Advanced colorectal cancer (ACRC) is a heterogeneous disease and classification of patients is nowadays inefficient. Roughly twenty per cent of patients present with favorable figures (less than 4 liver nodules and less than 5 cm) and are suitable for local treatments (surgery or local-ablative therapies). Additionally, 10-15% of patients have poor performance status (PS \>2) or are severe disabled due to geriatric syndromes or/and co-morbid diseases that preclude any treatment strategies than best supportive care alone. The rest of patients (fit patients not suitable for radical treatments) constitute the population of patients treated with palliative therapies. Despite of it not all these patients have the same prognosis. Patients with PS 0,1 and levels of LDH \<ULN (Intermediate-risk patients) have better PFS and OS irrespective of therapy in all randomized clinical trials (de Gramont et al, JCO 2000; Douillard et al, Lancet 2000; Koopman et al, 2007). CRYSTAL trial shows a benefit in PFS (1.5 months) in RASWT of FOLFIRI plus cetuximab compared with FOLFIRI alone. Nowadays the selection of patients for cetuximab treatment is based on mutational status of KRAS, which allow to select those patients who will not respond to therapy. Other surrogate markers of activity should be also evaluated. Our hypothesis is that the suggested biomarkers will allow the selection of the patients who will benefit the most from the biweekly cetuximab treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SCREENING
Masking
NONE
Enrollment
221
FOLFIRI (m) chemotherapy will be administered on day 1 of each 14-days-cycle. The administered doses will be: * Irinotecan 180 mg/m2 in infusion i.v., 120 minutes, on day 1 of each cycle. * l-Leucovorin 200 mg/m2 (or d,l-leucovorin 400 mg/m2), in infusion i.v., 120 minutes, on day 1. * One bolus i.v. (2-4 minutes) of 400 mg/m2 of 5-FU on day 1. * 5-FU in continuous infusion (2400 mg/m2) administered through an ambulatory pump during 46-48 hours.
FOLFOX6 (m) chemotherapy will be administered on day 1 of each 14-days-cycle. The administered doses will be: * Oxaliplatin 85 mg/m2 in infusion i.v., 120 minutes, on day 1 of each cycle. * l-Leucovorin 200 mg/m2 (or d,l-leucovorin 400 mg/m2) in infusion i.v., 120 minutes, on day 1. * One bolus i.v. (2-4 minutes) of 400 mg/m2 of 5-FU on day 1. * 5-FU in continuous infusion (2400 mg/m2) administered through an ambulatory pump during 46-48 hours.
\- 500 mg/m2 i.v. Every 2 weeks.
Hospital Provincial de Castellón
Castellon, Castellón, Spain
Hospital Son Espases
Palma, Malllorca, Spain
Hospital Son Llàtzer
Palma, Mallorca, Spain
Hospital Sant Joan de Reus
Reus, Tarragona, Spain
Complejo Hospitalario Universitario de Albacete
Albacete, Spain
Hospital Infanta Cristina de Badajoz
Badajoz, Spain
Hospital de Barbastro
Barbastro, Spain
Hospital Clínic de Barcelona
Barcelona, Spain
Hospital General Yagüe
Burgos, Spain
Hospital Sant Jaume de Calella
Calella, Spain
...and 17 more locations
Progression Free Survival
Measurements according to RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan. Two groups will be defined based on the score built from the proposed clinical variables and biomarkers. Instead of a binomial distribution, a Log-rank method has been used to calculate the sample size in order to include all the incidents during the follow-up. Expecting a minimum 20% difference (60 vs. 40%) on PFS at 12 months between groups and with the following assumptions: Alpha error (bilateral): 5% Beta error: 20% Results are reported by subgroups to compare outcome measure according to BRAF mutation. All patients belong to same treatment/study arm.
Time frame: 4 years
Overall Survival
Measured as time in months from start of study treatment to death or lost to follow up. Results are reported by subgroups to compare outcome measure according to BRAF mutation. All patients belong to same treatment/study arm.
Time frame: 4 years
Response Duration
Duration of the partial or total response to the treatment. Evaluation and classification according to RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors)
Time frame: 4 years
Frequency of Adverse Events
Frequency and type of adverse events (AEs). AEs were coded according to NCI CTCAE V3.0 and classified by frequency, relatedness to study treatment (related/not related) and severity (Grade). Severity ranges from grade 1 (low intensity) to Grade 5 (max. intensity, death)
Time frame: 4 years
Secondary Biomarkers Analysis
The secondary biomarkers in serum and tumoral tissue will be analysed in order to predict the acquired resistance.
Time frame: 4 years
Tumoral Response
Measurements according to RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan. Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR Results are reported by subgroups to compare outcome measure according to BRAF mutation. All patients belong to same treatment/study arm.
Time frame: 4 years
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