This study is a randomized, double-blind, post-chemotherapy, adjuvant phase III clinical trial. The primary aim of this study is to determine the value of regorafenib in improving disease-free survival (DFS). Patients with Stage III (IIIB or IIIC) colon cancer as defined by the 7th Edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual are randomized 1:1 to placebo or the experimental agent regorafenib following completion of at least four months of standard adjuvant therapy (e.g., 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX) , capecitabine, oxaliplatin (CapeOx), and other).
The primary aim of this study is to determine the value of regorafenib in improving DFS. The secondary aims are to evaluate the dose tolerance and long term toxicity of two years of regorafenib following standard adjuvant therapy, and to evaluate the effect of the use of regorafenib in overall survival (OS). Eligible patients in this double-blind study will be randomized to take either regorafenib 120 mg or placebo orally, once daily for 21 consecutive days of a 28 day cycle for 26 cycles (2 years). Accrual for this study will be approximately 1118 randomized patients. These 1118 patients will provide approximately 313 DFS events at the time of primary analysis. An initial futility analysis will be performed when 312 patients have been on study at least 3 months. The decision to continue the trial will be determined by success of both early stopping endpoints defined as follows: * The toxicity profile of regorafenib compared to placebo is acceptable. * The regorafenib regimen is tolerable for prolonged administration. An estimated compliance rate of 60% at 6 months for regorafenib will be required for continuation of the study. If toxicity is acceptable and compliance with regorafenib is at least 60% nominally, then accrual will continue. The second futility analysis will be conducted when approximately 67 DFS events are observed. Trial conduct and accrual will continue unless the primary endpoint (DFS) trends too far in the opposite direction (hazard ratio greater than or equal to 1.1). Toxicity will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. NSABP C-13 will include a Behavioral and Health Outcomes correlative science component. A C-13 Quality of Life (QOL) questionnaire will be administered at baseline (after consent and prior to randomization) and at 3 months, 6 months, 12 months, 18 months, 24 months, and 30 months. Submission of blood samples for C-13 correlative science studies will be a study requirement for all patients. Submissions will also include archived primary tumor tissue from the resected colon primary. Blood samples for pharmacokinetics (PK) will be collected on Day 15 of Cycle 1 and Day 15 of Cycle 2, with additional blood samples for biomarkers collected at various time points for future analysis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
34
3 tablets once a day by mouth for 21 consecutive days of 28 day cycle for 26 cycles
3 tablets once a day by mouth for 21 consecutive days of 28 day cycle for 26 cycles
St. Joseph Hospital of Orange
Orange, California, United States
St. Joseph Heritage Healthcare
Santa Rosa, California, United States
Kaiser Permanente Medical Center - Vallejo
Vallejo, California, United States
Colorado Cancer Research Program
Denver, Colorado, United States
Yale University
New Haven, Connecticut, United States
Disease-free survival (DFS) - time from randomization until first colon cancer recurrence, second primary colon cancer, or death due to any cause.
To determine whether treatment with regorafenib following adjuvant therapy improves disease-free survival (DFS) in patients with Stage IIIB or IIIC colon cancer
Time frame: Beginning at day 1 of cycle 3 (each cycle = 28 days) and every 6 months until study closure about 10 years
Overall Survival (OS) - time from randomization until death from any cause.
Determine the overall Survival
Time frame: Day 1 of every cycle of chemotherapy then 30 days post study therapy, then every 6 months (years 3-5) then yearly (years 6 & 7)
Toxicity - frequency and severity of adverse events categorized using the NCI Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0)
Evaluate toxicity associated with study therapy
Time frame: Every study visit through 30 days following study therapy
Compliance - Time to discontinuation of study therapy.
Evaluate the overall tolerability and compliance with study therapy
Time frame: Every study visit through discontinuation of study therapy, assessed for up to 24 months
Correlative Science - Biomarker evaluations
Explore molecular and genetic correlatives for the degree of benefit from regorafenib
Time frame: Before randomization, prior to beginning Cycle 6, every 6 months through year 5, and at the end of study therapy (maximum of 2 years).
Correlative Science - Pharmacokinetics - Plasma regorafenib concentrations
Evaluation of exposure to regorafenib
Time frame: Day 15 of Cycle 1 and Cycle 2 of study therapy.
Correlative Science - Pharmacodynamics
Evaluation of relationship between plasma concentrations and/or dose, efficacy, or adverse events
Time frame: Day 15 of Cycle 1 and Cycle 2 of study therapy.
Compare the symptoms experienced by patients receiving regorafenib to patients receiving placebo during treatment as measured by Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)
Severity of treatment related symptoms experienced by patients.
Time frame: Baseline, 3 months, 6 months, 12 months, 18 months, 24 months and 6 months after discontinuation of protocol therapy
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University of Florida
Gainesville, Florida, United States
Mount Sinai Comprehensive Cancer Center
Miami Beach, Florida, United States
Memorial Health University Medical Center
Savannah, Georgia, United States
Cancer Care Specialists of Illinois - Decatur Memorial Hospital
Decatur, Illinois, United States
Edward Hospital Cancer Center
Naperville, Illinois, United States
...and 41 more locations