Clinical trial NCT01661270: A Study of Aflibercept Versus Placebo With FOLFIRI in Patients With Metastatic Colorectal Cancer Previously Treated With an Oxaliplatin Chemotherapy
Official title: A Multinational, Randomized, Double-Blind Study of Aflibercept Versus Placebo With Irinotecan/ 5-FU Combination (FOLFIRI) in Patients With Metastatic Colorectal Cancer (MCRC) After Failure of an Oxaliplatin Based Regimen
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Colorectal Cancer Metastatic
Lead sponsor: Sanofi
Sponsor class: INDUSTRY
Collaborators: name: Regeneron Pharmaceuticals
First posted: 2012-08-09
Enrollment: 332
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Primary Objective:

To evaluate the improvement in progression-free survival (PFS) of aflibercept versus placebo in participants with metastatic colorectal cancer treated with FOLFIRI as second-line treatment for metastatic disease.

Secondary Objectives:

To compare the overall survival (OS) in the 2 treatment arms. To compare the overall response rate (ORR) in the 2 treatment arms. To assess the safety profile of the 2 treatment arms. To assess immunogenicity of intravenous (IV) aflibercept in selected centers.

Detailed description: Screening occurred from signed informed consent to randomization (up to 21 days). A treatment cycle was defined as a 2 week-period. All participants were followed during the study treatment and follow-up period until death or study cut off date, which ever comes first.

Eligibility criteria: Inclusion criteria:

* Histological or cytological proven adenocarcinoma of the colon or rectum.
* Metastatic disease that was not amenable to potentially curative treatment.
* One and only one prior chemotherapeutic regimen for metastatic disease. This prior chemotherapy must be an oxaliplatin containing regimen. Participants who were relapsed within 6 months of completion of oxaliplatin based adjuvant chemotherapy were eligible.

Exclusion criteria:

* Prior therapy with irinotecan.
* Eastern Cooperative Oncology Group (ECOG) performance status \>1.
* Less than 28 days elapsed from prior radiotherapy, from prior surgery and prior chemotherapy to the time of randomization. Less than 42 days elapsed from prior major surgery to the time to randomization.
* Adverse events (with exception of alopecia, peripheral sensory neuropathy grade ≤ 2 and those listed in specific exclusion criteria) from any prior anticancer therapy of grade \>1 (National Cancer Institute Common terminology Criteria \[NCI CTCAE\] v.3.0) at the time of randomization.
* Age \<18 years.
* History of brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis or new evidence of brain or leptomeningeal disease.
* Other prior malignancy. Adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix or any other cancer from which the participants had disease free for \> 5 years were allowed.
* Participation in another clinical trial with an investigational drug and any concurrent treatment with any investigational drug within 30 days prior to randomization.
* Any of the following within 6 months prior to randomization: myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft, New York Heart Association Functional Classification (NYHA) class III or IV congestive heart failure, stroke or transient ischemic attack.
* Any of the following within 3 months prior to randomization: treatment resistant peptic or duodenal ulcer disease, erosive oesophagitis or gastritis, grade 3 or 4 gastrointestinal bleeding/hemorrhage, gastrointestinal perforation/fistula, abdominal abscess, infectious or inflammatory bowel disease, diverticulitis, pulmonary embolism, or other uncontrolled thromboembolic event.
* Participants who had given high dose of aspirin or non steroidal anti-inflammatory agents (NSAIDS) or high steroids within 4 weeks prior to randomization. The definition of "high dose" was to be based on the investigator's judgment.
* Occurrence of deep vein thrombosis within 4 weeks, prior to randomization.
* Inadequate organ or bone marrow function.
* Pregnant or breast-feeding woman. Positive serum or urine pregnancy test prior to randomization. Participants with reproductive (M/F) who were not agree to use accepted and effective method of contraception during the study treatment period and for at least 6 months following completion of study treatment.
* Uncontrolled hypertension.
* Urine Protein: creatine ratio (UPCR) \>1 on morning spot urinalysis or proteinuria \> 500mg/24 hours.
* Participants on anticoagulant therapy with unstable dose of warfarin and/or having an out-of-therapeutic range international normalized ratio (INR) (\>3) within 4 weeks prior to randomization.
* Evidence of clinically significant bleeding diathesis or underlying coagulopathy.
* Known dihydropyrimidine dehydrogenase deficiency.
* Predisposing colonic or small bowel disorder in which the symptoms were uncontrolled as indicated by baseline of \> 3 loose stools daily.
* Prior history of chronic enteropathy, inflammatory enteropathy, chronic diarrhea, unresolved bowel obstruction/sub-obstruction, more than hemicolectomy, extensive small intestine resection with chronic diarrhea.
* History of anaphylaxis or known intolerance to atropine sulphate or loperamide or appropriate antiemetics to be administered in conjunction with FOLFIRI.
* Treatment with concomitant anticonvulsant agents that were cytochrome P450 3A4 (CYP3A4) inducers (phenytoin, phenobarbital, carbamazepine), unless discontinued \> 7 days.
* Participants with known Gilbert's syndrome.

