Pemetrexed and S-1 in Combination With Bevacizumab in Refractory Colorectal Cancer

NCT03843853 | Withdrawn Phase 2 FDA Drug

• 1 other identifier: KEEP-G 02
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Limited agents are optional after standard first and second line treatment for mCRC. Only Regorafenib and Fruquintinib are approved in China. PFS of these targeted drugs are not very long. Pemetrexed has shown significant efficacy in advanced lung cancer regarding PFS and OS with controllable toxicity. S-1 has been used in colorectal cancer with promising outcomes. Bevacizumab is also an important monoclonal antibody which could make benefits in treated patients. This study is aimed to explore the efficacy, safety in advanced colorectal cancer failed to standard therapy in Chinese population.

Conditions

Colorectal Neoplasms

Outcome Measures

Primary Outcomes (1)

• Progression-free Survival(PFS)

  PFS was defined as the time from assignment to disease progression radiological/clinical or death due to any cause, whichever occurs first. Subjects without progression or death at the time of analysis were censored at their last date of tumor evaluation.

  From assignment of the first subject to 3 months later after the last participant is recruited.The last participant will be recruited before November 1,2021

Secondary Outcomes (4)

• Overall Survival (OS)

  From assignment of the first subject until 40 death events observed, up to 2 years.

• Disease control rate (DCR)

  From assignment of the first subject to 3 months later after the last participant is recruited.The last participant will be recruited before November 1,2021

• Objective response rate(ORR)

  From assignment of the first subject to 3 months later after the last participant is recruited.The last participant will be recruited before November 1,2021

• Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

  From assignment of the first subject to 3 months later after the last participant is recruited.The last participant will be recruited before November 1,2021

Study Arms (1)

Pemetrexed + S-1 + Bevacizumab

EXPERIMENTAL

Pemetrexed 500 mg/m2 d1+ S-1 (20mg、25mg), capsule, 40\~60mg, Bid,p.o, d1\~14 + Bevacizumab 7.5 mg/kg d1; Repeated every 3 weeks

Drug: Pemetrexed; Drug: S-1; Drug: Bevacizumab

Interventions

Pemetrexed DRUG

Pemetrexed 500 mg/m2 d1

Pemetrexed + S-1 + Bevacizumab

S-1 DRUG

S-1 (20mg、25mg), capsule, 40\~60mg, Bid,p.o, d1\~14

Pemetrexed + S-1 + Bevacizumab

Bevacizumab DRUG

Bevacizumab 7.5 mg/kg d1

Also known as: Avastin

Pemetrexed + S-1 + Bevacizumab

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histological or cytological documentation of adenocarcinoma of the colon or rectum. All other histological types are excluded.
• Subjects with metastatic colorectal cancer(CRC) (Stage IV).
• Subjects must have failed at least two lines of prior treatment, which must include a fluoropyrimidine, oxaliplatin and irinotecan.
• Subjects have failed or refused third-line treatment with regorafenib or fruquintinib.
• Subjects treated with oxaliplatin in an adjuvant setting should have progressed during or within 6 months of completion of adjuvant therapy.
• Subjects who have withdrawn from standard treatment due to unacceptable toxicity and precluding retreatment with the same agent prior to progression of disease will also be allowed.
• Prior treatment with bevacizumab and/or cetuximab will be allowed, but the use of bevacizumab should be no more than one single line treatment.
• Measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, version 1.1.is necessary.
• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1.
• Life expectancy of at least 3 months.
• Adequate bone marrow, liver, cardiac and renal function as assessed by the laboratory required by protocol.
• Assigned informed consent.

You may not qualify if:

• Previous or concurrent cancer that is distinct in primary site or histology from colorectal cancer EXCEPT for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors \[Ta (non-invasive tumor), Tis (carcinoma in situ) and T1 (tumor invades lamina propria)\].
• Participants of other clinical trial within 4 weeks.
• Diseases which will impact the absorption of S-1, eg. dysphagia, chronic diarrhea, bowl obstruction
• Hemorrhage events of ≥grade 3 within 4 weeks.
• Known central nervous system metastasis.
• Uncontrolled hypertension. (Systolic blood pressure 140 mmHg or diastolic pressure 90 mmHg despite optimal medical management). Unstable angina,congestive heart failure,Myocardial infarction, Cardiac arrhythmias requiring anti-arrhythmic therapy.
• Urine protein ≥++ and 24h urine protein more than 1.0g.
• Chronically green wound or bone fracture.
• Arterial or venous thrombotic or embolic events.
• Tumor invading important blood vessel with high risk of severe hemorrhage.
• Current active bleeding or any surgery taken within 2 months.
• Abnormal coagulation function.
• Thromboemboli events within 6 months.
• Immune diseases or organ transplantation history.

Sponsors & Collaborators

• The First Affiliated Hospital with Nanjing Medical University: lead
• Jiangsu HanSoh Tharmaceutical Group Co., Ltd: collaborator

Study Sites (1)

the First Affiliated Hospital of Nanjing Medical University

Nanjing, Jiangsu, 210029, China

Location

Related Publications (3)

• Wu XY, Huang XE, You SX, Lu YY, Cao J, Liu J. Phase II study of pemetrexed as second or third line combined chemotherapy in patients with colorectal cancer. Asian Pac J Cancer Prev. 2013;14(3):2019-22. doi: 10.7314/apjcp.2013.14.3.2019.

  PMID: 23679311 BACKGROUND

• Passardi A, Fanini F, Turci L, Foca F, Rosetti P, Ruscelli S, Casadei Gardini A, Valgiusti M, Dazzi C, Marangolo M. Prolonged Pemetrexed Infusion Plus Gemcitabine in Refractory Metastatic Colorectal Cancer: Preclinical Rationale and Phase II Study Results. Oncologist. 2017 Aug;22(8):886-e79. doi: 10.1634/theoncologist.2017-0206. Epub 2017 Jun 7.

  PMID: 28592624 BACKGROUND

• Lim SW, Lee S, Lee J, Park SH, Park JO, Park YS, Lim HY, Kang WK, Kim ST. Pemetrexed Monotherapy as Salvage Treatment in Patients with Metastatic Colorectal Cancer Refractory to Standard Chemotherapy: A Phase II Single-arm Prospective Trial. J Cancer. 2018 Jul 30;9(16):2910-2915. doi: 10.7150/jca.24948. eCollection 2018.

  PMID: 30123359 BACKGROUND

MeSH Terms

Conditions

Colorectal Neoplasms

Interventions

Pemetrexed; S 1 (combination); Bevacizumab

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Intervention Hierarchy (Ancestors)

Guanine; Hypoxanthines; Purinones; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Glutamates; Amino Acids, Acidic; Amino Acids; Amino Acids, Peptides, and Proteins; Amino Acids, Dicarboxylic; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Serum Globulins; Globulins

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 14, 2019
• First Posted: February 18, 2019
• Study Start: May 1, 2019
• Primary Completion: November 1, 2021
• Study Completion: May 1, 2022
• Last Updated: July 25, 2022

Record last verified: 2022-07

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)