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Vorinostat, Fluorouracil, and Leucovorin Calcium in Treating Patients With Metastatic Colorectal Cancer That Has Not Responded to Previous Treatment

A Randomized Phase II Study of Two Dose-Levels of Vorinostat in Combination With 5-FU and Leucovorin in Patients With Refractory Metastatic Colorectal Cancer

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00942266
Enrollment
58
Registered
2009-07-20
Start date
2009-07-31
Completion date
2011-12-31
Last updated
2014-06-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Adenocarcinoma of the Colon, Adenocarcinoma of the Rectum, Recurrent Colon Cancer, Recurrent Rectal Cancer, Stage IV Colon Cancer, Stage IV Rectal Cancer

Brief summary

RATIONALE: Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as fluorouracil and leucovorin calcium, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known which dose of vorinostat is more effective when given together with combination chemotherapy in treating patients with metastatic colorectal cancer. PURPOSE: This randomized phase II trial is studying the best dose of vorinostat to see how well it works when given together with fluorouracil and leucovorin calcium in treating patients with metastatic colorectal cancer that has not responded to previous treatment.

Detailed description

PRIMARY OBJECTIVES: I. Describe the 2-months progression free rate on vorinostat 800mg/day x 3 in combination with 5-FU/L V every 2 weeks. (Arm I) II. Describe the 2-months progression free rate on vorinostat 1400mg/day x 3 in combination with 5-FU/L V every 2 weeks. (Arm II) SECONDARY OBJECTIVES: I. Describe the response rate on Arm 1 and Arm 2 of the study. II. Estimate the median progression free survival on both arms of the study. III. Describe the overall survival on Arm 1 and Arm 2 of the study. IV. Describe the toxicities on Arm 1 and Arm 2 of the study. V. Describe vorinostat pharmacokinetics on Arm 1 and Arm 2 of the study. VI. Describe 5-FU steady state pharmacokinetics on Arm 1 and Arm 2 of the study. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive low-dose oral vorinostat once daily on days 1-3, leucovorin calcium IV over 2 hours on day 2, and fluorouracil IV over 46 hours on days 2 and 3. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive high-dose oral vorinostat once daily on days 1-3 and leucovorin calcium and fluorouracil as in arm I. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. After completion of study therapy, patients are followed up for 30 days and then every 3 months.

Interventions

DRUGfluorouracil

Given IV

DRUGleucovorin calcium

Given IV

DRUGvorinostat

Given orally

OTHERpharmacological study

Correlative study

Sponsors

Merck Sharp & Dohme LLC
CollaboratorINDUSTRY
Roswell Park Cancer Institute
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Inclusion * Patients must have histologically or cytologically confirmed colorectal adenocarcinoma that is metastatic and which has failed standard treatment or for which no standard treatment is available * Patients should have fluoropyrimidine-refractory disease; radiographic evidence of progression within 4 weeks from the last dose of a fluoropyrimidine-based regimen (at least 6 weeks of fluoropyrimidine-based treatment) * Patients should have received and progressed on (or proved to be intolerant to) oxaliplatin and irinotecan; progression within 6 months from oxaliplatin-based therapy or irinotecan-based therapy is acceptable for eligibility * Patients with KRAS wild-type or unknown KRAS status tumors should have progressed on or within 6 months from last cetuximab or panitumumab-based therapy; no prior cetuximab therapy is required for KRAS mutant tumors * ECOG performance status =\< 2 * Life expectancy \>= 12 weeks * Ability to understand and the willingness to sign a written informed consent document * Ability to swallow pills * Absolute neutrophil count \>= 1,500/uL * Platelets \>= 100,000/uL * Total bilirubin =\< institutional upper limit of normal * AST(SGOT)/ALT(SGPT) =\< 3 x institutional upper limit of normal in the absence of metastatic disease to the liver and =\< 5 x institutional upper limit of normal in the setting of metastatic disease to the liver * Creatinine =\< 1.5 x institutional upper limit of normal * Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation * Males undergoing study treatment should also agree to adequate measures of contraception (partner contraception and use of condoms or abstinence, or vasectomy) Exclusion * Patients who have had chemotherapy or radiotherapy within 3 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from significant adverse events due to agents administered more than 3 weeks earlier * Patients may not be receiving any other investigational agents * Patients with known brain metastases should be excluded from this clinical trial * History of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat or other agents used in study * Greater than Grade 2 neuropathy as defined by CTCAE version 3.0 * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Baseline EKG with QTc prolongation that is grade 2 or higher by CTCAE version 3.0 * Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with vorinostat * Patients should not have taken valproic acid or other histone deacetylase inhibitors, for at least 4 weeks prior to enrollment * Patients with known HIV infection or known active viral hepatitis * Prior treatment with vorinostat * Other non-study medications known to increase the QTc interval

Design outcomes

Primary

MeasureTime frameDescription
Disease Control Rate (Stable Disease or Objective Response)At 2 monthsPer Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Secondary

