Once randomisation has been completed, the study treatment should be started preferably immediately; at the latest within one week following randomisation. The patients will be randomised in a ratio of 1:2 to the following two treatment arms. Patients in both treatment arms will receive standard chemotherapy with FOLFOXIRI as background treatment, which can be de-escalated to FOLFIRI in case of toxicity. Standard arm A: The patient will be treated with FOLFOXIRI plus bevacizumab for up to 12 cycles (24 weeks) or until progression (if the latter occurs before completing the 12 cycles). Within the 12 cycles, the FOLFOXIRI plus bevacizumab regimen may be de-escalated, owing to toxicity, to FOLFIRI and bevacizumab at the treating physician's discretion. After 12 cycles of the study treatment, a switch to a maintenance regimen with a fluoropyrimidine (5-FU infusion or capecitabine) plus bevacizumab, administered until progression occurs, is recommended. The recommended maintenance phase of the study is not part of the study treatment. However, maintenance therapy will be counted as first-line therapy. Experimental arm B: The patient will be treated with FOLFOXIRI plus weekly administration of cetuximab for up to 12 cycles (24 weeks) or until progression (if the latter occurs before completing the 12 cycles). Within the 12 cycles, the FOLFOXIRI plus cetuximab regimen may be de-escalated owing to toxicity, to FOLFIRI and cetuximab at the treating physician's discretion. After 12 cycles, a switch to a maintenance regimen with 5-FU and cetuximab or with irinotecan and cetuximab, administered until progression occurs, is recommended. The recommended maintenance phase of the study is not part of the study treatment. However, maintenance therapy will be counted as first-line therapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
109
Bevacizumab 5 mg/kg BW iv over 30 to 90\* min day 1
Irinotecan 150 mg/m² iv, 30 - 90 min. day 1
Folinic acid (racemic) 400 mg/m² iv, 120 min. day 1
Oxaliplatin 85mg/m² day 1
5-FU 3000 mg/m² iv over 48 h days 1-2
Cetuximab initially 400 mg/m² with infusion rate of ≤5 mg/min., subsequently 250 mg/m² iv with infusion rate of ≤10 mg/min. days 1+8
Klinikum der Universitaet Muenchen
Munich, Germany
Overall Response Rate (ORR)
(overall response rate) measured in percentage of all treated patients according to RECIST 1.1 criteria
Time frame: up to 48 months
Progression Free Survival (PFS)
Investigation of progression-free survival (PFS) from randomisation
Time frame: up to 60 months
Overall Survival (OS)
Investigation of overall survival (OS) from randomisation
Time frame: up to 60 months
Investigation of Early Tumour Shrinkage (ETS) as early-on-Treatment predictor for treatment
Investigation of early tumour shrinkage (ETS)
Time frame: up to 48 months
Investigation of Depth of Response (DpR) to define nadir for tumour response.
Investigation of depth of response (DpR)
Time frame: up to 48 months
Investigation of Molecular Biomarkers for Prediction of an Anti-EGFR Treatment
Investigation of molecular biomarkers for prediction of sensitivity and secondary resistance of an anti-EGFR treatment with cetuximab (including tumour biopsies and liquid biopsies from blood samples)
Time frame: up to 48 months
Prospective Analysis of Tumour Marker Level Evolution (CEA and CA 19-9)
Investigation of prospective analysis of tumour marker level evolution (CEA and CA 19-9)
Time frame: up to 48 months
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Recording of the safety and tolerability (NCI-CTCAE version 4.03 criteria) of the treatment
Time frame: up to 48 months
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