Cetuximab and Vemurafenib Plus FOLFIRI for BRAF V600E Mutated Advanced Colorectal Cancer (IMPROVEMENT)

Study Overview
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Brief Summary
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This clinical trial aims to evaluate the efficacy, safety of FOLFIRI with vemurafenib and cetuximab in Advanced Colorectal Cancer Patients with BRAF V600E mutation.

Official Title
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Cetuximab and Vemurafenib Plus FOLFIRI for BRAF V600E Mutated Advanced Colorectal Cancer (IMPROVEMENT): A Single-arm Study

Conditions
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Colorectal Cancer

Intervention / Treatment
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* Drug: Vemurafenib
* Drug: Cetuximab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients have histologically or cytologically confirmed advanced or recurrent CRC; Patients with BRAV V600E mutation/KRAS WT based on the NGS or ARMS-PCR detection of tumor tissue; Patients have measurable disease as defined by RECIST 1.1 as determined by investigator; Patient with a history of radiotherapy at least 3 months before on the day of providing consent, but the measurable lesion should not be within the scope of radiotherapy; Patients without a history of receiving vemurafenib or cetuximab; Patients with age of 18-75yr; Patients with a performance status of 0,1or 2 on the Eastern Cooperative Oncology Group.； Patients with Life expectancy of more than 12 weeks; Patients must have the ability to understand and sign the written informed consent voluntarily; Female of childbearing potential who are negative in a pregnancy test within 14 days before enrollment. Both male and female patients should agree to use an adequate method of contraception (total abstinence, an intrauterine device or hormone releasing system, an contraceptive implant and an oral contraceptive) starting with the first dose of study therapy through 120 days after the last dose of study therapy. Duration will be determined when the subject is assigned to treatment. Exclusion Criteria: Patients with KRAS/NRAS mutation; Patients with major surgery or severe trauma within 4 weeks before the first medication; Patients with hypersensitivity to the components in the study protocol;； Patients who are ready to give birth or are pregnant.。 Patients with brain metastases 。 Bone marrow, liver and kidney function did not meet the requirements of chemotherapy as follows： Neutrophil count<1,500/mm3； Platelet count <80,000/mm3； Total bilirubin >1.5-times the upper limit of normal； ALT/AST>2.5-times the upper limit of normal for patients without liver metastases; (5.0-times the upper limit of normal for patients without liver metastases) Creatinine >1.5-times the upper limit of normal； Patients with cancers other than advanced colorectal cancer within five years prior to the start of treatment in this study. Cervical carcinoma in situ, cured basal cell carcinoma and bladder epithelial tumor were excluded;； Patients without legal capacity or limited civil capacity;

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FIVC group<br>Irinotecan 180mg/m2 iv gtt (14 days per course) leucovorin 400mg/m2 iv gtt (14 days per course) 5-fluorouracil 400mg/m2 iv (14 days per course) 5-fluorouracil 2400 mg/m2 46h (14 days per course) vemurafenib 960mg po bid cetuximab 500mg/m2 iv gtt (14 days per course) | Drug: Vemurafenib<br>* 960mg po bid<br>* Other names: PLX4032, RG7204;Drug: Cetuximab<br>* 500mg/m2 iv gtt (14 days per course)<br>* Other names: ERBITUX;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective Response Rate(ORR) | Evaluation of tumor burden based on RECIST criteria every 3 cycles(each cycle is 14 days), ORR is the proportion of patients with reduction in tumor burden of a predefined amount, including complete response and partial response. | up to 55 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease Control Rate (DCR) | Evaluation of tumor burden based on RECIST criteria every 3 cycles(each cycle is 14 days), and DCR is the proportion of patients with reduction in tumor burden of a predefined amount, including complete response, partial response and stable disease | up to 55 months | 
| Progression-free survival | Evaluation of tumor burden based on RECIST criteria until first documented progress through study completion, an average of 6 weeks | Time from treatment beginning until the date of first documented progression, assessed up to 55 months | 
| Overall survival | From date of treatment beginning until the date of death from any cause, through study completion, an average of 6 weeks | Time from treatment beginning until date of death from any cause, assessed up to 55 months | 
| adverse events | Incidence of Treatment-related adverse Events | Through study completion, an average of 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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FLOFIRI, vemurafenib, cetuximab, BRAF V600E mutation, Advanced Colorectal Cancer