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Apatinib Versus Bevacizumab in Second-line Therapy for Colorectal Cancer(ABST-C)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03271255
Recruitment Status : Recruiting
First Posted : September 5, 2017
Last Update Posted : January 23, 2019
Information provided by (Responsible Party):
Ruilian Xu, Shenzhen People's Hospital

Brief Summary:
Bevacizumab, as an antibody of vascular endothelial generated factor (VEGF), combined with the fluorouracil-based chemotherapy regimens for metastatic colorectal cancer, has become the classical first-line treatment. However, vast majority of patients eventually will suffer progression disease. The second-line treatment includes replacing chemotherapy regimens whistle continuing bevacizumab or other anti-VEGF antibodies, such as Aflibercept and Ramucirumab. Apatinib is a small molecule tyrosine kinase inhibitor (TKI), which can highly selectively bind to and strongly block VEGF receptor 2 (VEGFR - 2), also potently suppress the activities of Ret, c-kit and c-src, resulting in reduced cell migration, proliferation, and tumor microvascular density mediated by VEGF .There are already robust data showing that antibodies aimed at blocking VEGF signaling pathways combined with chemotherapy to treat advanced colorectal cancer is superior as compared to chemotherapy alone. Thus, we hypothesize that the effect of using the second-line chemotherapy regimens combined with apatinib may be superior to those combined with bevacizumab. In this study,the patients who have progressed following or on first-line oxaliplatin and 5-FU combined with bevacizumab are randomised into two arms. Patients in the experimental arm receive second-line FOLFIRI combined with apatinib and those in the control arm receive second-line FOLFIRI combined with bevacizumab. To compare the efficacy and safety of the two arms, progression-free survival(PFS) is the primary end point.If apatinib is superior to bevacizumab in the second-line setting,it is one possible option of anti-angiogenic therapy in combination with second-line FOLFIRI for treatment of advanced colorectal cancer.

Condition or disease Intervention/treatment Phase
Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Drug: Apatinib Mesylate Tablets Drug: Bevacizumab Injection Phase 2

Detailed Description:

Firstly, screen eligible mCRC patients for enrolment. Our CRC clinical nurse specialists will document medical history of patients including diagnoses, first-line chemotherapy (mFOLFOX6 or CAPOX),bevacizumab dosage,toxicities,PFS on previous therapy.In the meantime,chest-abdonimal-pelvic CT and blood tests are to be examined to assess base-line measurable lesions and guarantee adequate organ function prior to enrolment.If all the values meet the criteria for enrolment, consent will be signed.

Secondly, randomise patients into two arms: Arm A-apatinib plus FOLFIRI regimen and arm B-bevacizumab plus FOLFIRI regimen.A software which is alike the procedure of coin flipping is used to randomise eligible patients.According to the selected regimen in specific arm,patients will be given full-dose drugs or reduced dose drugs if serious toxicities ( CTCAE v4.0 criteria grade 3/4) are complained since previous cycle of treatment.Symptoms and blood test results (including CEA and CA199) before each cycle will be recorded and the consultant oncologist, who is responsible for individual participants, will decide whether to continue next cycle chemotherapy with apatinib or bevacizumab based on the assigned arm.Radiological assessment consisting of chest-abdonimal-pelvic CT will be performed every 2 months.Notably,the monitor will check with physicians and nurse specialists for the accuracy and completeness of all data.

Thirdly, follow up participants and analyse primary end point (PFS) and secondary end points (OS,ORR and DCR).The causes of confirmed missing data in the trial should be recorded in detail to determine the mechanism of missing data and choose the suitable missing data handling methods.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Head-to-head comparison of apatinib versus bevacizumab plus sencond-line chemotherapy regimen FOLFIRI for treatment of metastatic colorectal cancer
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Apatinib Versus Bevacizumab in Combination With Second-line FOLFIRI in Patients With Metastatic Colorectal Cancer That Progressed During or After First-line Bevacizumab Plus an Oxaliplatin-based Regimen: A Randomised Phase 2 Trial
Actual Study Start Date : May 23, 2018
Estimated Primary Completion Date : September 30, 2022
Estimated Study Completion Date : December 31, 2022

Resource links provided by the National Library of Medicine

Drug Information available for: Bevacizumab

Arm Intervention/treatment
Experimental: Arm Apatinib


Apatinib Mesylate Tablets 500 mg po qd; Irinotecan 180 mg/m2 IV over 30-90 minutes,day 1; Leucovorin 400 mg/m2 IV infusion to match duration of irinotecan infusion,day 1; 5-FU 400 mg/m2 IV bolus day 1,then 1200 mg/m2/d x 2 days (total 2400 mg/m2 over 46-48 hours) continuous infusion; Repeat every 2 weeks.

