BAY 43-9006 Plus Cetuximab to Treat Colorectal Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )
ClinicalTrials.gov Identifier:
NCT00326495
First received: May 16, 2006
Last updated: April 19, 2014
Last verified: March 2014
  Purpose

Background:

  • Colorectal cancer (CRC) is a major public health problem in the U.S. and worldwide, and 5-year survival with widespread metastatic disease is less than 5%.
  • Expression of epidermal growth factor (EGFR) or up-regulation of the gene occurs in the majority of CRC cases (60-80%).
  • Therapies targeting EGFR, like cetuximab, have shown activity in the treatment of solid tumors like CRC.
  • Cetuximab is FDA approved for the treatment of EGFR-expressing CRC, but clinical responses to cetuximab are seen in only 10% of EGFR-expressing CRC.
  • One possible mechanism of resistance to cetuximab could be Ras mutations.
  • Another major pathway implicated in colon carcinogenesis is the vascular endothelial growth factor (VEGF) pathway, which is involved in angiogenesis and is a validated target for therapy in CRC.
  • BAY 43-9006 is both a Raf kinase inhibitor and an inhibitor of VEGF receptor (VEGFR2) tyrosine kinase.
  • We hypothesize that the combined inhibition of EGFR, VEGFR2, and the Ras-Raf pathway will demonstrate promising clinical activity in CRC.

Objectives:

  • To determine objective response rate and toxicity profile of combination of BAY 43-9006 and cetuximab in previously treated EGFR-expressing metastatic CRC.
  • To evaluate BAY 43-9006 pharmacokinetics & pharmacogenomics (CYP3A4/5).
  • To evaluate for this combination treatment pharmacodynamics, effect on tumor vascularity and effect on angiogenic cytokines.

Eligibility:

  • Adults with histologically or cytologically documented, measurable, EGFR-expressing metastatic CRC, which has recurred or progressed following at least one prior 5FU-based combination chemotherapy regimen administered for the treatment of metastatic disease.
  • Patients must have one lesion amenable to biopsy.

Design:

  • BAY 43-9006 will be administered 400 mg by mouth twice daily
  • Cetuximab will be administered as 400 mg/m(2) loading dose (week 1) followed by 250 mg/m(2) IV weekly.
  • If procedure may be performed safely, tumor biopsy will be obtained prior to treatment and after 4 weeks of treatment.
  • Expression and activation (phosphorylation) of signaling pathway components potentially affected by this treatment will be assessed.
  • DCE-MRI scan will be performed prior to treatment and after 8 weeks of treatment to evaluate tumor vascularity and metabolism.
  • Patients will be evaluated for response every 8 weeks using the RECIST criteria.
  • This trial uses a phase II optimal design targeting a response rate of 25%. Up to 66 patients may be treated.

Condition Intervention Phase
Metastatic Colorectal Cancer
Drug: Cetuximab
Drug: BAY 43-9006
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Study of BAY 43-9006 (Sorafenib) in Combination With Cetuximab (Erbitux ) in EGFR Expressing Metastatic Colorectal Cancer (CRC)

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Response assessment [ Time Frame: After 2 cycles ] [ Designated as safety issue: No ]

Estimated Enrollment: 66
Study Start Date: May 2006
Estimated Study Completion Date: November 2015
Estimated Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
administered orally at a dose of 400 mg BID
Drug: BAY 43-9006
is a potent inhibitor of c-raf, and wild-type and mutant b-raf in vitro
Active Comparator: 2
Cetuximab will be given IV at a dose of 400 mg/m2 initially as a loading dose on week 2, followed by 250 mg/m2 weekly starting on week 3
Drug: Cetuximab
Cetuximab is a recombinant human/mouse chimeric monoclonal antibody which binds specifically to the extracellular domain of the epidermal growth factor receptor (EGFR, HER1, c-ErbB) in normal and tumor cells, and competitively inhibits the binding of epidermal growth factor (EGF) and other ligands, such as transforming growth factor-alpha.

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Patients must have histologically or cytologically documented metastatic colorectal cancer, which has recurred or progressed following at least one prior chemotherapy regimen administered for the treatment of metastatic disease. The diagnosis should be confirmed by the Laboratory of Pathology at the Clinical Center, NIH.
  • Tumor should express EGFR, defined as any membrane staining for EGFR in tumor cells by immunohistochemistry (IHC) done on archival tumor blocks or slides.
  • Tumor blocks or unstained slides from archival pathological specimen suitable for the isolation of genomic DNA must be available to determine the status of mutations in KRAS in the tumor. (For the initial 13 evaluable patients already enrolled and treated on this study, every effort will be made to re-acquire these blocks from patients or their referring physicians for evaluation of KRAS.)
  • Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as greater than or equal to 20 mm with conventional techniques or as greater than or equal to 10 mm with spiral CT scan.
  • Patients must have received or been offered and declined at least one prior 5FU-containing combination chemotherapy regimen for metastatic disease, unless available chemotherapy regimens were for some reason contraindicated for a particular patient. Patients who have received chemotherapy and/or biologic therapy, excluding BAY 43-9006 or cetuximab, are eligible. This therapy must have been completed greater than or equal to 4 weeks prior to enrollment on protocol, and the patient must have recovered to eligibility levels from prior toxicity. Prior radiation or surgery should have been completed greater than or equal to 4 weeks prior to study enrollment and all associated toxicities resolved to eligibility levels.
  • Age greater than or equal to18 years. Colorectal cancer does not usually occur in patients less than 18 years of age.
  • Life expectancy greater than 3 months.
  • ECOG performance status 0 or 1.
  • Patients must have normal organ and marrow function as defined below:
  • absolute neutrophil count greater than or equal to 1,500/ microliter
  • platelets greater than or equal to 100,000/ microliter
  • total bilirubin less than or equal to 1.5 times the institutional upper limits of normal
  • AST(SGOT)/ALT(SGPT) less than or equal to 2.5 times the institutional upper limit of normal
  • creatinine less than or equal to 1.5 times the institutional upper limits of normal

