MDACC Study Summary 2004-0816 (Archived)

Study Summary
No. 2004-0816:.......Colorectal; Liver......Eddie Abdalla......Surgical Oncology

Study Summary Title



Study Summary Number:	2004-0816

Study Title:	SINGLE-INSTITUTION PHASE II TRIAL OF OXALIPLATIN, 5-FLUOROURACIL, LEUCOVORIN AND BEVACIZUMAB (FOLFOX-B) FOR INITIALLY UNRESECTABLE COLORECTAL LIVER METASTASES: DOWNSTAGING FOLLOWED BY HEPATIC RESECTION

Physician

New Patient Referral



Name:	Eddie Abdalla	Patients Call:	800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)

Dept:	Surgical Oncology	Referring MD Call:	800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)

Phone:	713-792-6940 Contact us about clinical trials

General Information



Disease Group:	Colorectal Liver	Supported By:	N/A

Phase of Study:	Phase II	Return Visit:	Patients will have CT scan of abdomen/pelvis/chest and CXR and CBC, blood chemistries and CEA every 3 months for 3 years after completion of treatment. PET scan every 6 months for 3 years after completion of treatment.

Treatment Agents:	5-Fluorouracil Bevacizumab Leucovorin Oxaliplatin	Home Care:	Anti-emetics prescribed in protocol as needed. Infusion 5-FU runs continuously 46 hours. Patients may choose to receive chemotherapy treatment from their home medical oncologist.

Treatment Loc:	Only at MDACC

Estimated Length of Stay in Houston:	N/A


Description/ Intervention:	The goal of this clinical research study is to learn if combination treatment with oxaliplatin (L-OHP), 5-fluorouracil (5-FU), leucovorin (LV), and bevacizumab (Avastin) before surgery can decrease the size of the tumors in the liver so that any cancer in the liver can be removed by surgery.

Study Objectives / Outcomes

To evaluate the efficacy of the use of the combination of oxaliplatin, 5-fluorouracil, leucovorin and bevacizumab (FOLFOX-B) in patients with unresectable colorectal liver metastases, with the objective to downstage hepatic disease and enable complete resection of residual disease.

Primary
To evaluate the resection rate in patients with initially unresectable hepatic colorectal metastases downstaged with FOLFOX-B. Complete resection of all liver lesions is the goal.

Secondary

(1) To evaluate the probability of complete response, partial response or stable disease
(2) To evaluate the proportion of patients who are resected, and the proportion of patients achieving
an R0 resection (among those receiving surgery)
(3) To correlate survival with downstaging and resection based on metastatic colorectal
prognostic score
(4) To evaluate the disease-free survival and overall survival
(5) To evaluate the positron emission tomography response rate
(6) To explore correlations of clinical response with telomerase and hTERT expression

Study Status Information



Study Activation / Registration Date:	11/16/2005

IRB Review and Approval Date:	03/16/2005

Study Type:	Phase Ii Or Phase I/Ii

Recruitment Status:	Terminated

Projected Accrual:	N/A

Enrollment Eligibility

If you do not meet the enrollment eligibility, there may be other treatment options for you. Please Contact the Referral Office for more information.

Inclusion Criteria:

1) Patients must have hepatic colorectal metastasis confirmed by percutaneous or intraoperative hepatic tumor biopsy.

2) Patients must have radiological evidence of measurable liver metastasis with helical CT scan (1 cm or greater in greatest transverse dimension).

3) Patients with synchronous disease and resectable intact primary tumors are eligible.

4) Colorectal liver metastases will be determined to be unresectable by a surgeon with expertise in hepatic surgery (equal to or greater than 10 resections performed in a year). A patient is defined as unresectable when distribution and extent of disease preclude margin negative resection (tumor contact with or involvement of all three major hepatic veins or portal confluence or a combination of involvement of main branches of portal veins and hepatic veins), but two adjacent hepatic segments with adequate vascular inflow and outflow are relatively spared (contain 4 or fewer lesions).

5) Performance status: Zubrod 0 or 1.

6) Patients with a prior history of non-colorectal cancer may be included if there is no evidence of malignancy for at least 5 years from last treatment and no evidence of recurrence. In addition, patients with completely resected non-melanoma skin cancer or cervical carcinoma in-situ may be included.

7) Radiological baseline studies shall be completed within 21 days of protocol registration.

