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Phase III Randomized Study of Fluorouracil, Leucovorin Calcium, Oxaliplatin, and Bevacizumab Versus Capecitabine, Oxaliplatin, and Bevacizumab in Patients With Locally Advanced, Metastatic, or Recurrent Colorectal Cancer
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outline Trial Contact Information Registry Information
Alternate Title
Combination Chemotherapy and Bevacizumab in Treating Patients With Locally Advanced, Metastatic, or Recurrent Colorectal Cancer
Basic Trial Information
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Phase
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Type
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Status
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Age
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Sponsor
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Protocol IDs
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Phase III
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Treatment
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Completed
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18 and over
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NCI
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SWOG-S0303 S0303, ECOG-S0303, NCT00070122
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Objectives - Compare overall survival in patients with locally advanced, metastatic, or recurrent colorectal cancer treated with fluorouracil, leucovorin calcium, oxaliplatin, and bevacizumab vs capecitabine, oxaliplatin, and bevacizumab.
- Compare progression-free survival and time to treatment failure in patients treated with these regimens.
- Compare the response of patients with measurable disease treated with these regimens.
- Compare toxicity rates of these regimens in these patients.
- Compare patient-reported functional status and convenience of therapy in patients treated with these regimens.
- Correlate germline polymorphisms of DNA repair (e.g., ERCC-1, XRCC1, GST-P1, XPD, and ribonucleotide reductase), target enzymes (e.g., thymidylate synthase, dihydropyrimidine dehydrogenase, and thymidine phosphorylase), angiogenesis (e.g., vascular endothelial growth factor), and growth factors (e.g., epithelial growth factor receptor) with survival, progression-free survival, and toxicity from chemotherapy in patients treated with these regimens.
- Correlate tumor mRNA expression levels of similar DNA repair enzymes as well as enzymes involved in angiogenesis with survival and progression-free survival in patients treated with these regimens.
- Correlate tumor mRNA expression levels of similar target enzymes before treatment with survival, progression-free survival, and toxicity in patients treated with these regimens.
Entry Criteria Disease Characteristics:
- Histologically or cytologically confirmed locally advanced, recurrent, or metastatic colorectal adenocarcinoma
- Not curable by surgery or amenable to radiotherapy with curative intent
- Previously resected colorectal cancer with new evidence of metastasis does not require separate histologic or cytologic confirmation unless one of the following is true:
- More than 5 years has elapsed between primary surgery and development of metastatic disease
- Primary tumor was T1-T2, N0, M0
- Site of primary lesion must be or have been in the large bowel as determined by endoscopy, radiology, or surgery
- Measurable or evaluable disease
- No known brain or leptomeningeal disease
Prior/Concurrent Therapy:
Biologic therapy Chemotherapy - No prior oxaliplatin
- No prior chemotherapy for advanced colorectal cancer
- Prior adjuvant therapy for resected stage II-III disease allowed provided at least 12 months have elapsed between completion of therapy and diagnosis of recurrent disease
Endocrine therapy Radiotherapy - At least 28 days since prior radiotherapy and recovered
Surgery - See Disease Characteristics
- More than 28 days since prior major surgical procedure or open biopsy
- More than 7 days since prior fine needle aspiration or core biopsy
- No concurrent major surgery
Other - More than 10 days since prior full-dose aspirin (325 mg)
- No concurrent antiplatelet agents (e.g., dipyridamole, ticlopidine, clopidogrel, or cilostazol)
- No other concurrent investigational agents
- No concurrent therapeutic anticoagulation
- Prophylactic anticoagulation of central venous lines allowed
- Low-dose prophylactic enoxaparin or heparin allowed
- No concurrent cimetidine
- No concurrent sorivudine or its related analogs (e.g., brivudine)
- No concurrent use of a cold cap or iced mouth rinses
Patient Characteristics:
Age Performance status Life expectancy Hematopoietic - No history of hemorrhagic or thrombotic disorders
- Absolute neutrophil count greater than 1,500/mm3
- Platelet count greater than 100,000/mm3
Hepatic - Bilirubin no greater than 2.0 times upper limit of normal (ULN)
- SGOT no greater than 2.5 times ULN (5 times ULN for patients with liver involvement)
- Alkaline phosphatase no greater than 2.5 times ULN (5 times ULN for patients with liver involvement or 10 times ULN for patients with bone involvement)
- INR no greater than 1.5
- PTT no greater than ULN
Renal - Creatinine no greater than 1.5 times ULN
- Creatinine clearance at least 50 mL/min
- Proteinuria less than 1+*
OR - Protein less than 500mg/24 hours*
[Note: *Proteinuria caused by ureteral stents and not due to nephropathy allowed] Cardiovascular - No uncontrolled hypertension
- Hypertension must be well-controlled (i.e., less than 160/90) and on a stable regimen of antihypertensive therapy
- No unstable angina
- No symptomatic congestive heart failure
- No myocardial infarction within the past 6 months
- No serious uncontrolled cardiac arrhythmia
- No New York Heart Association class III or IV heart disease
Pulmonary - No symptomatic pulmonary fibrosis
Other - Not pregnant or nursing
- Fertile patients must use effective contraception
- No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated stage I or II cancer currently in complete remission
- No active or uncontrolled severe infection
- No contraindication to oral medications (e.g., severe dysphagia)
- G-tubes or J-tubes allowed
- No peripheral neuropathy greater than grade 1
- No serious non-healing wound, ulcer, or bone fracture
- No significant traumatic injury within the past 28 days
- No other severe acute or chronic medical condition or laboratory abnormality that would preclude study participation
- No psychiatric condition that would preclude study participation
Expected Enrollment A total of 2,200 patients (1,100 per treatment arm) will be accrued for this study within 3 years. Outline This is a randomized, multicenter study. Patients are stratified according to Zubrod performance status (0 or 1 vs 2) and prior adjuvant therapy (yes vs no). Patients are randomized to 1 of 2 treatment arms. - Arm I: Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1 and fluorouracil IV continuously over 46-48 hours beginning on day 1. Patients are further randomized to receive bevacizumab or placebo* IV over 30-90 minutes on day 1. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity.
[Note: *As of 11/15/04, placebo is no longer part of treatment plan; all patients receive bevacizumab.]
- Arm II: Patients receive oxaliplatin IV over 2 hours on day 1 and oral capecitabine on days 1-15. Patients are further randomized to receive bevacizumab or placebo* as in arm I. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
[Note: *As of 11/15/04, placebo is no longer part of treatment plan; all patients receive bevacizumab.]
Patients are followed every 3 months until disease progression. After disease progression, patients are followed every 6 months for 2 years and then annually for up to 4 years after study entry.
Trial Contact Information
Trial Lead Organizations Southwest Oncology Group | | | Charles Blanke, MD, FACP, Study coordinator | | Ph: 503-494-1556; 800-494-1234 |
| | Heinz-Josef Lenz, MD, Study coordinator | | | |
Registry Information | | Official Title | | A Phase III Trial Of Modified FOLFOX6 Versus CAPOX, With Bevacizumab (NSC-704865) Or Placebo, As First-Line Therapy In Patients With Previously Untreated Advanced Colorectal Cancer | | Trial Start Date | | 2004-04-01 | | Registered in ClinicalTrials.gov | | NCT00070122 | | Date Submitted to PDQ | | 2003-08-14 | | Information Last Verified | | 2004-08-16 | | NCI Grant/Contract Number | | CA32102 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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