OR

  • creatinine clearance greater than or equal to 60 mL/min/1.73 m(2)
  • PT/PTT less than or equal to 1.5 times the institutional upper limits of normal
  • Patients must have at least one lesion amenable to biopsy, as determined by an associate investigator after discussion with a member of the interventional radiology team. This lesion should be different from target lesion(s) being followed on imaging studies to evaluate response to treatment.
  • The effects of the combination of BAY 43-9006 and cetuximab on the developing human fetus at the recommended therapeutic doses are unknown. For this reason and because raf kinase inhibitor agents used in this trial are known to be teratogenic, 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, for the duration of study participation, and for at least 2 months following completion of study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Ability to understand and the willingness to sign a written informed consent document and the ability to comply with daily oral self administration schedule.
  • Patients must have systolic blood pressure less than or equal to 150 mm Hg and diastolic blood pressure less than or equal to 90 mmHg. Concomitant antihypertensive medications to achieve control of blood pressure are allowed.

EXCLUSION CRITERIA:

  • Patients who have had chemotherapy, biologic therapy, or radiotherapy within 4 weeks prior to entering the study or those who have not recovered to at least eligibility levels from adverse events due to agents administered more than 4 weeks earlier. Patients must be greater than or equal to 2 weeks since any investigational agent administered as part of a Phase 0 study (also referred to as an early Phase I study or pre-Phase I study where a sub-therapeutic dose of drug is administered) at the PI s discretion, and should have recovered to eligibility levels from any toxicities
  • Patients who have received any other investigational agents within 4 weeks prior to entering the study or those who have not recovered to at least eligibility levels from adverse events due to agents administered more than 4 weeks earlier.
  • Patients with known brain metastases would be excluded from this clinical trial, with the exception of patients whose brain metastatic disease status remains stable for greater than or equal to 6 months after treatment of the brain metastases without steroids or anti seizure medications. These patients may be enrolled at the discretion of the principal investigator.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to BAY 43-9006 (for example, other multi-targeted kinase inhibitors, such as sunitinib) or cetuximab (for example, other drugs containing murine proteins, such as bevacizumab) used in the study.
  • Prior therapy with cetuximab or BAY 43-9006.
  • Patients on therapeutic anticoagulation are excluded. Prophylactic anticoagulation (i.e. low dose warfarin) of venous or arterial access devices is allowed provided that the requirements for PT, INR or PTT are met.
  • Evidence of bleeding diathesis.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active serious infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, uncontrolled hypertension, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant women are excluded from this study because BAY 43-9006 is a kinase inhibitor agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with BAY 43-9006, breastfeeding should be discontinued if the mother is treated with BAY 43-9006.
  • HIV-positive patients receiving anti-retroviral therapy are excluded from this study due to the possibility of pharmacokinetic interactions between anti-retroviral medications and BAY 43-9006. HIV positive patients not receiving antiretroviral therapy are excluded due to the possibility that BAY 43-9006 may worsen their condition and the likelihood that the underlying condition may obscure the attribution of adverse events with respect to BAY 43-9006.
  • History of another malignancy within the past 5 years, apart from adequately treated non-melanoma skin cancers, superficial bladder cancer or in situ cervical cancer.
  • Patients with conditions that would impair their ability to swallow tablets are excluded.
  • Use of the following medications will be not be allowed within 4 weeks prior to enrollment on the study and during the study: ketoconazole, itraconazole, ritonavir, cyclosporine, carbamazepine, phenytoin, phenobarbital, rifampin, St. Johns Wort, and prophylactic use of filgrastim and sargramostim. Products containing grapefruit juice will not be allowed while on study. BAY 43-9006 tosylate is metabolized by the P450 CYP3A enzyme; therefore, it is possible that BAY 43-9006 tosylate may interact with the above medications. Efforts should be made to switch patients who are taking enzyme-inducing anticonvulsant agents to other medications.
  • Patients in whom resection is indicated and can be performed safely (unless surgery is declined by the patient for other reasons).
  • For the optional PET/CT imaging with (89)Zr-panitumumab correlative study, participants with severe claustrophobia not relieved by oral anxiolytic medication or patients weighing > 136 kg (weight limit for scanner table).

Inclusion of Women and Minorities:

Both men and women and members of all races and ethnic groups are eligible for this trial.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00326495

Contacts
Contact: Michelle Eugeni, R.N. (301) 594-4325 meugeni@mail.nih.gov
Contact: Shivaani Kummar, M.D. (301) 435-0517 kummars@mail.nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: Michelle Eugeni    301-402-9537    meugeni@mail.nih.gov   
Sponsors and Collaborators
Investigators
Principal Investigator: Shivaani Kummar, M.D. National Cancer Institute (NCI)
  More Information

Additional Information:
Publications:
Responsible Party: National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )
ClinicalTrials.gov Identifier: NCT00326495     History of Changes
Obsolete Identifiers: NCT00343772
Other Study ID Numbers: 060164, 06-C-0164
Study First Received: May 16, 2006
Last Updated: April 19, 2014
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Sorafenib
Cetuximab
Advanced Cancer
Phase II
Colorectal Cancer
Colon Cancer
Rectal Cancer
CRC
Metastatic Colorectal Cancer

Additional relevant MeSH terms:
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Cetuximab
Sorafenib
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on July 29, 2014