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The primary purpose of this study is to determine the non-inferiority of overall survival FOLFIRI with or without Bevacizumab compared with Irinotecan (CPT-11) with or without Bevacizumab as Second-line therapy in Patient with Metastatic Colorectal Cancer.
Primary endpoint: Progression-free survival (PFS)ï¼› Secondary endpoints: Overall survival (OS), Time to treatment failure (TTF), Overall response rate (ORR), Disease Control Rate (DCR), Safety.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FOLFIRI +/- Bevacizumab | Experimental | Bevacizumab 5 mg/kg IV 90-30 min Day 1; CPT-11 180 mg/m2 IV 90 min Day 1; l-LV (dl-LV) 200 mg/m2 (400 mg/m2) IV 120 min Day 1; 5-FU - bolus 400 mg/m2 IV bolus Day 1; 5-FU - infusional 2400 mg/m2 IV continuous (46 hours) Day 1 - 3 |
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| CPT-11 +/- Bevacizumab | Experimental | Bevacizumab 5 mg/kg IV 90-30 min Day 1; CPT-11 180 mg/m2 IV 90 min Day 1 |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bevacizumab | Biological | 5 mg/kg intravenously administered over 90 minutes (can be reduced to 30 minutes at the minimum) on day 1 of a 2-week cycle. |
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| Measure | Description | Time Frame |
|---|---|---|
| Progression-free survival (PFS) | Time from the date of enrollment to the earlier of the date of confirmed progression or death from any cause. | Assessed until 1.5 years after the last patient enrolment |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | Time from the date of enrollment to death from any cause | Assessed until 1.5 years after the last patient enrolment |
| Time to treatment failure (TTF) | Time from the date of enrollment to the earlier of the date of confirmed progression, death from any cause, or discontinuation of protocol treatment. |
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Inclusion Criteria:
Exclusion Criteria:
History of other malignancy with a disease-free interval <5 years (other than curatively treated cutaneous basal cell carcinoma, curatively treated carcinoma in situ of the cervix, and gastroenterological cancer confirmed to be cured by endoscopic mucosal resection)
With massive pleural effusion or ascites requiring intervention
Radiological evidence of brain tumor or brain metastases
Active infection including hepatitis
Any of the following complication:
i) Gastrointestinal bleeding or gastrointestinal obstruction (including paralytic ileus) ii) Symptomatic heart disease (including unstable angina, myocardial infarction, and heart failure) iii) Interstitial pneumonia or pulmonary fibrosis iv) Uncontrolled diabetes mellitus v) Uncontrolled diarrhea (that interferes with daily activities despite adequate therapy)
Any of the following medical history:
Myocardial infarction: History of one episode within one year before enrollment or two or more lifetime episodes i) Serious hypersensitivity to any of the study drugs ii) History of adverse reaction to fluoropyrimidines suggesting dihydropyrimidine dehydrogenase (DPD) deficiency
Previous treatment with irinotecan hydrochloride
Current treatment with atazanavir sulfate
Previous treatment with tegafur, gimeracil, and oteracil potassium within seven days before enrollment
Pregnant or lactating females, and males and females unwilling to use contraception
Requires continuous treatment with systemic steroids
Psychiatric disability that would preclude study compliance
Otherwise determined by the investigator to be unsuitable for participation in the study
Concurrent gastrointestinal perforation or history of gastrointestinal perforation with 1 year before enrollment
History of pulmonary hemorrhage/hemoptysis ≥ Grade 2 (defined as bright red blood of at least 2.5mL) within 1 month prior to enrollment.
History of laparotomy, thoracotomy, or intestinal resection within 28 days before enrollment
Unhealed wound (except suture wounds from implantation of a central venous port), gastrointestinal ulcer, or traumatic fracture
Current or recent (within 1 year) thromboembolism or cerebrovascular disease
Currently receiving or requires anticoagulation therapy (> 325 mg/day of aspirin)
Bleeding diathesis, coagulopathy, or coagulation factor abnormality (INR ≥1.5 within 14 days before enrollment)
Uncontrolled hypertension
Urine dipstick for proteinuria >+2
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ruihua Xu, MD, PhD | Contact | 87343333 | xurh@sysucc.org.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cancer center of Sun Yat-sen University | Recruiting | Guangzhou | Guangdong | 510060 | China |
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| CPT-11 | Drug | 180 mg/m2 intravenously administered over 90 minutes on day 1 of a 2-week cycle |
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| 5-FU Bolus | Drug | 400 mg/m2 intravenous bolus on day 1 of a 2-week cycle. |
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| 5-FU Infusion | Drug | 2400 mg/m2 continuous infusion over 46 hours on day 1 and 2 of a 2-week cycle. |
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| l-LV (dl-LV) | Drug | 200 (dl-LV: 400) mg/m2 intravenously administered over 120 minutes on day 1 of a 2-week cycle. |
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| Assessed until 1.5 years after the last patient enrolment |
| Overall Response Rate (ORR) | Proportion of eligible patients with measurable lesions with a best overall response of CR or PR assessed by the attending physician. | Assessed at 6, 12 week and thereafter every 8 weeks, from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 weeks |
| Disease Control Rate (DCR) | Proportion of best overall response of CR, PR, or SD assessed by the attending physician. | Assessed at 6, 12 week and thereafter every 8 weeks, from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 weeks |
| Incidence of Adverse Events (Adverse Reactions) | The incidence of worst-grade adverse events (toxicities) on study as graded by NCI-CTCAE v 4.0 will be determined by treatment arm in all treated patients for the following events. | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 weeks |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| D009362 | Neoplasm Metastasis |
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
| D009385 | Neoplastic Processes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000068258 | Bevacizumab |
| D000077146 | Irinotecan |
| D005472 | Fluorouracil |
| D002955 | Leucovorin |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D002166 | Camptothecin |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D005575 | Formyltetrahydrofolates |
| 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 |
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