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    Clinical Trial Results:
    ADJUVANT TREATMENT OF FULLY RESECTED STAGE III COLON CANCER WITH FOLFOX-4 VERSUS FOLFOX-4 PLUS CETUXIMAB Tratamiento adyuvante con FOLFOX-4 versus FOLFOX-4 + cetuximab para el cáncer de colon en estadio III extirpado completamente

    Summary
    EudraCT number
    2005-003463-23
    Trial protocol
    ES   GB   DE   AT   BE   PT   DK   IT  
    Global end of trial date
    15 Oct 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Mar 2022
    First version publication date
    29 Mar 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    PETACC 8
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00265811
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Fédération Francophone de Cancérologie Digestive (FFCD)
    Sponsor organisation address
    7 Bd Jeanne d'Arc, Dijon, France,
    Public contact
    Karine Le Malicot, Fédération Francophone de Cancérologie Digestive (FFCD), karine.le-malicot@u-bourgogne.fr
    Scientific contact
    Karine Le Malicot, Fédération Francophone de Cancérologie Digestive (FFCD), karine.le-malicot@u-bourgogne.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 Aug 2012
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Jun 2011
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Oct 2016
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of the study is to assess and to compare the disease free survival curves according to treatment arm in completely resected stage III colon cancer.
    Protection of trial subjects
    The study was done in accordance with the Declaration of Helsinki (amended 2000) and the International Conference on Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH) Note for Guidance on Good Clinical Practice and approved by the appropriate Ethics Committees.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Dec 2005
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Portugal: 72
    Country: Number of subjects enrolled
    Spain: 666
    Country: Number of subjects enrolled
    United Kingdom: 70
    Country: Number of subjects enrolled
    Austria: 127
    Country: Number of subjects enrolled
    Belgium: 205
    Country: Number of subjects enrolled
    Denmark: 28
    Country: Number of subjects enrolled
    France: 794
    Country: Number of subjects enrolled
    Germany: 278
    Country: Number of subjects enrolled
    Italy: 319
    Worldwide total number of subjects
    2559
    EEA total number of subjects
    2489
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    1711
    From 65 to 84 years
    848
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Between Dec 22, 2005, and Nov 5, 2009, 2559 patients were enrolled from 340 sites in Europe and randomly assigned to treatment (2096 were randomised before June 17, 2008).

    Pre-assignment
    Screening details
    After checking the inclusion and non-inclusion criteria, patients were randomized to the protocol. We did this open-label randomised, controlled, multinational phase 3 study in patients aged between 18 and 75 years with pathologically confi rmed stage III colon adenocarcinoma.

    Period 1
    Period 1 title
    Randomized (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Open-label study

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    FOLFOX4 plus Cetuximab
    Arm description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h), with weekly cetuximab, which was given on day 1, 400 mg/m² (2 h infusion) the fi rst week, then every week at 250 mg/m² (1 h infusion) for subsequent infusions. Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.
    Arm type
    Experimental

    Investigational medicinal product name
    FOLFOX4
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h).

    Investigational medicinal product name
    Cetuximab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Weekly cetuximab, which was given on day 1, 400 mg/m² (2 h infusion) the first week, then every week at 250 mg/m² (1 h infusion) for subsequent infusions.

    Arm title
    FOLFOX4
    Arm description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h). Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.
    Arm type
    Active comparator

    Investigational medicinal product name
    FOLFOX4
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h).

    Number of subjects in period 1 [1]
    FOLFOX4 plus Cetuximab FOLFOX4
    Started
    791
    811
    Completed
    785
    805
    Not completed
    6
    6
         Kras mutated tumor
    1
    -
         Not treated Patients
    5
    4
         Kras Mutated Tumours
    -
    2
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: The presented results are on the target population meaning the Kras Wild-type treated patients that is why numbers are different from the baseline period. Some patients were in fact Kras mutated patients or some were never treated.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    FOLFOX4 plus Cetuximab
    Reporting group description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h), with weekly cetuximab, which was given on day 1, 400 mg/m² (2 h infusion) the fi rst week, then every week at 250 mg/m² (1 h infusion) for subsequent infusions. Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.

    Reporting group title
    FOLFOX4
    Reporting group description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h). Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.

    Reporting group values
    FOLFOX4 plus Cetuximab FOLFOX4 Total
    Number of subjects
    791 811 1602
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Age at baseline
    Units: years
        median (full range (min-max))
    60 (19 to 75) 60 (21 to 75) -
    Gender categorical
    Units: Subjects
        Female
    323 343 666
        Male
    468 468 936
    Subject analysis sets

    Subject analysis set title
    Kras Exon 2 Wild-type population
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All randomized KRAS wild-type patients with signed (Main and KRAS) Informed Consent Forms will be included in this analysis set, in the treatment arm assigned at randomization, irrespective of the treatment actually received, and irrespective of the violation of baseline eligibility criteria, other protocol deviations or the availability of post-randomization data. This population set will be used for the primary analyses of all primary and secondary efficacy variables.

    Subject analysis sets values
    Kras Exon 2 Wild-type population
    Number of subjects
    1602
    Age categorical
    Units: Subjects
        In utero
        Preterm newborn infants (gestational age < 37 wks)
        Newborns (0-27 days)
        Infants and toddlers (28 days-23 months)
        Children (2-11 years)
        Adolescents (12-17 years)
        Adults (18-64 years)
        From 65-84 years
        85 years and over
    Age continuous
    Age at baseline
    Units: years
        median (full range (min-max))
    60 (19 to 75)
    Gender categorical
    Units: Subjects
        Female
    666
        Male
    936

    End points

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    End points reporting groups
    Reporting group title
    FOLFOX4 plus Cetuximab
    Reporting group description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h), with weekly cetuximab, which was given on day 1, 400 mg/m² (2 h infusion) the fi rst week, then every week at 250 mg/m² (1 h infusion) for subsequent infusions. Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.

    Reporting group title
    FOLFOX4
    Reporting group description
    Patients received FOLFOX4 every 2 weeks (1 cycle): 85 mg/m² oxaliplatin (2 h infusion) on day 1, 200 mg/m² leucovorin on days 1 and 2, followed by 400 mg/m² fluorouracil (bolus), then 600 mg/m² fluorouracil (continuous infusion during 22 h). Treatment was continued for 12 cycles. Patients discontinued after completion of study treatment, occurrence of an unacceptable toxic eff ect, any disease recurrence, or withdrawal of consent.

    Subject analysis set title
    Kras Exon 2 Wild-type population
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All randomized KRAS wild-type patients with signed (Main and KRAS) Informed Consent Forms will be included in this analysis set, in the treatment arm assigned at randomization, irrespective of the treatment actually received, and irrespective of the violation of baseline eligibility criteria, other protocol deviations or the availability of post-randomization data. This population set will be used for the primary analyses of all primary and secondary efficacy variables.

    Primary: Disease-Free Survival (DFS)

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    End point title
    Disease-Free Survival (DFS)
    End point description
    DFS was defined as the interval from randomisation to locoregional or metastatic recurrence, the appearance of a secondary colon or rectal cancer, or death, whichever occurred first.
    End point type
    Primary
    End point timeframe
    until the end of the follow-up or appearance of an event
    End point values
    FOLFOX4 plus Cetuximab FOLFOX4
    Number of subjects analysed
    791
    811
    Units: patients
        Patients with locoregional or metastatic recurrenc
    190
    179
        Patients alive without event
    601
    632
    Statistical analysis title
    Kaplan-Meier and log -rank test
    Statistical analysis description
    DFS and overall survival with the Kaplan-Meier technique22 (primary analysis) and compared survival with a stratified two-sided log-rank test.
    Comparison groups
    FOLFOX4 plus Cetuximab v FOLFOX4
    Number of subjects included in analysis
    1602
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.66
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.05
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.85
         upper limit
    1.29

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    OS was defined as the interval from randomisation to death, whichever occurred first.
    End point type
    Secondary
    End point timeframe
    until the end of the follow-up or appearance of death
    End point values
    FOLFOX4 plus Cetuximab FOLFOX4
    Number of subjects analysed
    791
    811
    Units: patients
        Death
    94
    85
        Alive patients
    697
    726
    Statistical analysis title
    Kaplan-Meier and log -rank test
    Comparison groups
    FOLFOX4 plus Cetuximab v FOLFOX4
    Number of subjects included in analysis
    1602
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.56
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.81
         upper limit
    1.47

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    During treatment period and not earlier than 30 days after the last cycle.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    14.0
    Reporting groups
    Reporting group title
    Folfox + Cetuximab
    Reporting group description
    all patients with signed (Main and KRAS) Informed Consent Forms who started treatment with available KRAS determination and with a KRAS wild-type status, i.e. without mutations located within the codon 12 and 13 of the KRAS gene and randomized in the Folfox +Ceuximab group

    Reporting group title
    Folfox
    Reporting group description
    all patients with signed (Main and KRAS) Informed Consent Forms who started treatment with available KRAS determination and with a KRAS wild-type status, i.e. without mutations located within the codon 12 and 13 of the KRAS gene and randomized in the Folfox group

