Clinical trial NCT00094809: Chemotherapy Administered Every 2 Weeks With or Without Pegfilgrastim in Subjects With Advanced or Metastatic Colon Cancer
Official title: Chemotherapy Administered Every 2 Weeks With or Without a Single Injection of Pegfilgrastim as First or Second-Line Treatment in Subjects With Locally Advanced or Metastatic Colon Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Colon Cancer
Colorectal Cancer
Rectal Cancer
Keywords: Neulasta®
pegfilgrastim
Advanced
Chemotherapy
Lead sponsor: Amgen
Sponsor class: INDUSTRY
First posted: 2004-10-26
Enrollment: 252
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The purpose of this research study is to evaluate the safety and effectiveness of pegfilgrastim in reducing grade 3/4 neutropenia when given after one of three chemotherapy regimens (FOIL, FOLFOX or FOLFIRI) in patients with locally advanced or metastatic colorectal cancer. This study is considered to be "investigational" because the time between receiving pegfilgrastim and the next cycle of chemotherapy is only 11 days.


Eligibility criteria: Inclusion Criteria:

* Locally advanced or metastatic colorectal adenocarcinoma not curable by surgery or amenable to radiation therapy with curative intent.
* Histologically or cytologically documented locally advanced or metastatic colorectal cancer. The site of the primary lesion must be or has been confirmed endoscopically, radiologically, or surgically to be or has been in the large bowel.
* Measurable or evaluable disease.
* ECOG performance status 0, 1 or 2
* Life expectancy ≥ 12 weeks
* All of the following: (1) ≥ 4 weeks must have elapsed from the time of major surgery and subjects must have recovered from the effects (e.g., laparotomy); (2) ≥ 2 weeks must have elapsed from the time of minor surgery and subjects must have recovered from the operation (insertion of a vascular access device is not considered major or minor surgery); (3) ≥ 4 weeks must have elapsed from the time of major radiotherapy (e.g., chest or bone palliative radiation therapy).
* Subjects may have received prior adjuvant therapy and one prior chemotherapy regimen for metastatic disease providing 30 days has elapsed from last chemotherapy dose.
* Subject must have recovered from prior chemotherapy complications and in the opinion of the investigator, the subjects current status does not place the subject at risk for entry into the trial.
* Subjects with prior exposure to both oxaliplatin and irinotecan will not be eligible to participate in this study. However, if subject received prior therapy with oxaliplatin, they will be eligible to receive the FOLFIRI regimen. If subject received prior therapy with irinotecan, they will be eligible to receive the FOLFOX regimen.
* Age ≥ 18 years
* Absolute neutrophil count ≥ 1.5 x 109/L
* Platelet count ≥100 x 109/L
* Hemoglobin ≥ 9.0 g/dL (subjects may be receive a red blood cell transfusion to achieve this requirement)
* Creatinine ≤ 1.5 x UNL
* Total bilirubin ≤ 1.5 mg/dL (≤ 25.65 μmol/L), regardless of whether subjects have liver involvement secondary to tumor
* Aspartate aminotransferase ≤ 5 x UNL
* Alkaline phosphatase ≤ 5 x UNL
* Informed consent to participate on the study.

Exclusion Criteria:

* Standard chemoradiation as adjuvant treatment for colorectal cancer will be allowed, but prior radiotherapy to \>15% of bone marrow or outside of standard adjuvant colorectal cancer chemoradiation is not allowed.
* Known central nervous system metastases or carcinomatous meningitis.
* Predisposing colonic or small bowel disorders in which the symptoms are uncontrolled as indicated by baseline pattern of \>3 loose stools daily in subjects without a colostomy or ileostomy. Subjects with a colostomy or ileostomy may be entered at the Investigator's discretion.
* Pleural effusion or ascites, which cause respiratory compromise (≥Grade 2 dyspnea).
* Concurrent use of other investigational agents.
* No active infection requiring the start of systemic (intravenous or oral) anti-infective (antibiotic, antifungal, antiviral) within 72 hours of the administration of the first cycle of study chemotherapy.
* Symptomatic sensory peripheral neuropathy.
* The following conditions: Uncontrolled high blood pressure; unstable angina; symptomatic congestive heart failure; myocardial infarction ≤ 6 months prior to randomization; serious uncontrolled cardiac arrhythmia; New York Heart Association classification III or IV.
* Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinomas, or other cancer from which the patient has been disease-free for at least five years.
* Interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung.
* Medical or psychiatric conditions which, in the opinion of the Investigator, make participation in an investigational trial of this nature a poor risk.
* Known sensitivity to E. coli derived products (e.g., Filgrastim, HUMULIN® insulin, L-asparaginase, HUMATROPE® Growth Hormone, INTRON® A) or known sensitivity to any of the products to be administered during dosing.
* Subject is currently enrolled or has not yet completed at least 30 days since ending other investigational device or drug trial(s) or is receiving other investigational agent(s).
* Subject of child-bearing potential is evidently pregnant (e.g., positive HCG test) or is breast feeding.
* Subject is not using adequate contraceptive precautions.
* Subject will not be available for follow-up assessment.
* Concerns for subject's compliance with the protocol procedures.

Primary outcomes:
measure: Grade 3 or 4 Neutropenia
timeFrame: First 4 cycles of treatment (8 weeks)
measure: Grade 4 Neutropenia
timeFrame: First 4 cycles of treatment (8 weeks)
Secondary outcomes:
measure: Dose Delay or Reduction Due to Neutropenia
timeFrame: First 4 cycles of treatment (8 weeks)
measure: Dose Delay or Reduction for Any Reason
timeFrame: First 4 cycles of treatment (8 weeks)
measure: Febrile Neutropenia
timeFrame: First 4 cycles of treatment (8 weeks)
measure: Hospitalization Due to a Neutropenia-Related Event
timeFrame: First 4 cycles of neutropenia (8 weeks)
measure: Progression-Free Survival
timeFrame: Up to 24 months after first four cycles of treatment
measure: Objective Tumor Response
timeFrame: First 4 cycles of treatment (8 weeks)
measure: Survival
timeFrame: Up to 24 months after first four cycles of treatment
measure: Antibiotic Use Due to Febrile Neutropenia
timeFrame: First 4 cycles of treatment (8 weeks)
Other outcomes:
Locations:
Study officials:
affiliation: Amgen
name: MD
role: STUDY_DIRECTOR
References:
citation: Hecht JR, Pillai M, Gollard R, Heim W, Swan F, Patel R, Dreiling L, Mo M, Malik I. A randomized, placebo-controlled phase ii study evaluating the reduction of neutropenia and febrile neutropenia in patients with colorectal cancer receiving pegfilgrastim with every-2-week chemotherapy. Clin Colorectal Cancer. 2010 Apr;9(2):95-101. doi: 10.3816/CCC.2010.n.013.
citation: Lyman GH, Reiner M, Morrow PK, Crawford J. The effect of filgrastim or pegfilgrastim on survival outcomes of patients with cancer receiving myelosuppressive chemotherapy. Ann Oncol. 2015 Jul;26(7):1452-8. doi: 10.1093/annonc/mdv174. Epub 2015 Apr 7.