The MAX Study: Mitomycin C, Avastin and Xeloda in Patients With Untreated Metastatic Colorectal Cancer
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|ClinicalTrials.gov Identifier: NCT00294359|
Recruitment Status : Completed
First Posted : February 22, 2006
Last Update Posted : August 22, 2007
|First Submitted Date ICMJE||February 21, 2006|
|First Posted Date ICMJE||February 22, 2006|
|Last Update Posted Date||August 22, 2007|
|Study Start Date ICMJE||June 2005|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE
|Original Primary Outcome Measures ICMJE||Same as current|
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE||Same as current|
|Current Other Pre-specified Outcome Measures||Not Provided|
|Original Other Pre-specified Outcome Measures||Not Provided|
|Brief Title ICMJE||The MAX Study: Mitomycin C, Avastin and Xeloda in Patients With Untreated Metastatic Colorectal Cancer|
|Official Title ICMJE||The MAX Study: A Randomised Phase II/III Study to Evaluate the Role of Mitomycin C, Avastin and Xeloda in Patients With Untreated Metastatic Colorectal Cancer|
Although it is possible to cure bowel cancer when it is detected at an early stage, in many cases it may spread to involve other organs and in these cases is generally incurable. Chemotherapy prolongs survival and improves quality of life in such patients, but standard chemotherapy for this disease has not been defined.
There are several possible chemotherapy treatments for patients with bowel cancer, which has spread to other organs. However, these treatments are only partly effective and only work for a limited period of time. Most treatments are associated with a number of possible side effects which may have a detrimental effect on quality of life. Thus, it is imperative that more effective treatments with the lowest possible risk of side effects are developed.
Previous studies have shown that the addition of a new type of antibody treatment (bevacizumab) to an intensive combination chemotherapy regimen improved survival in patients with advanced bowel cancer and extended the time before tumours began to grow. However, intensive chemotherapy is likely to only be a suitable treatment for a proportion of patients with bowel cancer, because intensive chemotherapy causes a high rate of side effects.
This study compares a gentle chemotherapy treatment (capecitabine chemotherapy tablets given by mouth) with the combination of capecitabine and bevacizumab and the combination of capecitabine, bevacizumab and intravenous mitomycin C.
It is expected that a gentle chemotherapy treatment or a gentle chemotherapy treatment combined with bevacizumab would be an appropriate treatment for both young and fit patients as well as older and less fit patients who would not easily tolerate intensive chemotherapy.
Aims - The phase II stage of the study aims to determine the relative toxicity of the combination of capecitabine and bevacizumab and the combination of capecitabine, mitomycin C (MMC) and bevacizumab with that of capecitabine monotherapy and to assess tumour response rate (RECIST criteria) for each arm
For Phase III stage the primary objective is to compare progression-free survival (PFS) on the three arms. Secondary objectives are to determine treatment related toxicity; to determine tumour response rates (RECIST criteria); to determine overall survival for each treatment arm; to compare disease related symptoms and Quality of life and to determine cost effectiveness of bevacizumab containing treatments.
Research Plan Synopsis - Trial Design: Randomised, stratified multicentre phase II/III study. The study will proceed in 2 phases, initially a randomised phase II stage evaluating safety after 60 patients (approx 20 per arm) and 150 patients (approx 50 per arm) have completed at least 6 weeks' treatment. This will continue with a randomised phase III stage evaluating activity, toxicity and quality of life measures.
Treatments: Patients will be randomised to treatment in either one of the three arms: I) Capecitabine as monotherapy ; 2) Capecitabine and bevacizumab; or 3) Capecitabine and bevacizumab and MMC.
Drug administration: Arm 1: Capecitabine 2500mg/m2/d (in 2 divided doses) d1-14 q3weekly. Arm 2: Capecitabine administered as per Arm 1 plus Bevacizumab 7.5 mg/kg q3weekly. Arm 3: Capecitabine and Bevacizumab administered as per Arm 2 plus Mitomycin C 7 mg/m2 q 6weekly (maximum dose 14 mg, maximum 4 treatments).
