The purpose of this study is to determine whether it is possible to predict response to chemotherapy in patients with metastatic cancer who are treated with irinotecan by determining the mutational profile of the tumor.
Study Type
OBSERVATIONAL
Enrollment
79
Histological biopsy of the "index lesion" (a radiological measurable lesion on which biopsy is performed) at baseline, as well as when showing progressive disease. Histological biopsies will be subjected to DNA sequencing to assess the mutational profile, as well as to analysis of carboxylesterase activity.
Blood samples will be taken at baseline to determine patient's genetic background variation (germline DNA).
Blood samples will be taken for pharmacokinetic analysis of the active irinotecan metabolite (SN-38).
Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital
Amsterdam, North Holland, Netherlands
Erasmsus Medical Center - Daniël den Hoed clinic
Rotterdam, South Holland, Netherlands
University Medical Center Utrecht
Utrecht, Netherlands
Exploration of the correlation between the mutational profile and the percentage change in volumetric measurement of the index lesion after the first two cycles of chemotherapy.
Time frame: Change in radiological volume of the index lesion after the first 2 cycles of irinotecan. Radiological response (according to RECIST 1.1) after the first 2 cycles of irinotecan (i.e. after 2 x 3 weeks = 6 weeks)
Exploration of the correlation between the mutational profile and radiological response according to RECIST-criteria after the first two cycles of chemotherapy.
Time frame: Analysis 6 weeks after initiation of treatment
Exploration of the correlation between the mutational profile and progression free survival and overall survival.
Time frame: Overall survival approximately after 2 years of first cycle of irinotecan. Progression free survival approximately 3 months after first irinotecan
Exploration of the correlation between the mutational profile of the index lesion and patient's germline DNA background variation.
Time frame: Analysis after progressive disease, on average after 3 months.
Differences in mutational profile of metastasis prior to and after exposure to treatment.
Time frame: Analysis after progressive disease and subsequent post-treatment biopsy, on average after 3 months of treatment
Determine reliable and valid strategies for statistical analysis for biomarker discovery
Time frame: 2 years
Correlate response to pharmacokinetics of SN-38
Time frame: After progressive disease and subsequent post-treatment biopsy, in general after 3 months of treatment
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Patients who are being treated in Rotterdam will be subjected to blood draws for validation of the earlier developed midazolam phenotyping test (midazolam clearance test), which may be an indicator for pharmacokinetics of irinotecan.
Determine carboxylesterase activity in metastatic tumor material (pre- and posttreatment) and correlate intra-tumoral carboxylesterase activity to systemic SN-38 pharmacokinetics and to irinotecan response
Time frame: After progressive disease and subsequent post-treatment biopsy, in general after 3 months of treatment
Determine clinical applicability of the midazolam phenotyping probe
Time frame: After first cycle of irinotecan, at three weeks
Number and nature of all (serious) adverse events of study related procedures
Time frame: 14 days after baseline biopsy and 14 days after post-treatment biopsy (approximately after 3 months of treatment)