E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Colorectal cancer metastatic |
tumore del colon-retto metastatico |
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E.1.1.1 | Medical condition in easily understood language |
Colorectal cancer metastatic |
tumore del colon-retto metastatico |
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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 | 16.0 |
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 |
Study Part 1: To determine the recommended dose for the aflibercept, oxaliplatin and capecitabine (XELOX) combination to be used in the Part 2 of the study
Study Part 2: To assess the percentage of patients without progression of the disease at 6 months after the start of maintenance therapy with aflibercept single-agent, following the first-line induction therapy with XELOX and aflibercept combination in patients with previously untreated metastatic colorectal cancer
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E.2.2 | Secondary objectives of the trial |
Study Part 2: Include the evaluation of progression free survial, overall survival, response to treatment, the overall safety (during induction and maintenance therapy) and the assessment of aflibercept pharmacodynamics and biomarkers parameters. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Histologically or cytologically-proven adenocarcinoma of the colon or rectum.
- Metastatic disease not amenable to potentially curative treatment (i.e. unresectable).
- Measurable lesion as assessed by RECIST criteria
- No prior systemic anti-cancer treatment for metastatic disease
- No prior adjuvant treatment after resection of distant metastases
- No prior treatment with angiogenesis inhibitors
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E.4 | Principal exclusion criteria |
- Age <18 years
- Eastern Cooperative Oncology Group Performance status >/= 2
- Less than 4 weeks from prior radiotherapy or prior surgery (or until the surgical wound is fully healed)
- Treatment with any other investigational product within the prior 28 days
- Other prior neoplasm
- History of brain metastases, active seizure disorder, uncontrolled spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease
- Any of the following within the prior 6 months: myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft, severe congestive heart failure, stroke or transient ischemic attack.
- Any of the following within the prior 3 months: moderate/severe gastrointestinal bleeding/hemorrhage, treatment resistant peptic ulcer disease, erosive oesophagitis or gastritis, infectious or inflammatory bowel disease, diverticulitis, pulmonary embolism or other uncontrolled thromboembolic event
- Deep vein thrombosis within the prior 4 weeks
- Any severe acute or chronic medical condition, which could impair the ability of the patient to participate in the study
- Inadequate bone marrow, liver and renal function: neutrophils < 1.5x10^9/L, platelets < 100x10^9/L, hemoglobin < 9.0 g/dL, total bilirubin >1.5 x upper normal limit (ULN), transaminases >3 x ULN (unless liver metastasis are present), alkaline phosphatase >3 x ULN (unless liver metastasis are present), serum creatinine > 1.5 x ULN
- Patients on anticoagulant therapy with warfarin.
- Symptomatic peripheral sensory neuropathy
- Inability to take oral medications
- Prior history of chronic enteropathy, inflammatory enteropathy, chronic diarrhea, malabsorption syndrome, unresolved bowel obstruction/sub-obstruction, surgery more extensive than hemicolectomy, extensive small intestine resection with chronic diarrhea
- Known dihydropyrimidine dehydrogenase deficiency
- known history of hypersensitivity to aflibercept
- Any contraindication to administer oxaliplatin or capecitabine as per package insert of each drug
- Urine protein-creatinine ratio (UPCR) >1 on morning spot urinalysis or proteinuria > 500 mg/24-h.
- Uncontrolled hypertension within the prior 3 months
- Evidence of clinically significant bleeding predisposition or underlying coagulopathy, non-healing wound.
- Pregnant or breast-feeding women.
- Patients with reproductive potential who do not agree to use an accepted effective method of contraception.
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E.5 End points |
E.5.1 | Primary end point(s) |
Study Part 1: treatment related Dose Limiting Toxicity(ies) (DLTs) observed at first cycle
Study Part 2: proportion of patients alive without progression at 6 months after the start of the maintenance therapy |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Study Part 1: at the end of the first cycle of treatment up to the end of dose-escalation study Part 1
Study Part 2: 6 months after the start of the maintenance therapy |
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E.5.2 | Secondary end point(s) |
a) Study Part 1: number of patients reporting adverse events or laboratory abnormalities per each dose level tested
b) Study Part 1: Tumor response category: Complete Response (CR), Partial Response (PR), No Change (NC) or Progressive Disease (PD)
c) Study Part 2: Progression free survival
d) Study Part 2: Overall survival
e) Study Part 2: Proportion of patients reaching a total metastases resection (if applicable)
f) Study Part 2: Proportion of patients with complete or partial response as defined in RECIST 1.1 criteria
g) Study Part 2: Number of patients reporting adverse events or laboratory abnormalities as per NCI-CTCAE 4.03 criteria
h) Study Part 2: Aflibercept pharmacodynamic parameters evaluation
i) Study Part 2: Aflibercept biomarkers evaluation |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
a) Every cycle up to 30 days after the last treatment administration, study period
b) Every 9 weeks up to disease progressio
c) Study period, approximately 2.5 years
d) Study period, approximately 2.5 years
e) Up to 12 months after the end of study enrollment
f) Up to 12 months after the end of study enrollment
g) Every cycle up to 30 days after the last treatment administration, study period
h) During the study treatment period
i) During the study treatment period |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | Yes |
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 | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
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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 | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
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.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 30 |
E.8.9.1 | In the Member State concerned days | |