Analysis: A total sample size of 333 patients (111 per group) will be required to detect an improvement of at least 3.1 months in progression free survival from 5.5 to 8.6 months using a 2-tailed comparison, 2.5% level of significance, 3-year accrual and 1-year follow-up. The 12-month survival rate for patients on capecitabine alone is 50%. A sample size of 111 per arm will have 80% power to detect an increase of 17% in the 1-year rate from 50% to 67% based on a significance level of 2.5%, 3-year accrual and 1-year follow-up. For both endpoints (PFS and survival) the difference between capecitabine alone and the regimen containing MMC is expected to be greater (in the order of 4.5 months) which will yield > 80% power to detect the difference in PFS.
Whilst not a primary comparison, the study will nevertheless still have 80% power to detect a 5.5 month difference between the two experimental arms as a secondary comparison based on a level of significance of 1.7%. Secondary endpoints include treatment related toxicity. Toxicity analyses will include treatment-received population, which includes all patients who received at least 1 dose of study treatment. Toxicity will be described by tabulating the proportions of patients with a worst toxicity grade of 0, 1, 2, 3, or 4 for each of the relevant NCI CTC AE scales.
Phase II: Confidence intervals for the difference in the incidence of bevacizumab and MMC associated grade 3/4 toxicities on the three arms will be calculated. If the incidence of these toxicities in the triple combination regimen (Capecitabine/MMC/ bevacizumab) exceeds the rate of toxicity experienced in the capecitabine/bevacizumab combination by more than 20% then consideration will be given to dose adjustment or stopping recruitment into the triple combination arm.
Phase III: The PFS for capecitabine chemotherapy alone is expected to be about 5.5 months and this is expected to increase to 9 months with the addition of bevacizumab, which is considered to be clinically meaningful. Using an overall 95% confidence level and 80% power and a 2.5% significance level for each comparison 111 patients per arm are required to detect differences based on a 36-month accrual and 12-month follow-up.
Outcomes and Significance - This randomised phase II/III study aims to compare capecitabine monotherapy with capecitabine plus bevacizumab and capecitabine plus bevacizumab plus MMC in patients with previously untreated metastatic colorectal cancer.
The use of either MMC or bevacizumab to 5FU based chemotherapy appears to result in improved activity without substantial increases in toxicity. Thus regimens incorporating these agents could have significant activity and be well tolerated. These regimens could be suitable as a low toxicity palliative regimen for a broad range of the population of patients with metastatic colorectal cancer including older patients with co-morbidities.
As it is anticipated that rates of acute toxicity with each regimen will be lower than those observed with oxaliplatin or CPT-11-based regimens, the target population may be more broad ranging than most other studies. Thus, it may include older patients, patients with limited performance status (PS2), patients with co-morbidities or patients in whom there are concerns relating to toxicity with oxaliplatin or CPT-11-based combination chemotherapy. However, it is not restricted to this population and younger, fitter patients may also be enrolled in the study as a lower rate of side effects is likely to be associated with improved quality of life.
|Study Type ICMJE||Interventional|
|Study Phase ICMJE||Phase 2
|Study Design ICMJE||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Condition ICMJE||Metastatic Colorectal Cancer|
|Intervention ICMJE||Drug: Mitomycin C; Capecitabine; Bevacizumab|
|Study Arms ICMJE||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Completed|
|Estimated Enrollment ICMJE
|Original Enrollment ICMJE||Same as current|
|Actual Study Completion Date ICMJE||July 2007|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
|Ages ICMJE||18 Years and older (Adult, Older Adult)|
|Accepts Healthy Volunteers ICMJE||No|
|Contacts ICMJE||Contact information is only displayed when the study is recruiting subjects|
|Listed Location Countries ICMJE||Australia, New Zealand|
|Removed Location Countries|
|NCT Number ICMJE||NCT00294359|
|Other Study ID Numbers ICMJE||AG0501CR|
|Has Data Monitoring Committee||Not Provided|
|U.S. FDA-regulated Product||Not Provided|
|IPD Sharing Statement ICMJE||Not Provided|
|Responsible Party||Not Provided|
|Study Sponsor ICMJE||Australasian Gastro-Intestinal Trials Group|
|Collaborators ICMJE||Not Provided|
|PRS Account||Australasian Gastro-Intestinal Trials Group|
|Verification Date||August 2007|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP