Patient case: 70-year-old male with gastrointestinal stromal tumor; genetic feature: KIT (V654A)

Clinical trial: New Individualized Therapy Trial for Metastatic Colorectal Cancer

Summary: The purpose of this study is to evaluate the safety and tolerability of imatinib mesylate in combination with panitumumab for the treatment of stage IV colorectal cancer that has spread to the liver. It will also assess the whether imatinib mesylate, either alone or in combination with panitumumab, is effective in treating this type of cancer. In addition, the study will evaluate the feasibility of a predefined lab score and whether it can predict which patients will respond to treatment with imatinib mesylate.


Eligibility: Inclusion Criteria:
  -  Patients ≥ 18 years of age.
  -  Histologically documented diagnosis of Stage IV Metastatic Colorectal Cancer with Liver Metastases, refractory or progressive after at least one (1) prior line of therapy that must include a fluoropyrimidine (5-fluorouracil or capecitabine) AND (oxaliplatin OR irinotecan), i.e. FOLFOX, FOLFIRI, XELOX, or XELIRI.
  -  Documentation of wild type k-Ras expression in the liver lesion.
  -  At least one measurable site of disease (as defined by Response Evaluation Criteria in Solid Tumors, see Appendix 3), or other response assessment criteria, as appropriate.
  -  Must have ≥ 1 measurable liver lesion that can be accessed by CT guided biopsy.
  -  Performance status 0,1, or 2 (ECOG).
  -  Adequate end organ function, defined as the following: total bilirubin < 1.5 x ULN, SGOT and SGPT < 2.5 x UNL, creatinine < 1.5 x ULN, ANC > 1.5 x 10^9/L, platelets > 100 x 10^9/L.
  -  Life expectancy of at least 3 months.
  -  Female patients of childbearing potential must have negative pregnancy test within 7 days before initiation of study drug dosing. Postmenopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Female patients of reproductive potential must agree to employ an effective barrier method of birth control throughout the study and for up to 7 days following discontinuation of study drug.
  -  Written, voluntary informed consent.
  Exclusion Criteria:
  -  Patient has received any other investigational agents within 28 days of first day of study drug dosing, unless the disease is rapidly progressing.
  -  Patient is < 5 years free of another primary malignancy except: if the other primary malignancy is neither currently clinically significant nor requiring active intervention, or if other primary malignancy is a basal cell skin cancer or a cervical carcinoma in situ. Existence of any other malignant disease is not allowed.
  -  Patient with Grade III/IV cardiac problems as defined by the New York Heart Association Criteria. (i.e., congestive heart failure, myocardial infarction within 6 months of study)
  -  Female patients who are pregnant or breast-feeding.
  -  Patient has a severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection).
  -  Patient has a known brain metastasis not treated with definitive therapy with stable disease ≥ 4 weeks.
  -  Patient has known chronic liver disease (i.e., chronic active hepatitis, and cirrhosis).
  -  Patient has a known diagnosis of human immunodeficiency virus (HIV) infection.
  -  Patient received chemotherapy within 2 weeks (6 weeks for nitrosourea or mitomycin-C)prior to study entry, unless the disease is rapidly progressing.
  -  Patient previously received radiotherapy to ≥ 25% of the bone marrow
  -  Patient had a major surgery within 2 weeks prior to study entry.
  -  Patient with any significant history of non-compliance to medical regimens or with inability to grant reliable informed consent.
  -  Patients intolerant to imatinib mesylate.

Relevance to patient case: not relevant