Aflibercept or Bevacizumab as Second-line Treatment of RAS Mutated Metastatic Colorectal Cancer

Metastatic Colorectal Cancer Clinical Trial

— ARBITRATION  

Official title:

AflibeRcept or Bevacizumab In Combination With Folfiri as Second-line Treatment of RAS Mutated metastaTIc cOlorectal Cancer patieNts

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04397601
• Other study ID #: 04/20
• Status: Recruiting
• Start date: May 11, 2020
• Est. completion date: May 11, 2024

Study information

• Verified date: May 2020
• Source: National Cancer Institute, Naples
• Contact: Alessandro Ottaiano, MD
• Phone: 0815903510
• Email: a.ottaiano[@]istitutotumori.na.it
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Colorectal cancer is the third most frequent neoplasm after prostate and lung in man and breast and lung cancers in woman from Western Countries. The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. In this context, the assessment of RAS (N- and K-) oncogene mutations is able to predict the response to anti-EGFR agents being mutated RAS mCRC patients resistant to these drugs. In this group of patients the use of anti-angiogenic drugs (bevacizumab and aflibercept) is predominant. Still to date there are no studies to guide oncologists in the selection of the best anti-angiogenic drug (bevacizumab beyond progression vs aflibercept) after failure of the first-line chemotherapy in RAS-M mCRC patients. The present is the first observational, pragmatic, prospective study aimed to report outcomes of mCRC patients treated with folfiri plus bevacizumab versus folfiri plus aflibercept in second-line treatment of mRAS mCRC. Furthermore, the serum levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), vascular endothelial growth factor-A and C (VEGF-A and C), stromal cell-derived factor-1 (SDF-1), platelet-derived growth factor beta (PDGF-β), basic fibroblast growth factor (bFGF), interleukin-8 (IL-8), chemokine (C-C motif) ligand 2 (CCL2), and chemokine (C-C motif) ligand 5 (CCL5) and Placental Growth Factor (PlGF), will be evaluated before starting second-line chemotherapy with bevacizumab or aflibercept in order to evidence any pattern related to response and/or prognosis. The hypothesis is that knowledge of eventual unbalance of these factors could help to select the best anti-angiogenic drug in second-line treatment of mRAS mCRC patients.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 220
• Est. completion date: May 11, 2024
• Est. primary completion date: May 11, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Cytological or histological diagnosis of RAS mutated mCRC;

• progression at first-line chemotherapy with fluoropyrimidines, oxaliplatin and bevacizumab;

• stage IV;

• age <75 years;

• ECOG Performance Status 0 or 1;

• life expectancy> 3 months;

• negative pregnancy test for all potentially childbearing women.

Exclusion Criteria:

• presence of primary non-treated stenosing colorectal neoplasm;

• active or uncontrolled infections or bleedings;

• other concomitant uncontrolled diseases or blood laboratory values contraindicating the study drugs at clinician evaluation;

• presence of brain metastases;

• refusal or inability to provide informed consent;

• impossibility to guarantee follow-up.

Related Conditions & MeSH terms

• Colorectal Neoplasms
• Metastatic Colorectal Cancer

Intervention

Drug:
• Folfiri/Bevacizumab
Irinotecan (180 mg/m2), leucovorin (400 mg/m2), fluorouracil as an intravenous bolus of 400 mg/m2, and fluorouracil as a continuous 46-h infusion of 2400 mg/m2 in combination with bevacizumab (5 mg/kg) on day 1 of each 14-day cycle.
• Folfiri/Aflibercept
Irinotecan (180 mg/m2), leucovorin (400 mg/m2), fluorouracil as an intravenous bolus of 400 mg/m2, and fluorouracil as a continuous 46-h infusion of 2400 mg/m2 in combination with aflibercept (4 mg/kg) on day 1 of each 14-day cycle.

Locations

Country	Name	City	State
Italy	SSD-Terapie Innovative Metastasi Addominali, Dipartimento di Oncologia Addominale, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale".	Naples

Sponsors (1)

Lead Sponsor	Collaborator
National Cancer Institute, Naples

Country where clinical trial is conducted

Italy, 

References & Publications (1)

Ottaiano A, Capozzi M, Tafuto S, De Stefano A, De Divitiis C, Romano C, Avallone A, Nasti G. Folfiri-Aflibercept vs. Folfiri-Bevacizumab as Second Line Treatment of RAS Mutated Metastatic Colorectal Cancer in Real Practice. Front Oncol. 2019 Aug 13;9:766. doi: 10.3389/fonc.2019.00766. eCollection 2019. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Serum level of VEGF-A (Vascular Endothelial Growth Factor-A).	The molecule will be measured through ELISA test.	3 years
Other	Serum level of PlGF (Placental Growth Factor).	The molecule will be measured through ELISA test.	3 years
Primary	Overall Survival (OS).	OS will be measured from treatment start until death from any cause.	3 years
Secondary	Toxic effects.	Toxic effects will be assessed by CTCAE of the National Cancer Institute, version 4.0, June 14, 2010.	3 years
Secondary	Responses' duration.	Time elapsed from date of response to progression occurrence.	3 years
Secondary	Progression-free survival (PFS).	PFS will be determined from the date of treatment start until progression.	3 years