To estimate the progression free survival for subjects treated with panitumumab in combination with a chemotherapy regimen of oxaliplatin, 5-Fluorouracil (5-FU) and leucovorin (FOLFOX) as first-line chemotherapy regimen for subjects with metastatic colorectal cancer with WT (wild type) KRAS according to the IGFRp (protein receptor insulin growth factor) and MMP-7 (Matrilysin) expression.
By transactivation, phosphorylated insulin growth factor receptor I (p-IGF-IR) can activate epidermal growth factor receptor (EGFR). Matrilysin (MMP-7), can activate IGF-IR (insulin-like growth factor receptor ) by degrading IGFBP-3 (Insulin-like growth factor-binding protein 3) and releasing IGF-I (Insulin-like growth factor 1). Concomitant expression of MMP-7 and p-IGF-IR (using a specific monoclonal antibody (p-1316) recognizing the phosphorylated carboxy-terminal part of the IGF-IR) (DP (Double Positivity)) correlates with poor prognosis in WT KRAS patients treated with anti-EGFR antibodies plus irinotecan.The primary objective of this trial is to estimate the progression free survival (PFS) by DP (Double Positivity)immunohistochemistry (IHC) expression in patients with wild-type KRAS mCRC (metastatic colorectal cancer)treated with panitumumab and mFOLFOX6. Two groups are established by DP status (MMP7+/p-IGF-IR+ vs. MMP7+/p-IGF-IR-, MMP7-/p-IGF-IR+ or MMP7-/p-IGF-IR-). With a power of 80% and a bilateral alpha level of 0.05, assuming an accrual period of 12 months (m) and a follow-up period of 18 m, 40 patients are planned to be included in each group to detect a Hazard Ratio of 2. The median PFS of the DP group is expected to be 6 m and the total number of expected events is 56. Secondary objectives include disease control rate, duration of response, time to response and survival according the DP status. Neither interim analysis nor multiple comparison adjustment is planned.Treatment: Both groups will receive panitumumab 6 mg/kg and mFOLFOX6 every 2 weeks. If patients have not progressed after 6 m of treatment they will continue with panitumumab monotherapy until disease progression.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
78
Panitumumab and FOLFOX will be administered to patients with DP once every 14 days until 6 months of treatment or until disease progression (PD) or unacceptable toxicity. If patients have not progressed after 6 months of treatment with panitumumab and FOLFOX they will continue with panitumumab monotherapy until disease progression.
Panitumumab and FOLFOX will be administered to patients with no-DP (MMP7+/p-IGF-IR-, MMP7-/p-IGF-IR+ or MMP7-/p-IGF-IR) once every 14 days until 6 months of treatment or until disease progression (PD) or unacceptable toxicity. If patients have not progressed after 6 months of treatment with panitumumab and FOLFOX they will continue with panitumumab monotherapy until disease progression.
Progression-free survival time according to the MMP7 status (PFS)
To estimate the PFS by DP immunohistochemistry (IHC) expression in patients with wild-type KRAS mCRC treated with panitumumab and mFOLFOX6. Two groups are established by DP status (MMP7+/p-IGF-IR+ vs. MMP7+/p-IGF-IR-, MMP7-/p-IGF-IR+ or MMP7-/p-IGF-IR-).
Time frame: 5 years
Duration of response (DOR)
Time from first confirmed objective response to radiologic disease progression per modified RECIST criteria.
Time frame: 5 years
Time to response (TTR)
Time from randomization date to date of first confirmed objective response
Time frame: 5 years
Time to treatment failure (TtTF)
Time from enrolment to the date the decision was made to end the treatment phase for any reason.
Time frame: 5 years
Objective response rate (ORR)
Incidence of either a confirmed CR or PR per modified RECIST criteria. CRs or PRs will be confirmed no less than 28 days after the criteria for response are first met. All subjects without a confirmed response will be considered non-responders.
Time frame: 5 years
Disease Control Rate (DCR)
Incidence of either a confirmed CR or PR or stable disease (SD) while in the treatment phase; subjects prematurely discontinuing without a post baseline tumor response assessment or subjects with an observed response that is not confirmed will be considered non-responders otherwise.
Time frame: 5 years
Overall Survival (OS)
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Hospital General Universitario de Elche
Elche, Alicante, Spain
Hospital Son Espases de Mallorca
Palma de Mallorca, Balearic Islands, Spain
Hosptial Son Llatzer de Mallorca
Palma de Mallorca, Balearic Islands, Spain
Hosptial General de l'Hospitalet de Barcelona
L'Hospitalet de Llobregat, Barcelona, Spain
Corporació Sanitaria Parc Taulí de Barcelona
Sabadell, Barcelona, Spain
Hospital de l'Esperit Sant
Santa Coloma de Gramenet, Barcelona, Spain
Consorcio Hospitalario Provincial de Castellon
Castellon, Castellon, Spain
Hosptial de Logroño
Logroño, La Rioja, Spain
Hospital Universitario La Paz de Madrid
Madrid, Madrdi, Spain
Clínica Universitaria de Navarra
Pamplona, Navarre, Spain
...and 20 more locations
Time from randomization date to date of death.
Time frame: 5 years
Time To Progression (TTP)
Time from randomization date to date of radiologic disease progression per modified RECIST criteria.
Time frame: 5 years
Duration of Stable Disease (DoSD)
Calculated for only those subjects with a best response of SD during the treatment period, time from enrolment to date of first observed PD or death due to PD (whichever comes first) in either the combination or monotherapy phases
Time frame: 5 years
Incidence and severity of AEs
Incidence and severity of AEs (Common Toxicity Criteria version 3.0)
Time frame: 5 years
Molecular predictive markers for response.
Molecular predictive markers for response.
Time frame: 5 years