The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.

Primary outcomes:
measure: Progression-free Survival (PFS)
timeFrame: 26.7 months
Secondary outcomes:
measure: Overall Survival (OS)
timeFrame: 31.6 months
measure: Percentage of Participants With Objective Response
timeFrame: 26.6 months
Other outcomes:
Locations:
city: Beijing
country: China
facility: Investigational Site Number 156003
city: Beijing
country: China
facility: Investigational Site Number 156001
city: Beijing
country: China
facility: Investigational Site Number 156002
city: Beijing
country: China
facility: Investigational Site Number 156004
city: Chengdu
country: China
facility: Investigational Site Number 156016
city: Chongqing
country: China
facility: Investigational Site Number 156020
city: Fuzhou
country: China
facility: Investigational Site Number 156021
city: Guangzhou
country: China
facility: Investigational Site Number 156008
city: Hangzhou
country: China
facility: Investigational Site Number 156010
city: Hangzhou
country: China
facility: Investigational Site Number 156011
city: Hangzhou
country: China
facility: Investigational Site Number 156009
city: Harbin
country: China
facility: Investigational Site Number 156015
city: Nanjing
country: China
facility: Investigational Site Number 156012
city: Nanjing
country: China
facility: Investigational Site Number 156013
city: Shanghai
country: China
facility: Investigational Site Number 156006
city: Shanghai
country: China
facility: Investigational Site Number 156007
city: Shenyang
country: China
facility: Investigational Site Number 156014
city: Tianjin
country: China
facility: Investigational Site Number 156005
city: Wuhan
country: China
facility: Investigational Site Number 156019
city: Wuhan
country: China
facility: Investigational Site Number 156018
city: Xi'An
country: China
facility: Investigational Site Number 156017
city: Hong Kong
country: Hong Kong
facility: Investigational Site Number 344002
city: Shatin, Nt
country: Hong Kong
facility: Investigational Site Number 344001
city: Amagasaki-Shi
country: Japan
facility: Investigational Site Number 392006
city: Bunkyo-Ku
country: Japan
facility: Investigational Site Number 392003
city: Bunkyo-Ku
country: Japan
facility: Investigational Site Number 392004
city: Gifu-Shi
country: Japan
facility: Investigational Site Number 392009
city: Kitaadachi-Gun
country: Japan
facility: Investigational Site Number 392002
city: Kobe-Shi
country: Japan
facility: Investigational Site Number 392001
city: Kochi-Shi
country: Japan
facility: Investigational Site Number 392005
city: Kumamoto-Shi
country: Japan
facility: Investigational Site Number 392007
city: Nagakute-Shi
country: Japan
facility: Investigational Site Number 392008
city: Takatsuki-Shi
country: Japan
facility: Investigational Site Number 392010
city: Singapore
country: Singapore
facility: Investigational Site Number 702002
city: Singapore
country: Singapore
facility: Investigational Site Number 702001
city: Taipai
country: Taiwan
facility: Investigational Site Number 158003
city: Taipei
country: Taiwan
facility: Investigational Site Number 158002
Study officials:
affiliation: Sanofi
name: Clinical Sciences & Operations
role: STUDY_DIRECTOR
References:
citation: Li J, Xu R, Qin S, Liu T, Pan H, Xu J, Bi F, Lim R, Zhang S, Ba Y, Bai Y, Fan N, Tsuji A, Yeh KH, Ma B, Wei V, Shi D, Magherini E, Shen L. Aflibercept plus FOLFIRI in Asian patients with pretreated metastatic colorectal cancer: a randomized Phase III study. Future Oncol. 2018 Aug;14(20):2031-2044. doi: 10.2217/fon-2017-0669. Epub 2018 Aug 17.