The addition of RAD001, an mTOR inhibitor, to irinotecan and anti-EGFR antibody cetuximab may increase efficacy for patients with metastatic colorectal cancer who progressed on prior chemotherapy. This approach is biologically directed to overall target the cancer cell at multiple levels, and potentially preventing chemotherapy and EGFR-therapy resistance.
OUTLINE: This is a multi-center study. PHASE I: * UGT1A1 \*28 7/7 genotype IS NOT present * Cetuximab 250 mg/m2 IV days 1, 8, and 15 * Irinotecan 125 mg/m2 IV days 1 and 8 * RAD001 PO QD (dose determined at the time of registration; subjects will remain at this dose level until treatment discontinuation) PHASE II: * Randomization based on UGT1A1 \*28 7/7 Genotype or Prior Irinotecan Exposure ARM A: * Cetuximab 250 mg/m2 IV days 1, 8, and 15 * Irinotecan 125 mg/m2 IV days 1 and 8 AT TIME OF PROGRESSIVE DISEASE, ARM A TREATMENT WILL CROSSOVER: * Cetuximab 250 mg/m2 IV days 1, 8, and 15 * Irinotecan 125 mg/m2 IV days 1 and 8 * RAD001 PO QD (maximum tolerated dose) ARM B: * Cetuximab 250 mg/m2 IV days 1, 8, and 15 * Irinotecan 125 mg/m2 IV days 1 and 8 * RAD001 PO QD (maximum tolerated dose) AT TIME OF PROGRESSIVE DISEASE, ARM B TREATMENT WILL BE DISCONTINUED ECOG performance status 0-2 Life Expectancy: Not specified Hematopoietic: * Absolute neutrophil count (ANC) ≥ 1,500 mm3 * Platelets ≥ 100,000 mm3 * Hemoglobin (Hgb) ≥ 9 g/dL * White blood cell count (WBC) ≥ 2,000 mm3 * INR \< 1.5 x upper limit of normal (ULN) if not on anticoagulation (if on anticoagulation must have an in-range INR (usually between 2 and 3) on a stable dose of warfarin) * PTT \< 1.5 x ULN Hepatic: * Bilirubin ≤ 1.5 x ULN * Aspartate aminotransferase (AST, SGOT) ≤ 2.5 x ULN * Alanine aminotransferase (ALT, SGPT) ≤ 2.5 x ULN * Albumin ≥ 3.0 g/dL Renal: * Calculated creatinine clearance of ≥ 60 cc/min using the Cockcroft-Gault formula Cardiovascular: * No uncontrolled cardiac arrhythmia requiring medication, transient ischemic attack (TIA), or cerebrovascular accident (CVA) within 6 months prior to being registered for protocol therapy * No uncontrolled congestive heart failure, myocardial infarction, or unstable angina within 6 months prior to being registered for protocol therapy Pulmonary: * No severely impaired lung function as demonstrated by pulse O2 saturation ≤ 90% at rest on room air, or pulmonary function test FEV1 ≤ 2L * No history of prior chronic lung infection such as tuberculosis, atypical tuberculosis, or histoplasmosis as evidenced by a chest CT or x-ray within 21 days prior to being registered for protocol therapy
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
41
Irinotecan 125 mg/m2 IV days 1 and 8
Cetuximab 250mg/m2 IV days 1, 8 and 15
Patients on Arm A will crossover and receive RAD001 at disease progression
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Medical & Surgical Specialists, LLC
Galesburg, Illinois, United States
To determine the MTD of RAD001 in combination with irinotecan and cetuximab as second line therapy in patients with metastatic colorectal cancer
Time frame: Phase I
To evaluate the objective response (CR or PR) rates of patients treated with irinotecan and cetuximab with or without RAD001 in patients with metastatic colorectal cancer
Time frame: Phase II
To evaluate the pharmacokinetic (PK) profile for RAD001 after one cycle of therapy, on cycle 2 day 1
Time frame: Phase I
To evaluate the time to progression, duration of objective response (CR or PR) and overall survival of patients treated with irinotecan and cetuximab with or without RAD001
Time frame: Phase II
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Cancer Care Center of Southern Indiana
Bloomington, Indiana, United States
Oncology Hematology Associates of SW Indiana
Evansville, Indiana, United States
IN Onc/Hem Associates
Indianapolis, Indiana, United States
Indiana University Simon Cancer Center
Indianapolis, Indiana, United States
St. Vincent Hospital & Health Centers
Indianapolis, Indiana, United States
Community Regional Cancer Center
Indianapolis, Indiana, United States
Arnett Cancer Care
Lafayette, Indiana, United States
Horizon Oncology Center
Lafayette, Indiana, United States
...and 4 more locations