    Serious adverse events
    Folfox + Cetuximab Folfox
    Total subjects affected by serious adverse events
         subjects affected / exposed
    212 / 785 (27.01%)
    148 / 805 (18.39%)
         number of deaths (all causes)
    94
    85
         number of deaths resulting from adverse events
    5
    3
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    10 / 785 (1.27%)
    6 / 805 (0.75%)
         occurrences causally related to treatment / all
    10 / 10
    6 / 6
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 785 (0.13%)
    0 / 805 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Nervous system disorders
    Ischaemic stroke
         subjects affected / exposed
    1 / 785 (0.13%)
    1 / 805 (0.12%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    14 / 785 (1.78%)
    16 / 805 (1.99%)
         occurrences causally related to treatment / all
    11 / 14
    13 / 16
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    0 / 785 (0.00%)
    1 / 805 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Sudden death
         subjects affected / exposed
    1 / 785 (0.13%)
    0 / 805 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    8 / 785 (1.02%)
    1 / 805 (0.12%)
         occurrences causally related to treatment / all
    8 / 8
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anaphylactic reaction
         subjects affected / exposed
    3 / 785 (0.38%)
    0 / 805 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    39 / 785 (4.97%)
    16 / 805 (1.99%)
         occurrences causally related to treatment / all
    38 / 39
    16 / 16
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    14 / 785 (1.78%)
    4 / 805 (0.50%)
         occurrences causally related to treatment / all
    13 / 14
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    11 / 785 (1.40%)
    5 / 805 (0.62%)
         occurrences causally related to treatment / all
    8 / 11
    2 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    13 / 785 (1.66%)
    10 / 805 (1.24%)
         occurrences causally related to treatment / all
    9 / 13
    9 / 10
         deaths causally related to treatment / all
    1 / 1
    1 / 1
    Pulmonary fibrosis
         subjects affected / exposed
    2 / 785 (0.25%)
    0 / 805 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Respiratory failure
         subjects affected / exposed
    1 / 785 (0.13%)
    1 / 805 (0.12%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Infections and infestations
    Device related infection
         subjects affected / exposed
    8 / 785 (1.02%)
    4 / 805 (0.50%)
         occurrences causally related to treatment / all
    1 / 8
    2 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    6 / 785 (0.76%)
    5 / 805 (0.62%)
         occurrences causally related to treatment / all
    5 / 6
    4 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    6 / 785 (0.76%)
    4 / 805 (0.50%)
         occurrences causally related to treatment / all
    4 / 6
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    4 / 785 (0.51%)
    2 / 805 (0.25%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Folfox + Cetuximab Folfox
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    784 / 785 (99.87%)
    804 / 805 (99.88%)
    Investigations
    Neutrophils count decreased
         subjects affected / exposed
    533 / 785 (67.90%)
    593 / 805 (73.66%)
         occurrences all number
    533
    593
    Platelet count decreased
         subjects affected / exposed
    497 / 785 (63.31%)
    599 / 805 (74.41%)
         occurrences all number
    497
    599
    Haemoglobin decreased
         subjects affected / exposed
    449 / 785 (57.20%)
    481 / 805 (59.75%)
         occurrences all number
    449
    481
    Alanine aminotransferase increased
         subjects affected / exposed
    202 / 785 (25.73%)
    162 / 805 (20.12%)
         occurrences all number
    202
    162
    Aspartate aminotransferase increased
         subjects affected / exposed
    209 / 785 (26.62%)
    177 / 805 (21.99%)
         occurrences all number
    209
    177
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    133 / 785 (16.94%)
    137 / 805 (17.02%)
         occurrences all number
    133
    137
    Blood alkaline phosphatase increased
         subjects affected / exposed
    115 / 785 (14.65%)
    130 / 805 (16.15%)
         occurrences all number
    115
    130
    White blood cell count decreased
         subjects affected / exposed
    100 / 785 (12.74%)
    124 / 805 (15.40%)
         occurrences all number
    100
    124
    Nervous system disorders
    Neuropathy peripheral
         subjects affected / exposed
    651 / 785 (82.93%)
    723 / 805 (89.81%)
         occurrences all number
    651
    723
    Dysgeusia
         subjects affected / exposed
    146 / 785 (18.60%)
    157 / 805 (19.50%)
         occurrences all number
    146
    157
    Headache
         subjects affected / exposed
    64 / 785 (8.15%)
    89 / 805 (11.06%)
         occurrences all number
    64
    89
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    502 / 785 (63.95%)
    508 / 805 (63.11%)
         occurrences all number
    502
    508
    Mucosal inflammation
         subjects affected / exposed
    414 / 785 (52.74%)
    289 / 805 (35.90%)
         occurrences all number
    414
    289
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    117 / 785 (14.90%)
    120 / 805 (14.91%)
         occurrences all number
    117
    120
    Eye disorders
    Conjunctivitis
         subjects affected / exposed
    90 / 785 (11.46%)
    37 / 805 (4.60%)
         occurrences all number
    90
    37
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    491 / 785 (62.55%)
    500 / 805 (62.11%)
         occurrences all number
    491
    500
    Nausea
         subjects affected / exposed
    447 / 785 (56.94%)
    528 / 805 (65.59%)
         occurrences all number
    447
    528
    Vomiting
         subjects affected / exposed
    232 / 785 (29.55%)
    268 / 805 (33.29%)
         occurrences all number
    232
    268
    Constipation
         subjects affected / exposed
    240 / 785 (30.57%)
    240 / 805 (29.81%)
         occurrences all number
    240
    240
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
         subjects affected / exposed
    121 / 785 (15.41%)
    103 / 805 (12.80%)
         occurrences all number
    121
    103
    Skin and subcutaneous tissue disorders
    Dermatitis acneiform
         subjects affected / exposed
    707 / 785 (90.06%)
    25 / 805 (3.11%)
         occurrences all number
    707
    25
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    210 / 785 (26.75%)
    85 / 805 (10.56%)
         occurrences all number
    210
    85
    Dry skin
         subjects affected / exposed
    177 / 785 (22.55%)
    22 / 805 (2.73%)
         occurrences all number
    177
    22
    Dermatitis allergic
         subjects affected / exposed
    102 / 785 (12.99%)
    70 / 805 (8.70%)
         occurrences all number
    102
    70
    Skin fissures
         subjects affected / exposed
    148 / 785 (18.85%)
    8 / 805 (0.99%)
         occurrences all number
    148
    8
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    203 / 785 (25.86%)
    158 / 805 (19.63%)
         occurrences all number
    203
    158
    Hypokalemia
         subjects affected / exposed
    80 / 785 (10.19%)
    39 / 805 (4.84%)
         occurrences all number
    80
    39

