Metastatic Colorectal Cancer
Conditions
Keywords
Hedgehog, CRC, Colorectal Cancer, Hedgehog Pathway Inhibitor
Brief summary
This was a randomized, placebo-controlled, double-blind study of vismodegib (GDC-0449) added to biochemotherapy standard-of-care regimens for metastatic colorectal cancer (CRC), with treatment until disease progression. Patients received either FOLFOX (FOL=leucovorin calcium \[folinic acid\], F=fluorouracil, OX=oxaliplatin) or FOLFIRI (FOL=leucovorin calcium \[folinic acid\] F=fluorouracil, IRI=irinotecan hydrochloride) chemotherapy with bevacizumab. The decision of which regimen (FOLFOX or FOLFIRI) to use was made by the treating physician and patient. Patients were randomized to receive vismodegib or placebo and were stratified based on the chemotherapy regimen chosen and whether or not Response Evaluation Criteria in Solid Tumors (RECIST) measurable disease was present at baseline.
Interventions
Vismodegib 150 mg was provided in hard gelatin capsules in 3 different strengths, 25 mg, 125 mg, and 150 mg.
Placebo to vismodegib consisted of the excipients for vismodegib without the active molecule in hard gelatin capsules matching the active drug product in color and size.
DRUGBevacizumab
Bevacizumab 5 mg/kg was administered intravenously (IV) over 90 minutes for the first infusion, shortening to 60 and 30 minutes for subsequent infusions.
DRUGModified FOLFOX
Following administration of bevacizumab, patients received oxaliplatin 85 mg/m\^2 IV administered over 90 minutes concurrently with folinic acid 400 mg/m\^2 (d,I-racemic form, or 200 mg/m\^2 I-isomer form) IV administered over 120 minutes, then fluorouracil 400 mg/m\^2 administered as an IV bolus, then 2400 mg/m\^2 administered as a continuous IV infusion over 46 hours.
DRUGFOLFIRI
Following administration of bevacizumab, patients received irinotecan 180 mg/m\^2 IV administered over 90 minutes concurrently with folinic acid 400 mg/m\^2 (d,I-racemic form, or 200 mg/m\^2 I-isomer form) administered IV over 120 minutes, then fluorouracil 400 mg/m\^2 administered as an IV bolus, then fluorouracil 2400 mg/m\^2 administered as a continuous IV infusion over 46 hours.
Sponsors
Genentech, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Histologically confirmed metastatic colorectal cancer (CRC) * Representative tumor specimens in paraffin blocks (preferred) or at least 15 unstained slides, with an associated pathology report, must be confirmed to be available and requested at any time prior to entry of study * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 * Adequate hematopoetic capacity * Adequate hepatic function * Adequate renal function * Use of an effective method of barrier contraception (for women of childbearing potential) * Signed informed consent
Exclusion criteria
* Prior chemotherapy for metastatic CRC or adjuvant chemotherapy for CRC within the prior 6 months * Clinically suspected or confirmed CNS metastases or carcinomatous meningitis * Major surgical procedure within 4 weeks prior to the first day of treatment in this study (Day 1) * Pelvic radiation within 2 weeks prior to Day 1 * Wound dehiscence requiring intervention, gastrointestinal perforation, or bowel obstruction * Pregnancy or lactation * Uncontrolled medical illnesses including the following: Infection requiring intravenous (IV) antibiotics, congestive heart failure not controlled with medication, hypertension not controlled with medication * Thromboembolic disease * History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or that might affect interpretation of the results of the study or render the patient at high risk from treatment complications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) | From first treatment through the data cut-off date of March 15, 2010, up to 90 weeks | Progression-free survival (PFS) was defined as the time from randomization to the earlier of documented disease progression (PD) or death from any cause. PD: At least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter recorded since treatment started, unequivocal progression of existing non-target lesions, or the appearance of one or more new lesions. For patients without measurable disease, PD was defined as an increase in the size of a lesion to one that is measurable or unequivocal progression of a non-target lesion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | From first treatment through the data cut-off date of March 15, 2010, up to 90 weeks | Indian + Sonic Hedgehog antigen expression was measured by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) from archival tumor tissue taken from each patient prior to enrollment in the study. Results are reported in 3 categories; the 33% of patients with the lowest level of expression, the 35% of patients with a middle level of expression, and the 32% of patients with the highest level of expression. PFS was defined as the time between randomization and disease progression, as confirmed by radiography, or death for any reason. