The main objective is to compare resection rates (R0 or R1) for hepatic metastases in the experimental arm (tri chemotherapy plus targeted therapy) versus the control arm (bi chemotherapy plus targeted therapy); in both arms the targeted therapy is selected according to K-Ras status of the patient's tumor. The secondary objectives are to evaluate the objective response rate (CR and PR) after 4 cycles of treatment, according the RECIST V1.1 evaluation scale. * the rate of complete remission (CR) at 6 months after the last study treatment (hepatic surgery or last chemotherapy cycle). * the specific rates of resection R0, R1, R2. * the complete pathological response Rate, * the relapse-free survival rate in (R0 or R1) resected patients, * the response duration in non-resected patients, * the toxicity according to CTC AE V4 scale except for the neurotoxicity that will be evaluated with the Levi scale, * the post operative complications using the DINDO classification, * the progression-free survival (PFS) and overall survival (OS). The objectives of the biological study are: * to evaluate tumor-related predictive factors such as somatic mutations (KRAS, BRAF, TP53) and genetic amplification related factors (EGFR), * to evaluate patient-related predictive factors in connection with genetic polymorphisms (Fc gamma and VEGF receptors), * to evaluate ADCC activity via immunohistochemistry in order to analyze the lympho free and progression-free survival, * to study circulating of tumor cells as prognostic factor for metastatic colorectal cancer, non- resectable at presentation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
256
85mg/m² over 120 mn every 2 weeks up to progression or toxicity
400mg/m² over 120 mn every 2 weeks up to progression or toxicity
400mg/m² in bolus, then 2400mg/m² over 46 h every 2 weeks up to progression or toxicity
180mg/m² over 90 mn every 2 weeks up to progression or toxicity
150mg/m² over 30-90 mn every 2 weeks up to progression or toxicity
5mg/kg over 90 mn every 2 weeks up to progression or toxicity
500mg/m² over 90 mn every 2 weeks up to progression or toxicity
Centre Val d'Aurelle
Montpellier, France
The main objective is to compare resection rates (R0 or R1) for hepatic metastases
Number of patients (%) with hepatic metastases R0 or R1 resection.
Time frame: at least 4-6 weeks after the end of chemotherapy
The objective response rate (CR and PR) after 4 cycles of treatment
The objective response rate (CR and PR) will be evaluated by the investigator with RECIST v1.1 criteria after 4 cycles. Patients with symptoms suggestive of disease progression will have a tumoral evaluation when symptoms will occur
Time frame: after 8 weeks
Complete remission rate (CR) 6 months after the last study treatment (hepatic surgery or last chemotherapy cycle)
Number of patients (%) with complete remission (CR) at 6 months after the last study treatment (hepatic surgery or last chemotherapy cycle)
Time frame: 6 months
Specific resection rates R0/R1/R2
Specific resection rates (%) R0/R1/R2 is the rate of patients with a R0, R1 or R2 resection.
Time frame: 24 weeks
Complete pathological response
Number of patients with Complete pathological response, defined as the absence of tumoral residues after the last chemotherapy cycle. It will be evaluated on liver resection piece, based on total or complete tumor necrosis in all tumor nodules
Time frame: 24 weeks
Toxicity of treatment
Tolerance of the treatment will be based on toxicities of evaluated products by clinical and biological measurements (NCIC/CTC (CTCAE V4) criteria, except for peripheral neuropathy toxicity (Lévi scale)
Time frame: Every 2 weeks
Post operatory complications
Each post operatory complications (Hemorrhage, fistula, insufficiency, heart failure,..) will be graduated using Dindo classification (2004)
Time frame: after 4 weeks
Progression-free survival (PFS)
Progression-free survival is defined as the time from randomization to progression (RECIST v1.1 criteria) or death. Patients alive without progression will be censored at the last follow-up.
Time frame: 8 months
Overall survival (OS)
Overall survival is defined as the time from randomization to death any cause or last follow-up news for patients alive (censored data).
Time frame: 14 months
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