MeasureTime frameDescription
Response RateEvery 8 weeks; up to 100 weeks.Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
ToxicityDailyNumber of participants with an adverse event. Please refer to the adverse event reporting for more detail.
Median Progression-free SurvivalEvery 8 weeks, up to 100 weeks.Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Vorinostat Pharmacokineticsday 2 (cycle 1)Blood samples (5 ml of blood each) will be collected in red-top vacutainers (no anticoagulant) at 0 (pre- vorinostat), 0.5, 1, 2, 3, 4, 6, and 8 hours after the vorinostat dose on the first day of 5-FU infusion on cycle 1 (day 2 of cycle 1). Mean area under the curve is presented with 95% CI.
Fluorouracil Steady-state PharmacokineticsDay 1Blood samples will be collected for determination of plasma 5-FU steady state concentration at 6 hours after start of 5-FU continuous infusion. The mean per treatment arm are presented.
Overall SurvivalEvery 12 weeks

Countries

United States

Participant flow

Participants by arm

ArmCount
Arm I: Low-dose Vorinostat
Patients receive low-dose oral vorinostat once daily on days 1-3, leucovorin calcium IV over 2 hours on day 2, and fluorouracil IV over 46 hours on days 2 and 3. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. fluorouracil: Given IV leucovorin calcium: Given IV vorinostat: Given orally pharmacological study: Correlative study
43
Arm II: High-dose Vorinostat
Patients receive high-dose oral vorinostat once daily on days 1-3 and leucovorin calcium and fluorouracil as in arm I. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. fluorouracil: Given IV leucovorin calcium: Given IV vorinostat: Given orally pharmacological study: Correlative study
15
Total58

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event21
Overall StudyDisease Progression3811
Overall StudyFailure to thrive and pt withdrawal01
Overall StudyIntercurrent illness01
Overall Studymedical deterioration (pneumonia)01
Overall StudyPhysician Decision20
Overall StudyWithdrawal by Subject10

Baseline characteristics

CharacteristicArm I: Low-dose VorinostatArm II: High-dose VorinostatTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
14 Participants6 Participants20 Participants
Age, Categorical
Between 18 and 65 years
29 Participants9 Participants38 Participants
Age, Continuous60.5 years
STANDARD_DEVIATION 10.3
61.1 years
STANDARD_DEVIATION 10.5
60.6 years
STANDARD_DEVIATION 10.1
Sex: Female, Male
Female
22 Participants9 Participants31 Participants
Sex: Female, Male
Male
21 Participants6 Participants27 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
42 / 4315 / 15
serious
Total, serious adverse events
12 / 436 / 15

Outcome results

Primary

Disease Control Rate (Stable Disease or Objective Response)

Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Time frame: At 2 months

Population: All treated and eligible patients; per protocol

ArmMeasureValue (NUMBER)
Arm I: Low-dose VorinostatDisease Control Rate (Stable Disease or Objective Response)53 percentage of participants
Arm II: High-dose VorinostatDisease Control Rate (Stable Disease or Objective Response)53 percentage of participants
Secondary

Fluorouracil Steady-state Pharmacokinetics

Blood samples will be collected for determination of plasma 5-FU steady state concentration at 6 hours after start of 5-FU continuous infusion. The mean per treatment arm are presented.

Time frame: Day 1

Population: All treated and eligible patients

ArmMeasureValue (MEAN)
Arm I: Low-dose VorinostatFluorouracil Steady-state Pharmacokinetics389.4 ng/ml
Arm II: High-dose VorinostatFluorouracil Steady-state Pharmacokinetics423.5 ng/ml
Secondary

Median Progression-free Survival

Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Time frame: Every 8 weeks, up to 100 weeks.

Population: All treated and eligible patients; per protocol

ArmMeasureValue (MEDIAN)
Arm I: Low-dose VorinostatMedian Progression-free Survival2.4 months
Arm II: High-dose VorinostatMedian Progression-free Survival2.9 months
Secondary

Overall Survival

Time frame: Every 12 weeks

Population: All treated and eligible patients; per protocol

ArmMeasureValue (MEDIAN)
Arm I: Low-dose VorinostatOverall Survival6.5 months
Arm II: High-dose VorinostatOverall Survival6.7 months
Secondary

Response Rate

Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Time frame: Every 8 weeks; up to 100 weeks.

Population: All treated and eligible patients; per protocol

ArmMeasureValue (NUMBER)
Arm I: Low-dose VorinostatResponse Rate2.3 percentage of participants
Arm II: High-dose VorinostatResponse Rate100 percentage of participants
Secondary

Toxicity

Number of participants with an adverse event. Please refer to the adverse event reporting for more detail.

Time frame: Daily

Population: All treated and eligible patients; per protocol

ArmMeasureValue (NUMBER)
Arm I: Low-dose VorinostatToxicity42 participants
Arm II: High-dose VorinostatToxicity15 participants
Secondary

Vorinostat Pharmacokinetics

Blood samples (5 ml of blood each) will be collected in red-top vacutainers (no anticoagulant) at 0 (pre- vorinostat), 0.5, 1, 2, 3, 4, 6, and 8 hours after the vorinostat dose on the first day of 5-FU infusion on cycle 1 (day 2 of cycle 1). Mean area under the curve is presented with 95% CI.

Time frame: day 2 (cycle 1)

Population: Vorinostat PKs were be performed on day 2 of vorinostat in the first 10 patients of each arm treated at RPCI

ArmMeasureValue (MEAN)
Arm I: Low-dose VorinostatVorinostat Pharmacokinetics12.6 hr∙μM
Arm II: High-dose VorinostatVorinostat Pharmacokinetics14.7 hr∙μM

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026