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Vismodegib 150 mg Patients received vismodegib 150 mg orally once daily starting on Day 3 of each 2-week treatment cycle. In addition, patients received either Modified FOLFOX (FOL=leucovorin calcium \[folinic acid\], F=fluorouracil, OX=oxaliplatin) + bevacizumab or FOLFIRI (FOL=leucovorin calcium \[folinic acid\] F=fluorouracil, IRI=irinotecan hydrochloride) + bevacizumab on Days 1-3 of each 2-week treatment cycle. The decision of which regimen (FOLFOX or FOLFIRI) to use was made by the treating physician and patient. | 98 |
| Placebo to Vismodegib Patients received placebo to vismodegib orally once daily starting on Day 3 of each 2-week treatment. In addition, patients received either Modified FOLFOX (FOL=leucovorin calcium \[folinic acid\], F=fluorouracil, OX=oxaliplatin) + bevacizumab or FOLFIRI (FOL=leucovorin calcium \[folinic acid\] F=fluorouracil, IRI=irinotecan hydrochloride) + bevacizumab on Days 1-3 of each 2-week treatment cycle. The decision of which regimen (FOLFOX or FOLFIRI) to use was made by the treating physician and patient. | 101 |
| Total | 199 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 4 | 4 |
| Overall Study | Death | 6 | 3 |
| Overall Study | Disease progression - clinical | 8 | 3 |
| Overall Study | Disease progression - radiographic | 41 | 51 |
| Overall Study | Physician decision to withdraw patient | 15 | 9 |
| Overall Study | Reason for discontinuation not available | 3 | 2 |
| Overall Study | Subject decision to withdraw | 15 | 11 |
Baseline characteristics
| Characteristic | Vismodegib 150 mg | Placebo to Vismodegib | Total |
|---|---|---|---|
| Age, Continuous | 60.8 years STANDARD_DEVIATION 10.4 | 60.4 years STANDARD_DEVIATION 11 | 60.6 years STANDARD_DEVIATION 10.7 |
| Sex: Female, Male Female | 39 Participants | 46 Participants | 85 Participants |
| Sex: Female, Male Male | 59 Participants | 55 Participants | 114 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 62 / 62 | 61 / 61 | 36 / 36 | 36 / 37 |
| serious Total, serious adverse events | 21 / 62 | 29 / 61 | 9 / 36 | 18 / 37 |
Outcome results
Primary
Progression-free Survival (PFS)
Progression-free survival (PFS) was defined as the time from randomization to the earlier of documented disease progression (PD) or death from any cause. PD: At least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter recorded since treatment started, unequivocal progression of existing non-target lesions, or the appearance of one or more new lesions. For patients without measurable disease, PD was defined as an increase in the size of a lesion to one that is measurable or unequivocal progression of a non-target lesion.
Time frame: From first treatment through the data cut-off date of March 15, 2010, up to 90 weeks
Population: Intent-to-treat patient population: All randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vismodegib 150 mg | Progression-free Survival (PFS) | 9.3 Months |
| Placebo to Vismodegib | Progression-free Survival (PFS) | 10.1 Months |
Secondary
Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression
Indian + Sonic Hedgehog antigen expression was measured by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) from archival tumor tissue taken from each patient prior to enrollment in the study. Results are reported in 3 categories; the 33% of patients with the lowest level of expression, the 35% of patients with a middle level of expression, and the 32% of patients with the highest level of expression. PFS was defined as the time between randomization and disease progression, as confirmed by radiography, or death for any reason.
Time frame: From first treatment through the data cut-off date of March 15, 2010, up to 90 weeks
Population: Intent-to-treat patient population: All randomized patients. Tissue for evaluation was only available for 64 patients in the vismodegib group and 75 patients in the placebo group.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Vismodegib 150 mg | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | ≤ 33%, n=(16,30) | 9.2 Months |
| Vismodegib 150 mg | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | 33% - 67%, n=(18,28) | 7.4 Months |
| Vismodegib 150 mg | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | > 67%, n=(30,17) | 10.7 Months |
| Placebo to Vismodegib | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | ≤ 33%, n=(16,30) | 9.4 Months |
| Placebo to Vismodegib | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | 33% - 67%, n=(18,28) | 11.3 Months |
| Placebo to Vismodegib | Progression-free Survival (PFS) in Patients With Various Degrees of Hedgehog Antigen Tumor Expression | > 67%, n=(30,17) | 14.4 Months |