Drug: Apatinib Mesylate Tablets
Apatinib combination with FOLFIRI regimen as the second-line chemotherapy for mCRC
Other Name: YN968D1

Active Comparator: Arm Bevacizumab


Bevacizumab Injection 5 mg/kg IV over 30 minutes,day 1; Irinotecan 180 mg/m2 IV over 30-90 minutes,day 1; Leucovorin 400 mg/m2 IV infusion to match duration of irinotecan infusion,day 1; 5-FU 400 mg/m2 IV bolus day 1,then 1200 mg/m2/d x 2 days (total 2400 mg/m2 over 46-48 hours) continuous infusion; Repeat every 2 weeks.

Drug: Bevacizumab Injection
Bevacizumab combination with FOLFIRI regimen as the second-line chemotherapy for mCRC
Other Name: Avastin

Primary Outcome Measures :
  1. Progression-free Survival (PFS) Time [ Time Frame: The follow-up period ranges from the first patient recruited to the last patient within 6 months after admission, up to 2 years ]
    PFS was defined as the time from the date of randomization until the date of objectively determined progressive disease (PD) [according to Response Evaluation Criteria in Solid Tumors (RECIST) version (v). 1.1] or death due to any cause, whichever was first. PD is at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeters (mm). Participants who died without a reported prior progression were considered to have progressed on the day of their death. Participants who did not progress or were lost to follow-up were censored at the day of their last radiographic tumor assessment.

Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: The follow-up period ranges from the first patient recruited to the last patient within 6 months after admission,up to 2 years ]
    OS was defined as the time in months from the date of randomization to the date of death from any cause. For participants not known to have died as of the cut-off date, OS was censored at the last known date alive.

  2. Percentage of Participants Achieving an Objective Response (Objective Response Rate) [ Time Frame: The follow-up period ranges from the first patient recruited to the last patient within 3 months after admission. ]
    The objective response rate is equal to the proportion of participants achieving a best overall response of partial response or complete response (PR + CR). Response was defined using RECIST, v. 1.1 criteria. CR was defined as the disappearance of all target and non-target lesions and any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm and normalization of tumor marker level of non-target lesions; PR was defined as having at least a 30% decrease in sum of longest diameter of target lesions taking as reference the baseline sum diameter.

  3. Percentage of Participants Achieving a Stable Disease (SD) or a confirmed CR or PR (Disease Control Rate) [ Time Frame: The follow-up period ranges from the first patient recruited to the last patient within 3 months after admission. ]
    Participants achieved disease control if they had a best overall response of CR, PR or SD. According to RECIST v1.1, CR was the disappearance of all non-nodal target lesions, with the short axes of any target lymph node reduced to <10 mm, the disappearance of all non-target lesions, and the normalization of tumor marker levels (if tumor markers were initially above the ULN); PR was defined as at least a 30% decrease in the sum of the diameters of target lesions (including the short axes of any target lymph node), taking as reference the baseline sum diameter. SD was neither sufficient shrinkage to qualify as PR nor sufficient increase to qualify as PD, taking as reference the smallest sum diameter since treatment started.

