Patient case: 57-year-old male with lung adenocarcinoma; genetic feature: KRAS (G12V), high tumor mutational burden

Clinical trial: Study Evaluating the Safety and Efficacy of FOLFIRI Plus Cetuximab or FOLFOX Plus Cetuximab as First-line Therapy in Subjects With KRAS Wild-type Metastatic Colorectal Cancer (APEC-Study)

Summary: This is an open-label, non-randomized, multicenter Phase II study evaluating folinic acid + fluorouracil + irinotecan (FOLFIRI) plus cetuximab (Erbitux) or folinic acid + fluorouracil + oxaliplatin (FOLFOX) plus cetuximab as first-line therapy of patients with KRAS wild-type metastatic colorectal cancer.
  Only subjects with k-ras oncogene (KRAS) wild-type tumors are eligible. Efficacy will be assessed every 8 weeks. Treatment will be continued until progressive disease or unacceptable adverse events occur. After the end of study treatment, information on further anticancer treatment and survival will be collected every 3 months.


Eligibility: Inclusion Criteria:
  Signed written informed consent
  -  Inpatient or outpatient subjects, 18 years of age
  -  Diagnosis of histologically confirmed adenocarcinoma of the colon or rectum
  -  Metastatic disease (M1)
  -  Life expectancy of at least 12 weeks
  -  Presence of at least 1 measurable index lesion (not lie in an irradiated area) by computed tomography (CT) scan or magnetic resonance imaging (MRI)
  -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at study entry
  -  Effective contraception for both male and female subjects if the risk of conception exists
  -  White blood cell count greater than or equal to (>=) 3,000 per cubic millimeter (/mm^3) with neutrophils >=1,500/mm3, platelet count >=100,000/mm3, hemoglobin >=5.6 millimole per liter (mmol/L) (9 gram per deciliter [g/dL])
  -  Total bilirubin less than or equal to (<=) 1.5 x upper reference range
  -  Aspartate aminotransferase (AST) <=2.5 x upper reference range, or <=5 x upper reference range in case of liver metastasis
  -  Serum creatinine <=1.5 x upper reference range
  -  Recovery from relevant toxicity to previous treatment before study entry
  -  KRAS wild-type status of tumor tissue
  Exclusion Criteria:
  -  Previous chemotherapy for colorectal cancer except adjuvant treatment if terminated >6 months before the start of treatment in this study
  -  Radiotherapy, surgery (excluding prior diagnostic biopsy) or any investigational drug in the 30 days before the start of treatment in this study
  -  Concurrent chronic systemic immune therapy, targeted therapy, anti-vascular endothelial growth factor (VEGF) therapy, or epidermal growth factor receptor (EGFR-) pathway targeting therapy not indicated in this study protocol
  -  Concurrent hormone therapy not indicated in this study protocol except for physiologic replacement or contraception
  -  Known hypersensitivity reaction to any of the components of study treatments
  -  Pregnancy (absence to be confirmed by beta human choriongonadotrophin [beta-hCG] test) or lactation period
  -  Brain metastasis and/or leptomeningeal disease (known or suspected)
  -  Clinically relevant coronary artery disease, history of myocardial infarction in the last 12 months, or high risk of uncontrolled arrhythmia
  -  Acute or sub-acute intestinal occlusion or history of inflammatory bowel disease
  -  Peripheral neuropathy > grade 1
  -  Previous malignancy other than colorectal cancer in the last 5 years except basal cell cancer of the skin or preinvasive cancer of the cervix
  -  Known alcohol or drug abuse
  -  Medical or psychological conditions that would not permit the patient to complete the study or sign informed consent
  -  Participation in another clinical study within the past 30 days
  -  Significant disease which, in the investigator's opinion, would exclude the patient from the study
  -  Legal incapacity or limited legal capacity
  -  KRAS mutated status of tumor tissue

Relevance to patient case: not relevant