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Drugs used against cancer work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as CMAB009, can block tumor growth in different ways. Giving combination chemotherapy together with CMAB009 as first treatment after diagnosis of a metastatic colorectal cancer(first-line treatment)may improve the treatment efficacy. However, it is not yet known whether giving combination chemotherapy together with CMAB009 is more effective than combination chemotherapy alone. This open-label trial investigates the effectiveness of CMAB009 in combination with a standard and effective chemotherapy FOLFIRI(5-Fluorouracil /Folinic acid plus Irinotecan)for RAS/BRAF wild-type, metastatic colorectal cancer in first-line setting, compared to the same chemotherapy alone.
Patients will be randomly assign in one of the two groups to either receive the combination chemotherapy alone or with CMAB009 and will then be treated until progression of the disease or unacceptable toxicity occurred. Regular efficacy assessments(every 8 weeks)based on imaging will be performed throughout the study together with regular safety assessments.
After participant discontinuation from the trial, regular updates on further treatments and survival status will be requested from the investigator.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CMAB009 + FOLFIRI | Experimental | Drug: CMAB009(recombinant chimeric anti-EGFR monoclonal antibody injection), will be administered every 7 days at an initial dose of 400mg/m^2 and 250mg/m^2 for subsequent infusions until progression of disease , withdrawal of consent, or unacceptable toxicity. Drug: Irinotecan bi-weekly irinotecan infusion of 180mg/m^2 on Day 1. Drug: Folinic Acid infusion 400mg/m^2 of folinic acid in on Day 1. Drug: 5-Fluorouracil bolus 5-Fluorouracil bolus of 400mg/m^2 followed by a 46-48 h continuous infusion of 2400mg/m^2. every 2 weeks until progression of disease , withdrawal of consent, or unacceptable toxicity. |
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| FOLFIRI | Active Comparator | FOLFIRI Drug: Irinotecan bi-weekly irinotecan infusion of 180mg/m^2 on Day 1. Drug: Folinic Acid infusion 400mg/m^2 of folinic acid in on Day 1. Drug: 5-Fluorouracil bolus 5-Fluorouracil bolus of 400mg/m^2 followed by a 46-48 h continuous infusion of 2400mg/m^2. every 2 weeks until progression of disease , withdrawal of consent, or unacceptable toxicity. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CMAB009 | Drug | for injection only |
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| Measure | Description | Time Frame |
|---|---|---|
| Progression-Free Survival (PFS) | The PFS duration (in months) is determined by a specially authorized Independent Radiology Review Committee (IRaC) through blinded review of imaging data. It is defined as the time from randomization to the first confirmed progression of disease by imaging or death from any cause within 90 days after the last tumor assessment or randomization, whichever is later (equivalent to 1.5 times the interval between two consecutive tumor assessments). | Tumor assessments are conducted every 8 weeks after randomization until the end of the study, an average of 1 year. |
| Measure | Description | Time Frame |
|---|---|---|
| Objective Response Rate (ORR) | The objective response rate is calculated as the percentage of evaluable subjects with complete response (CR) and partial response (PR) (ORR = CR + PR). | Tumor assessments are conducted every 8 weeks after randomization until the end of the study, an average of 1 year. |
| Overall Survival(OS) |
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Inclusion Criteria:
Exclusion Criteria:
Radiotherapy or surgery(excluding prior diagnostic biopsy)in the 30 days before trial treatment
Hepatic, marrow, liver and renal function as follows:
Marrow: white blood cell count <3.0 × 109/L with neutrophils<1.5 × 109/L, platelet count<100×109/L and hemoglobin<90 g/L; Liver function: Total bilirubin >1.5 × upper limit of reference range; Aspartate transaminase (AST) and alanine transaminase (ALT) > 2.5 × upper limit of reference range , or> 5 × upper reference range in subjects with liver metastasis; Renal function: Serum creatinine >1.5 × upper limit of reference range, or creatinine clearance<50 mL/min
Previous chemotherapy for CRC adjuvant treatment if terminated <12 months before diagnosis of recurrence or metastatic disease
Previous treatment with anti-EGFR monoclonal antibody, epidermal growth factor receptor tyrosine kinase inhibitor, or other EGFR targeted inhibitors(such as cetuximab, Nimotuzumab, or panitumumab)
Known hypersensitivity or allergic reactions against any of the components of the trial treatments
History of organ allograft, autologous stem cell transplantation, or allogeneic stem cell transplantation
Other non-permitted concomitant anti-cancer therapies
Known brain metastasis and/or leptomeningeal disease
