Metastatic Colorectal Cancer
Conditions
Keywords
Colorectal Cancer, Cediranib, RECENTIN
Brief summary
The purpose of this study is to determine if Cediranib when added to chemotherapy is more effective than chemotherapy alone in prolonging life expectancy and slowing disease progression in patients with previously untreated metastatic colorectal cancer.
Interventions
oral tablet
intravenous infusion
intravenous oxaliplatin 130 mg/ m\^2(day 1) followed by oral capecitabine 1,000 mg/ m\^2twice daily (day 1 to day 15)
oral tablet
Sponsors
Study design
Eligibility
Inclusion criteria
* Written Informed Consent * Carcinoma of the colon or rectum * One or more measurable lesions
Exclusion criteria
* Adjuvant/neoadjuvant therapy within 6-12 months of study entry * Untreated unstable brain or meningeal metastases * Specific laboratory ranges * Specific cardiovascular problems * Participation in other trials within 30 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival | RECIST assessed at baseline every 6 weeks through to week 24 and 12 week thereafter through to progression or data cut off date of 21/03/10 whichever was earliest. | RECIST criteria defined as follows: Target lesions Complete Response (CR) Disappearance of all target lesions Partial Response (PR) At least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD.Progressive Disease (PD) At least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD recorded (either at baseline or at previous assessment since treatment began).Stable Disease (SD) Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Non-target lesions Complete Response (CR) Disappearance of all non-target lesions Non-Complete Response (non-CR/Non- Progression \[non-PD\]) Persistence of one or more non-target lesion or/and maintenance of tumour marker level above the normal limits. Progression (PD) Unequivocal progression of existing nontarget lesions. |
| Overall Survival | Baseline through to date of death upto and including data cut off date of 21/03/10 | Number of months from randomisation to the date of death from any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response | Treatment period from initial response up until data cut-off date of 21/03/10 | Based on RECIST measurements taken throughout the study and best objective tumour response at the defined analysis cut-off point. Measured from the time the criteria for CR/PR are first met (whichever is recorded first) until the patient progresses or dies. |
| Overall Response Rate | Baseline through to date of death upto and including data cut off date of 21/03/10 | Objective tumour response(defined as a confirmed response of CR or PR).The definition for a confirmed response was met when an initial RECIST response of PR/CR was confirmed at the next scheduled visit as a PR/CR according to an evaluable assessment.Intervening assessments of non-evaluable or stable disease were allowable as long as the initial RECIST response was confirmed.RECIST criteria defined as follows: Target lesions Complete Response(CR)Disappearance of all target lesions Partial Response (PR).At least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD. Progressive Disease (PD) At least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD recorded (either at baseline or at previous assessment since treatment began).Stable Disease (SD) Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.Non-target lesions Complete Response (CR) Disappearance of all non-target lesi |
| Time to Wound Healing Complications | Post-randomisation until end of study | Number of days from post-randomisation surgery until wound healing complications |
| Rate of Resection of Liver Metastases | Post-randomisation until end of study | Number of patients undergoing liver resection, based on patients with liver disease at baseline |
| Best Percentage Change in Tumour Size | Baseline through to date of death upto and including data cut off date of 21/03/10 | Maximum percentage reduction or minimum percentage increase in tumour size where size is the sum of the longest diameters of the target lesions |
Countries
Argentina, Australia, Brazil, Bulgaria, China, Czechia, Germany, Hungary, India, Philippines, Poland, South Korea, Switzerland, Taiwan, United Kingdom
Participant flow
Recruitment details
Randomised=full analysis set: Cediranib 20mg=502, Placebo=358; Safety set: Cediranib 20mg=500, Cediranib 30mg=214, Placebo=358
Pre-assignment details
Cediranib 30 mg discontinued following Phase II, Cediranib 20 mg chosen dose for comparing with Placebo. 1254 patients enrolled to the study, 1076 recieved study treatment; 2 patients lost for Cediranib 20 mg/day, and 2 patients lost for Cediranib 30 mg/day.The 4 patients that didn't receive drug are intentionally included.
