with conventional switch of chemotherapy together with the anti-angiogenic agent is the determination of a distinct cytokines and angiogenic factor (CAF) profile during treatment with FOLFOX and bevacizumab, which allows early detection/prediction of progressive disease. The primary objective of the marker-driven randomized part (n=150 patients) with marker-driven switch of antiangiogenic agent and maintenance of chemotherapy is the evaluation of the efficacy of an early marker-driven switch of anti-angiogenic treatment (bevacizumab to aflibercept)
This is a multicentre, multinational, open labeled, prospective, randomized, controlled phase II study designed to assess the clinical utility of an early marker driven change of anti-angiogenic treatment (bevacizumab to aflibercept) maintaining the chemotherapy backbone until definite radiological progression in first line treatment of patients with metastatic colorectal cancer. After completing the run in phase of the study, with at least 30 patients completing their first line treatment (due to progression, secondary resection or toxicity) and being evaluable for CAF analyses, the results will be reviewed by an Independent Data Monitoring Committee (IDMC). Based on that review the decision to continue with, modify or cancel the randomized part will be made.
The primary endpoint of the run-in phase with conventional switch of chemotherapy together with the anti-angiogenic agent is:
• Progression free survival (PFS1) of first line treatment
The primary endpoint of the randomized part with marker-driven switch of antiangiogenic agent and maintenance of chemotherapy is:
• Progression free survival rate at 6 months (PFSR@6) after first cycle after randomization.
Investigators
Thomas Seufferlein
Prof. Dr. Thomas Seufferlein
University of Ulm
Eligibility Criteria
Inclusion Criteria
- •Patients with histologically confirmed diagnosis of colorectal cancer presenting with unresectable stage IV (UICC) disease (primary tumor may be present)
- •Patients with at least one measurable lesion, with size \> 1 cm (RECIST v1.1)
- •ECOG Performance status ≤ 2
- •Life expectancy \> 3 months
- •Age ≥18 years.
- •Haematologic function: ANC ≥ 1.5 x 109/L, platelets ≥ 100 x109/L, hemoglobin ≥ 9 g/dl or 5.59 mmol/l
- •Patients not receiving therapeutic anticoagulation must have an INR \< 1.5 and aPTT \< 1.5 x ULN within 7 days prior to enrollment. 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 enrollment.
- •Adequate liver function as measured by serum transaminases (AST \& ALT) ≤ 2.5 x ULN (in case of liver metastases \< 5 x ULN) and total bilirubin ≤ 1.5 x ULN
- •Adequate renal function: Serum creatinine ≤ 1.5 x ULN
- •Signed, written informed consent
Exclusion Criteria
- •Treatment with any other investigational agent within 30 days prior to entering this study.
- •Prior systemic or local treatment of metastatic disease.
- •Prior adjuvant or neo-adjuvant chemotherapy/radiotherapy completed less than 6 months prior to study entry.
- •Pre History or evidence upon physical/neurological examination of CNS disease (unrelated to cancer) (unless adequately treated with standard medical therapy) e.g. uncontrolled seizures.
- •Fertile women (\< 1 year after last menstruation) and men of childbearing potential unwilling or unable to use effective means of contraception (adequate: intrauterine device, long-acting injection, hormon implant, vasectomy) during treatment and for 6 months after the end of treatment.
- •Pregnancy or lactation
- •Positive serum pregnancy test within 7 days of starting study treatment in premenopausal women and women \< 1 year after the onset of menopause.
- •Past or current history (within the last 2 years prior to treatment start) of other malignancies except metastatic colorectal cancer (patients with curatively treated basal and squamous cell carcinoma of the skin or in situ carcinoma of the cervix are eligible).
- •Peripheral neuropathy NCI CTCAE-grade ≥ 1
- •Known DPD-insufficiency.
Outcomes
Primary Outcomes
Randomized part: PFS rate at 6 months after first cycle after randomization
Time Frame: 6 months
Randomized part with marker-driven switch of anti-angiogenic treatment
Run-in phase: Progression free survival (PFS1) of first line treatment
Time Frame: approx. 10-12 months
Run-in phase with conventional switch of chemotherapy together with the anti-angiogenic agent. Primary endpoint: • Progression free survival (PFS1) of first line treatment Randomized part with marker-driven switch of antiangiogenic agent and maintenance of chemotherapy. Primary endpoint: • PFS rate at 6 months (PFSR@6) after first cycle after randomization
Secondary Outcomes
- Time to randomization (TTR)(approx. 10-12 months)
- PFS1, after first cycle after randomization (PFSr) and of second line treatment (PFS2)(approx. 20 months)
- Overall survival (OS)(5 years)
- Predictive value of CAF particularly PlGF and VEGF-B for early detection of progression during treatment with chemotherapy and bevacizumab(approx. 10-12 months)
- Determination and validation of a CAF profile based on PlGF and VEGF-B predicting tumor progression before radiologic progression(approx. 10-12 months)
- Overall response rate (RR) and Secondary resection rate (sRR)(approx. 20 months)
- Changes in CAF during early marker-driven switch and conventional treatment approach(approx. 20 months)
- Prognostic value of CAF at baseline and/or during treatment(approx. 20 months)
- Toxicity, Quality of life (QoL)(approx. 20 months)