Previous malignancy other than CRC in the last 5 years except basal cell cancer of the skin or preinvasive cancer of the cervix
Participation in another clinical trial within the past 30 days
Concurrent chronic systemic immune therapy or hormone therapy except physiologic replacement
Any unstable systemic disease, such as active infection, uncontrolled hypertension, unstable angina pectoris, angina in the last 3 months, cardiac failure of New York Heart Association classes ≥II, history of myocardial infarction, serious cardiac arrhythmias that require drug treatment, liver, kidney or metabolic disease in the last 6 months
Acute or sub-acute intestinal occlusion or history of inflammatory bowel disease
severe bone marrow function failure
Any disease, metabolic disorders, or physical/laboratory examination suspected, or patients with high risk of complications
Known and declared history of human immunodeficiency virus(HIV)infection
HBV-DNA >1.0 × 103copy
Pregnancy or breastfeeding
Alcohol or drug abuse
Legal incapacity or limited legal capacity
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| Name | Affiliation | Role |
|---|---|---|
| Yuankai Shi Professor, Ph.D | Cancer Institute and Hospital, Chinese Academy of Medical Sciences | Principal Investigator |
| Yi Ba Professor, Ph.D | Tianjin Medical University Cancer Institute and Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cancer hospital Chinese academy of medical sciences | Beijing | Beijing Municipality | 100021 | China | ||
| Tianjing medical university cancer institute and hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40328753 | Derived | Shi Y, Ba Y, Wang J, Xiong J, Gu K, Chen Y, Zheng Z, Wang Z, Guo W, Cheng Y, Yin X, Liu Y, Bai Y, Li E, Li Q, Zhu L, Li W, Jiang D, He J, Chen J, Sun J, Hou S. First-line treatment of anti-EGFR monoclonal antibody cetuximab beta plus FOLFIRI versus FOLFIRI alone in Chinese patients with RAS/BRAF wild-type metastatic colorectal cancer: a randomized, phase 3 trial. Signal Transduct Target Ther. 2025 May 7;10(1):147. doi: 10.1038/s41392-025-02229-4. |
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| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
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| ID | Term |
|---|---|
| C559688 | CMAB009 |
| D000077146 | Irinotecan |
| D002955 | Leucovorin |
| D005472 | Fluorouracil |
| ID | Term |
|---|---|
| D002166 | Camptothecin |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D005575 | Formyltetrahydrofolates |
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| Irinotecan | Drug | for injection only |
|
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| Folinic acid | Drug | for injection only |
|
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| 5-fluorouracil | Drug | for injection only |
|
|
Defined as the time from randomization to death (in months). For subjects still alive or lost to follow-up as of the data analysis cutoff date, survival is censored at the subject's last known alive time. |
| From randomization until the end of the study, an average of 1 year. |
| Disease Control Rate (DCR) | Refers to the percentage of subjects with the best response of complete response (CR), partial response (PR), and stable disease (SD) according to RECIST 1.1 criteria (DCR = CR + PR + SD). | Tumor assessments are conducted every 8 weeks after randomization until the end of the study, an average of 1 year. |
| Time to Response (TTR) | For subjects with the best response of CR or PR according to RECIST 1.1 criteria, the time from randomization to the first occurrence of response (CR or PR) according to RECIST 1.1. | Tumor assessments are conducted every 8 weeks after randomization until the end of the study, an average of 1 year. |
| Quality of Life Assessment Indicators | Quality of life assessment (QOL) is conducted using the EORTC QLQ-C30 questionnaire, with individual item categorical scores linearly transformed to a 0-100 scale. | Assessments are conducted at baseline and subsequent visits every 8 weeks until withdrawal from the study and entry into the follow-up period. |
| Resection Rate of Hepatic Metastasis | The resection rate of hepatic metastasis is calculated as the number of subjects achieving complete resection (R0 resection) divided by the total number of subjects. | From randomization to the end of study |
| Safety Endpoint | Drug exposure, All types of AEs and incidence rates, Mortality rate and causes of death, Safety laboratory tests, Vital signs and Immunogenicity. | From enrollment to the end of study |
| Tianjin |
| Tianjin Municipality |
| 300000 |
| China |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
| D013763 |
| Tetrahydrofolates |
| D005492 | Folic Acid |
| D011622 | Pterins |
| D011621 | Pteridines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D003067 | Coenzymes |
| D045762 | Enzymes and Coenzymes |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |