Trial Comparing Two Two Sequences of Therapy in Colorectal Metastatic Patients
Condition: Metastatic Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional
Phase: Phase 3

Summary: 
      Primary Objectives:

      Aim of this study is to compare the efficacy and safety of two different sequences of
      chemotherapeutic agents in order to optimize the treatment of patients with metastatic
      colorectal cancer progressed to a first line chemotherapy with FOLFIRI and bevacizumab.
      Primary endpoint will be overall survival, defined as the time elapsed from the date of
      randomization to the date of patient death due to any cause, or the last date the patient was
      known to be alive.

      Secondary Objectives Progression free survival, Quality of life, Health resource utilisation
      and economic evaluation, Toxicity and incidence of adverse events

      The study regimen includes:

      Strategy A: FOLFOX-4 followed, after progression, by irinotecan/cetuximab Strategy B:
      irinotecan/cetuximab followed, after progression, by FOLFOX-4 Patients will be randomly
      assigned to one of the two treatment sequences (with 1:1 ratio) using a block design
      randomization procedure stratified according to center.

      The patient accrual period is planned for approximately 36 months. To assess OS, all pts will
      be followed for up to 18 months after the last patient is randomised. The maximum estimated
      study duration is approximately 54 months.All statistical analyses will be based on an
      intention-to-treat approach. CONSORT rules will be applied to describe study flow and
      protocol deviations.
    

Detailed description: 
      Target population:

      Patients with histologically confirmed metastatic colorectal cancer progressed after a first
      line treatment containing FOLFIRI and BEV

      Inclusion criteria:

        -  Age >18 < 75 years of age

        -  Diagnosis of histologically proven adenocarcinoma of the colon or rectum, stage IV

        -  K-ras wild-type

        -  ECOG performance status 0-1 at study entry

      Endpoints:

      - Response Rate, Disease control rate, The duration of overall response, Overall survival,
      PFS, Time to treatment failure, Quality of Life, Incidence of AEs, Frequency and nature of
      serious adverse reactions (SADRs), Premature withdrawals

      Statistical methods:

      Assuming a randomization ratio of 1:1, 282 deaths are required in order to achieve a power of
      80% of detecting a hazard ratio of 0.72 in favour of one of the two sequences, translating in
      an increase of median survival time from 10 to 14 months, with a type I error of 5%,
      two-sided, using the Mantel-Cox version of the log-rank test. With a uniform accrual period
      of 3 years and a follow-up of 18 months, about 350 patients will be needed to reach the
      target number of events.

      All statistical analyses will be based on an intention-to-treat approach. CONSORT rules will
      be applied to describe study flow and protocol deviations.

      All OS and PFS curves will be drawn with the Kaplan-Meier method. Results will be presented
      as Hazard Ratio (HRs) and their 95% Confidence Interval (CIs).

      On annual basis, starting from the second year, an interim analysis will be conducted. In
      principle, no formal stopping rule will be applied, unless otherwise suggested by the DSMC.
      Safety reports will be drawn on annual basis.
    

Intervention name(s): FOLFOX-4; Irinotecan/Cetuximab
Intervention type(s): Drug; Drug
Intervention description(s): Day 1: OXA will be administered as a 85 mg/m2 iv infusion over 2 hours; Leucovorin as a 100 mg/m2 infusion over 2 hours, 5-FU will be given as a 400 mg/m2 bolus injection, and then as a 600 mg/m2 continuous infusion over 22 hours after the first infusion Day 2: Leucovorin 100 mg/m2 (alone), followed by 5-FU 400 mg/m2 bolus injection, and 5-FU 600 mg/m2 continuous infusion after the first infusion Cycle length is 2 weeks comprising approximately 48 hours of infusion and 12 days of rest. Cycles are to be repeated every second week for a total of either 6 (12 weeks) or 12 cycles (24 weeks).; CET 400 mg/m2 intravenously via infusion pump given over a 120 min time and weekly CET infusions at a maintenance dose of 250 mg/m2 given over a 60 min time.
IRI 180 mg/m2 iv infusion over 30-90 min. Cycle length is 2 weeks and it is to be repeated until disease progression.
Other intervention name(s): Oxaliplatin, 5FU, Leucovorin; CPT11/Cetuximab
Intervention MeSH terms: Leucovorin; Oxaliplatin; Irinotecan; Cetuximab
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: metastatic; colorectal cancer; two sequences therapy