E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Advanced colorectal cancer, refractory to all available medications |
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E.1.1.1 | Medical condition in easily understood language |
Advanced colorectal cancer that do not respond to standard treatment. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10010035 |
E.1.2 | Term | Colorectal cancer stage IV |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10052358 |
E.1.2 | Term | Colorectal cancer metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the spontaneous evolution of tumoral metabolic progression index measured by serial FDG PET-CT without any intercurrent antitumor therapy as a prognostic factor for overall survival in patients with advanced colorectal cancer. |
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E.2.2 | Secondary objectives of the trial |
•Test TMPI as a prognostic marker for PFS.
•Assess the prognostic value of baseline tumor FDG uptake on PFS and OS.
•Compare TMPI to classical clinico-biologic assessment of prognosis (alkaline phosphatase, platelets count, LDH, tumor bulk)
•Test the prognostic value of MRI based apparent diffusion coefficient (ADC) and variation of vADC based on voxel-based diffusion maps.
•Translational research:
-To identify and quantify tumor-specific rearrangements in plasma DNA using next-generation sequencing.
-To characterize which of these tumor-specific rearrangements in plasma DNA form genomic and epigenetic determinants of tumoral metabolic progression guided by FDG-PET-CT metabolic imaging.
-To identify these tumor-specific rearrangements in previous tumor tissue.
-To analyze whether CTC levels correlate with tumoral metabolic progression guided by FDG PET-CT metabolic imaging.
-To assess the prognostic value of CTCs on overall survival.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Participants must have histologically confirmed colorectal cancer that is metastatic or unresectable and for which standard treatments do not exist or are no longer effective.
•Participants should be candidate for a Phase I study
•The tumor should be refractory to all standard chemotherapy agents (fluoropyrimidines, irinotecan, and oxaliplatin) and anti‐EGFR monoclonal antibodies in case of wild type K‐ras (cetuximab or panitumumab) administered before study entry. Prior treatment with bevacizumab, regorafenib and/or aflibercept is allowed but not mandatory
•Age equal or over 18 years.
•Life expectancy of greater than 12 weeks.
•ECOG performance status ≤ 1.
•Participants must have normal organ and marrow function as defined below:
Total bilirubin within 2 × normal institutional upper limits
AST/ALT/Alk Phosphatase levels < 5 × normal institutional upper limits
Creatinine within 2 × normal institutional upper limits or creatinine clearance > 35mL/min
•Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and during the assessment. For women of child-bearing potential a pregnancy test (urinary or serum) must be performed within 7 days prior to inclusion and it must be negative. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician within one month.
•Signed written informed consent obtained prior to any study specific screening procedures.
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E.4 | Principal exclusion criteria |
Patients who exhibit any of the following conditions at screening will not be eligible for admission into the study:
•Participants who have had chemotherapy or targeted therapy within 2 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier.
•Participants who have had a major surgery or radiotherapy within 4 weeks prior to entering the study.
•Patients receiving any experimental agents during the assessment time period.
•Patients with uncontrolled brain metastases.
•Bleeding diathesis, history of cardiovascular ischemic disease or cerebrovascular incident within the last six months.
•Uncontrolled concurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, psychiatric illness or any significant disease which, in the investigator’s opinion, would exclude the patient from the study.
•Pregnancy or breast-feeding before the FDG PET-CT scan examinations
•Uncontrolled Diabetes.
•Individuals with a history of a different malignancy are ineligible except for the following circumstances. Individuals with a history of other malignancies are eligible if they have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin.
•Medical, geographical, sociological, psychological or legal conditions that would not allow the patient to complete the study or sign informed consent.
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E.5 End points |
E.5.1 | Primary end point(s) |
To assess the spontaneous evolution of tumoral metabolic progression index measured by serial FDG PET-CT without any intercurrent antitumor therapy as a prognostic factor for overall survival in patients with advanced colorectal cancer. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At baseline and after two weeks to be correlated with the patient overall survival. |
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E.5.2 | Secondary end point(s) |
1. To test tumoral metabolic progression index as a prognostic marker for progression free survival.
2. To assess the prognostic value of baseline tumor FDG uptake on progression free survival and overall survival.
3. To compare tumoral metabolic progression index to classical clinico-biologic assessment of prognosis (alkaline phosphatase, platelets count, LDH, tumor bulk)
4. To test the prognostic value of MRI based apparent diffusion coefficient (ADC) and variation of vADC based on voxel-based diffusion maps.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. At baseline and after two weeks to be correlated with the patient progression free survival.
2. At baseline and to be correlated with the patient progression free survival and overall survival.
3. At baseline and after two weeks to be correlated with the patient overall survival.
4. At baseline and after two weeks to be correlated with the patient progression free survival and overall survival.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
This is an interventional non-therapeutic study aiming to assess the spontaenous evolution of tumoral metabolic progression index measured by serial FDG PET-CT and MRI without any intercurrent antitumor therapy as a prognostic factor for overall survival in patients with advanced colorectal cancer. |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Required number of evaluable patients with documented death will be 37 as required by the stat.analysis/Database is fully cleaned&frozen for the primary analysis&for the analysis of the 2nd endpoint/Number of events is not reached&a decision to stop accrual has been taken by the principal investigator/Participants will be followed for 1year or until 1of the following criteria applies/Withdrawal/Lost to follow-up/Death |
Required number of evaluable patients with documented death will be 37 as required by the stat.analysis/Database is fully cleaned&frozen for the primary analysis&for the analysis of the 2nd endpoint/Number of events is not reached&a decision to stop accrual has been taken by the principal investigator/Participants will be followed for 1year or until 1of the following criteria applies/Withdrawal/Lost to follow-up/Death |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 2 |
E.8.9.2 | In all countries concerned by the trial days | 0 |