The percentage of patients with defined unresectable metastatic disease who will benefit from a first-line treatment enabling secondary complete metastasectomy is unknown but limited. Definition of optimized treatment algorithms is difficult due to very inhomogeneous patient populations. This open label, multicentre Phase II study primarily aims to assess the resection rate achievable in a selected patient population with initially unresectable metastatic disease limited to the liver only in order to evaluate feasibility, safety and efficacy with regards to secondary resection of hepatic lesions in these patients. The trial aims to enrol only patients meeting defined criteria of unresectability with regards to their hepatic lesions and will exclude patients with extrahepatic lesions in order to examine the most appropriate, highly active treatment regimen for this group of unresectable patients with the highest probability of a successful secondary metastasectomy with curative intent. The trial will be conducted in highly specialized centres with a track record of successful interdisciplinary treatment approaches in the field of metastatic colorectal cancer to allow the precise assessment of the peri-operative safety parameters as well as an evaluation of the surgical treatment approaches. The IXO regimen selected for this study has shown in a phase I/II study promising efficacy and a favourable safety profile. Bevacizumab has demonstrated a significant survival benefit in combination with chemotherapy in metastatic colorectal cancer. Therefore the study will allow evaluation of its potential benefit in combination with the two most active current chemotherapy regimens in the first-line and post-operative treatment setting.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
IXO plus bevacizumab regimen is given every 3 weeks (Q3W), in the following order: Bevacizumab (A): 7.5 mg/kg via IV infusion, day 1 Oxaliplatin (O): 100 mg/m2 via 2-hour IV infusion, day 1 Irinotecan (I): 160 mg/m2 via 1-hour IV infusion, day 1 Capecitabine (X): 950 mg/m2 twice daily PO, days 2 - 15
The Ottawa Hospital Cancer Center
Ottawa, Ontario, Canada
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
University Health Network
Toronto, Ontario, Canada
McGill University Health Centre
Montreal, Quebec, Canada
conversion to resectability during downsizing therapy with IXO+A patients with initially unresectable liver-only metastases associated with colorectal cancer
Time frame: after 8 IXO+A cycles
Recurrence-free survival (RFS)
Time frame: Every 2 cycles
Progression-free survival (PFS)
Time frame: Every 2 cycles
Time to response (TTR)
Time frame: Every 2 cycles
Overall survival (OS)
Time frame: Every 2 cycles
Pathological complete response (pCR) rate
Time frame: assessed post-operatory
Overall response rate (ORR)
Time frame: Every 2 cycles
Number of participants with Adverse Events as a measure of Safety and Tolerability
Time frame: Every 3 weeks
Surgical safety (frequency of surgical complications)
Time frame: assessed post-operatory
Pathological changes in the non-tumoural liver following therapy with IXO+A
Time frame: assessed post-operatory
R0, R1, R2 resection rate after up to 8 cycles of downsizing therapy with IXO+A
Time frame: assessed post-operatory
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