Participants by arm
| Arm | Count |
|---|---|
| Cediranib 20 mg Cediranib 20 mg + FOLFOX/XELOX | 502 |
| Placebo Placebo + FOLFOX/XELOX | 358 |
| Cediranib 30 mg Cediranib 30 mg/day + FOLFOX/XELOX | 216 |
| Total | 1,076 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 289 | 141 | 234 |
| Overall Study | Incorrect enrolment/eligib not fulfilled | 1 | 0 | 1 |
| Overall Study | Lost to Follow-up | 2 | 1 | 5 |
| Overall Study | Severe non-compliance with protocol | 2 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 19 | 15 | 12 |
Baseline characteristics
| Characteristic | Cediranib 20 mg | Placebo | Cediranib 30 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 57.8 years STANDARD_DEVIATION 11.14 | 57.2 years STANDARD_DEVIATION 11.63 | 59.4 years STANDARD_DEVIATION 10.69 | 57.6 years STANDARD_DEVIATION 11.34 |
| Gender Female | 203 Participants | 146 Participants | 93 Participants | 442 Participants |
| Gender Male | 299 Participants | 212 Participants | 123 Participants | 634 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 209 / 214 | 485 / 500 | 341 / 358 |
| serious Total, serious adverse events | 94 / 214 | 204 / 500 | 105 / 358 |
Outcome results
Overall Survival
Number of months from randomisation to the date of death from any cause
Time frame: Baseline through to date of death upto and including data cut off date of 21/03/10
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 20 mg | Overall Survival | 19.7 Months |
| Placebo | Overall Survival | 18.9 Months |
Progression-free Survival
RECIST criteria defined as follows: Target lesions Complete Response (CR) Disappearance of all target lesions Partial Response (PR) At least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD.Progressive Disease (PD) At least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD recorded (either at baseline or at previous assessment since treatment began).Stable Disease (SD) Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Non-target lesions Complete Response (CR) Disappearance of all non-target lesions Non-Complete Response (non-CR/Non- Progression \[non-PD\]) Persistence of one or more non-target lesion or/and maintenance of tumour marker level above the normal limits. Progression (PD) Unequivocal progression of existing nontarget lesions.
Time frame: RECIST assessed at baseline every 6 weeks through to week 24 and 12 week thereafter through to progression or data cut off date of 21/03/10 whichever was earliest.
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation.The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 20 mg | Progression-free Survival | 8.6 Months |
| Placebo | Progression-free Survival | 8.2 Months |
Best Percentage Change in Tumour Size
Maximum percentage reduction or minimum percentage increase in tumour size where size is the sum of the longest diameters of the target lesions
Time frame: Baseline through to date of death upto and including data cut off date of 21/03/10
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cediranib 20 mg | Best Percentage Change in Tumour Size | -42.49 Percentage [change in tumour size (mm) ] | Standard Deviation 28.139 |
| Placebo | Best Percentage Change in Tumour Size | -40.61 Percentage [change in tumour size (mm) ] | Standard Deviation 31.992 |
Duration of Response
Based on RECIST measurements taken throughout the study and best objective tumour response at the defined analysis cut-off point. Measured from the time the criteria for CR/PR are first met (whichever is recorded first) until the patient progresses or dies.
Time frame: Treatment period from initial response up until data cut-off date of 21/03/10
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 20 mg | Duration of Response | 8.5 Months |
| Placebo | Duration of Response | 6.9 Months |
Overall Response Rate
Objective tumour response(defined as a confirmed response of CR or PR).The definition for a confirmed response was met when an initial RECIST response of PR/CR was confirmed at the next scheduled visit as a PR/CR according to an evaluable assessment.Intervening assessments of non-evaluable or stable disease were allowable as long as the initial RECIST response was confirmed.RECIST criteria defined as follows: Target lesions Complete Response(CR)Disappearance of all target lesions Partial Response (PR).At least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD. Progressive Disease (PD) At least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD recorded (either at baseline or at previous assessment since treatment began).Stable Disease (SD) Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.Non-target lesions Complete Response (CR) Disappearance of all non-target lesi
Time frame: Baseline through to date of death upto and including data cut off date of 21/03/10
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cediranib 20 mg | Overall Response Rate | 254 Participants |
| Placebo | Overall Response Rate | 178 Participants |
Rate of Resection of Liver Metastases
Number of patients undergoing liver resection, based on patients with liver disease at baseline
Time frame: Post-randomisation until end of study
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cediranib 20 mg | Rate of Resection of Liver Metastases | 21 Participants |
| Placebo | Rate of Resection of Liver Metastases | 17 Participants |
Time to Wound Healing Complications
Number of days from post-randomisation surgery until wound healing complications
Time frame: Post-randomisation until end of study
Population: Two cediranib doses (20 mg and 30 mg) were initially included in this study; however, it was intended that one dose would be selected for continuation. The decision was taken to continue with cediranib 20 mg. All efficacy analyses compared cediranib 20mg to placebo. No statistical analyses were performed on the 30mg group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 20 mg | Time to Wound Healing Complications | 18 Days |
| Placebo | Time to Wound Healing Complications | 18 Days |