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Inoperable colorectal adenocarcinoma excluding vermiform appendix cancer and anal canal cancer confirmed by histology
  • Age ≥18 years ≤ 70 years at the time of informed consent
  • ECOG performance status (PS) ≤ 1
  • Provided informed consent before study-specific screening procedures
  • Life expectancy not less than 90 days
  • Participants have progressive disease on or within 6 months post the combination of bevacizumab and FOLFOX or CAPOX as the first-line chemotherapy for metastatic colorectal cancer
  • Adequate organ function based on the following laboratory values obtained within 14 days prior to enrolment (excluding patients who received blood transfusions or hematopoietic growth factors within 14 days before the laboratory test) Neutrophil count: ≥1500/mm3 Platelet count: ≥10.0 x 104/mm3 Hemoglobin: ≥9.0 g/dL Total bilirubin: ≤1.5 mg/dL AST, ALT: ≤100 IU/L (≤200 IU/I if liver metastases present) Serum creatinine: ≤1.5 mg/dL Measurable or nonmeasurable disease based on the Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1)
  • Adequate blood coagulation function [International Normalized Ratio (INR) ≤1.5 and Partial Thromboplastin Time (PTT) or activated PTT (aPTT) ≤1.5 x upper limit of normal (ULN)). Participants on full-dose anticoagulation must be in a stable phase of anticoagulant therapy and if taking oral anticoagulation, participants must have an INR ≤3 without clinically significant active bleeding or a high risk of bleeding
  • A historical colorectal cancer tissue sample is available for assessment of biomarkers with signed consent
  • Signed informed consent to be provided

Exclusion Criteria:

  • History of other malignancy with a disease-free survival <5 years (excluding curatively treated cutaneous basal cell carcinoma, curatively treated cervical in situ carcinoma , and gastroenterological carcinoma confirmed to be cured by endoscopic mucosal resection)
  • With a large amount of pleural effusions or ascites requiring intervention
  • Radiological evidence of brain metastases or brain tumor
  • Actively infectious condition including hepatitis
  • One of the following complications: 1) Gastrointestinal obstruction (including paralytic ileus) or gastrointestinal bleeding 2) Symptomatic cardiac disease (including unstable angina, myocardial infarction, and heart failure) 3) Pulmonary fibrosis or interstitial pneumonia 4) Uncontrolled diarrhea (that affects daily activities although adequate therapy 5) Uncontrolled diabetes mellitus
  • One of the following medical histories: 1) Myocardial infarction: One episode within one year prior to enrollment or two or more lifetime episodes 2) Remarkable hypersensitivity to any of the study drugs ii) History of side effect to fluoropyrimidines suggestive of dihydropyrimidine dehydrogenase (DPD) deficiency
  • Pregnant or lactating females, and males and females reluctant to use contraception
  • Psychiatric disability that would disturb study compliance
  • Other conditions determined by the investigator to be not suitable for participation in the study
  • History of concurrent gastrointestinal perforation or gastrointestinal perforation within 1 year prior to enrollment
  • Pulmonary hemorrhage/hemoptysis ≥ Grade 2 (identified as bright red blood of not less 2.5mL) within 1 month before enrollment.
  • History of thoracotomy,laparotomy, or intestinal resection within 28 days prior to enrollment
  • Unhealed wound (other than suture wounds due to implantation of a central venous port), traumatic fracture, or gastrointestinal ulcer
  • Current cerebrovascular disease or thromboembolism or either within 1 year before enrollment
  • Current anticoagulation therapy or requiring anticoagulation agents (> 325 mg/day of aspirin)
  • Bleeding diathesis, coagulopathy, or coagulation factor abnormality (INR ≥1.5 within 14 days before enrollment)
  • Uncontrolled hypertension Urine dipstick for proteinuria >+2

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03271255

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Contact: Ruilian Xu, MD +8675522942497
Contact: Wan He, MD,PhD +8675522942411

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China, Guang Dong
Shenzhen People's Hospital Recruiting
Shenzhen, Guang Dong, China
Contact: Ruilian Xu, MD    +8613923889123   
Contact: Wan He, MD,PhD    +8618823719462   
Sponsors and Collaborators
Shenzhen People's Hospital
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Principal Investigator: Ruilian Xu, MD Shen Zhen People's Hospital


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Responsible Party: Ruilian Xu, Dean of Oncology Department, Shenzhen People's Hospital Identifier: NCT03271255    
Other Study ID Numbers: Shenzhen CRC-001
First Posted: September 5, 2017    Key Record Dates
Last Update Posted: January 23, 2019
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All data will be shared with other researchers.
Supporting Materials: Study Protocol
Clinical Study Report (CSR)
Time Frame: After the data is formally published.
Access Criteria: Open access.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Ruilian Xu, Shenzhen People's Hospital:
colorectal cancer
Additional relevant MeSH terms:
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Colorectal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Intestinal Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action