8) Laboratory data as follows (within 21 days of protocol registration): Adequate bone marrow as evidenced by; Hemoglobin greater than or equal to 9.0 g %; White blood cell count greater than or equal to 3,000 cells/mm; Platelet count greater than or equal to 100,000 cells/mm(3); Absolute neutrophil count greater than or equal to 1500/mm(3).

9) Continued from inclusion # 9: Laboratory data as follows (within 21 days of protocol registration): Adequate renal function as evidenced by; Creatinine less than or equal to 1.5 mg/dL or estimated creatinine clearance greater than or equal to 60 cc/min; Urinalysis: less than or equal to trace proteinuria. If greater than trace proteinuria exists, a 24- hour urine collection for assessment of protein must demonstrate less than 500 mg of protein/24 hours.

10) Continued from inclusion #10: Laboratory data as follows (within 21 days of protocol regsitration): Adequate hepatic function as evidenced by; Total Bilirubin less than or equal to 2.0 mg %; Alanine aminotransferase less than or equal to 280 IU/L; Aspartate aminotransferase less than or equal to 230 IU/L; International normalized ratio less than or equal to 2.0.

11) Women must not be pregnant or lactating. Women of childbearing potential must have a negative Beta-HCG serum pregnancy test and to refrain from breast-feeding, as specified in the informed consent given the unknown risk of teratogenicity of agents in the study. Patients of childbearing potential agree to use an effective form of contraception during the study and for 90 days following the last dose of study medication.

12) Age greater than or equal to 18 years.

13) Coumadin, 1 mg, for patency of central venous catheter or therapeutic doses of coumadin (INR less than or equal to 3) permitted.

14) Patients or their legally authorized representative must agree to participate, be able to read, understand and provide informed consent to participate in the trial.

15) Patients must be recovered from both acute and late effects of any prior surgery, radiotherapy or other antineoplastic therapy.

Exclusion Criteria:

1) Patients with surgically resectable colorectal liver metastases.

2) Patients with evidence of unresectable extrahepatic disease.

3) Patients with CNS metastases.

4) Patients with diffusely distributed bilateral hepatic metastases without sparing of two adjacent hepatic segments.

5) Patients who have previously undergone chemotherapy treatment for metastatic disease.

6) Patients who developed metastatic disease less than or equal to 6 months from adjuvant chemotherapy for stage II or stage III colorectal cancer.

7) Patients who have ever received bevacizumab.

8) Previous or concurrent treatment of hepatic metastatic disease with resection, radiotherapy, radiofrequency ablation, cryotherapy/other ablative techniques, or hepatic artery infusion chemotherapy.

9) Patients who underwent a major invasive surgical procedure or open biopsy within 28 days prior to registration.

10) Patients who underwent colonoscopy, core biopsy, or fine needle aspiration within 7 days prior to registration.

11) Patients who had an arterial thromboembolic event, including transient ischemic attack (TIA), cerebrovascular accident (CVA), unstable angina, or myocardial infarction (MI) within 12 months of registration. Patients must not have greater than or equal to Grade 2 peripheral vascular disease.

12) Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, cardiac disease NYHA class III or IV, unstable angina pectoris, unstable cardiac arrhythmia or tachycardia (heart rate greater than or equal to 100 beats per minute), poorly controlled hypertension (systolic blood pressure greater than or equal to 200 mmHg or diastolic blood pressure greater than or equal to 100 mmHg) or psychiatric illness/social situations that would limit compliance with study requirements are excluded.

13) Patients with preexisting chronic hepatic disease (chronic active hepatitis B or C, cirrhosis), which would preclude surgical resection of metastases.

14) Patients with known hypersensitivity to any of the components of oxaliplatin, 5-fluorouracil, leucovorin or bevacizumab (AVASTIN™).

15) Patients who have received chemotherapy within 30 days of the first scheduled day of protocol treatment.

16) Patients who received radiotherapy within 4 weeks of trial entry.

17) Patients who are receiving concurrent investigational therapy or who have received investigational therapy within 30 days of the first scheduled day of protocol treatment (investigational therapy is defined as treatment for which there is currently no regulatory authority approved indication).

18) Peripheral neuropathy greater than or equal to Grade 2.

19) Patients with an active infection or with a fever greater than or equal to 38.5 degrees C within 3 days of the first scheduled day of protocol treatment.

20) Patients with known autoimmune disease including HIV.

Links

Registration Number: NCT00508872
Study Information on Clinical Trials Registry (clinicaltrials.gov)