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    25 Jun 2007
    Correction of participating countries, provision of details of all involved groups and country coordinating investigators (changed for Austria and Germany) Provision of clear definitions of the conditions to be fulfilled and the expected time points for primary and final analyses, clarification of definition of end of trial Clarification of visit and assessment schedule At the request of the IDMC, introduction of electrolyte measurement at baseline, 3 months, 6 months after start of treatment, at the end of treatment Visit and at the second follow-up visit (12 months after surgery) if still abnormal Clarification of time intervals for colonoscopy Update of pretreatment recommendations before cetuximab administrations: addition of corticosteroid Clarification of dosage reduction and treatment continuation rules Harmonization of description of the adverse events page with the CRF Update of informed consent based on changes introduced by this amendment (main study and for translational research) Update of planned statistical analyses Correction of errors
    30 Apr 2008
    * Addition of a second primary objective, namely the comparison of treatments in patients with KRAS wild type tumors • Adjustment of the risk reduction (hazard ratio) expected from the addition of cetuximab, in the entire study population. • Implementation of one interim analysis for the entire study population and one for the population of patients with KRAS wild type tumors • Increase of the total sample size from 2000 to 2842 patients to achieve the necessary number of events for the primary statistical analysis within a reasonable time frame, considering the adjustments of the individual alpha required because of two primary endpoints and the implementation of interim analysis and the need to maintain the original power of 90%. • Update of the planned statistical analyses and related assumptions, considering the additional primary objective • Introduction of retrospective KRAS assessment in all patients • Clarification of time interval between curative R0 resection and start of treatment • Update of the Patient Information based on introduction of KRAS assessment (main study) • Update of the handling instructions and compatibility of cetuximab with various infusion set materials
    14 Aug 2008
    • Introduction of an inclusion criterion regarding KRAS status. • Introduction of prospective KRAS assessment in all new patients. The specific logistics are described in a separate document. • The only primary objective will be the comparison of disease free survival (DFS) between the two treatment arms in the population of patients with KRAS wild-type tumors. • Addition of a new secondary objective, namely the comparison of DFS in the entire population of all patients randomized up to 24:00h, 17 June 2008 (to be performed only if a significant effect on DFS, in the KRAS wild-type population is seen). • Interim analysis only for the primary objective in patients with a KRAS wild-type tumor. • In total 2099 patients have been included until the recruitment stop on 17 June 2008, of whom an estimated 957 patients have assessable KRAS wild-type tumors. An additional 450 patients with a KRAS wild-type tumor should be included to achieve the necessary number of events for the primary statistical analysis, within a reasonable time frame. Therefore, it is estimated that 825 patients will need to be assessed for the KRAS status of their tumors after the restart of patient enrollment (assuming 57.5% will be KRAS wild-type and there will be 5% withdrawals, for other reasons, prior to randomization). • Prolongation of the survival follow-up to 7 years after randomization of the last patient (i.e. 10.5 years in total assuming a recruitment period of 3.5 years). • Update of the planned statistical analyses and related assumptions, considering the population change for primary analysis. • Update of the Patient Information based on introduction of KRAS assessment (main study) and introduction of a new patient information and informed consent necessary for the prescreening of patients for KRAS status. • Update of Translational Research sections • Corrections of errors
    30 Jun 2009
    Change of an inclusion criterion regarding the age of the patients. The FFCD has decided to follow the additional DSMB recommendations regarding patients aged 71 or older which has strongly recommended taking a precautionary measure, no longer to include patients aged 71 or older (at screening), because of an increased risk of toxicity or death observed in the population > 70 years old in the PETACC8 study as compared to the population < 71 years old, whatever the treatment arm is. Furthermore, these results are in line with the analysis of the ACCENT database presented at the main ASCO meeting (2009) that support the use of 5-FU-based regimens without Oxaliplatin in elderly patients >70 years old (McCleary et al., ASCO 2009).

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/24928083
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