A Phase II trial to demonstrate the response rate, using the Response evaluation criteria in solid tumours (RECIST) criteria, of patients with locally advanced / metastatic colorectal cancer treated with combination of irinotecan, oxaliplatin, UFT and cetuximab.

ENDPOINTS Primary: Objective response rate (RECIST) Secondary: Progression free survival (PFS), Overall survival (OS) Toxicity (CTCAE), Resectability of liver, lung and pelvic disease after chemotherapy, Time to progression (TTP).

POPULATION: The trial aims to recruit 50 patients with inoperable, metastatic colorectal cancer ELIGIBILITY: Histologically confirmed colorectal adenocarcinoma Normal haematology and adequate renal and liver function Written informed consent and able to attend follow-up for at least 3 months TREATMENT 4 weekly cycles of chemotherapy with alternating irinotecan (day 1) and oxaliplatin(day 15). Cetuximab every 2 weeks and oral UFT with Leucovorin for 3 weeks every 4 weeks.

DURATION First patient recruited April 2009. Accrual to take place over 24 months Follow-up will continue until death or for a minimum of 3 years

Inclusion Criteria:

• Histologically confirmed adenocarcinoma of the colon or rectum.
• Patients must not have a mutation of K-ras
• Inoperable metastatic or locoregional disease (synchronous or recurrence)
• No previous chemotherapy for established metastatic disease (adjuvant chemotherapy must have been completed more than 6 months prior to trial entry)
• Measurable or evaluable disease
• Bone marrow function: neutrophil count >1.5 x109/l and platelet count >150 x109/l
• Hepatobiliary function: serum bilirubin <1.5 x upper limit of normal (ULN); ALP <5 x ULN; transaminase (AST or ALT) <3 x ULN.(≤ 5 if liver mets are present)
• Renal function: estimated creatinine clearance >50 ml/min, or measured Glomerular filtration rate (GFR) (EDTA or creatinine clearance) in normal range
• ECOG performance status 0-1 and considered fit and able to undergo all possible treatments
• For women of child-bearing potential a negative pregnancy test is required and adequate contraceptive precautions such as a sheath for their partner must be used
• For men - adequate contraception such as a sheath must be used
• Patients must give written, informed consent
• Life expectancy ≥ 3 months.

Exclusion Criteria:

• Patients that have a K-ras mutation
• Concurrent uncontrolled medical illness, or other previous or current malignant disease likely to interfere with protocol treatments or comparisons
• Partial or complete bowel obstruction
• Prior EGFR antibody therapy
• Age <18
• Chronic diarrhoea or inflammatory bowel disease
• Known Pyruvate Dehydrogenase Phosphatase (DPD) deficiency
• Gilbert's syndrome or other congenital abnormality of biliary transport
• Previous transplant surgery, requiring immunosuppressive therapy
• Regular / uncontrolled angina or cardiac arrhythmias
• Clinically relevant coronary artery disease. History of Myocardial infarction in the last 12 months
• Previous investigational agent in the last 4 weeks
• Metastatic disease to brain
• Any pregnant or lactating women
• Patients receiving therapy with haloginated antiviral drugs (eg: sorivudine)
• Patients who have experienced life-threatening toxicities with fluoropyrimidines treatment
• Patients suffering from any condition that may affect the absorption of UFT or folinic acid.
• Patients with known deficiency of or are on inhibitors of cytochrome P450 2A6
• Patients who have previously had radiotherapy to the abdomen or pelvis in the last 6 months
• Any medical or psychological condition that in the opinion of the investigator would not enable the patient to complete the study or knowingly give informed consent