Stage IV Colon Cancer, Stage IV Rectal Cancer
Conditions
Brief summary
This phase II trial is studying how well giving high-dose cholecalciferol works in treating patients receiving combination chemotherapy and bevacizumab as first-line therapy for metastatic colorectal cancer. Cholecalciferol during treatment may delay the development of colorectal cancer. Drugs used in chemotherapy, such as leucovorin calcium, fluorouracil, and oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving cholecalciferol together with combination chemotherapy and monoclonal antibody therapy may be an effective treatment for colorectal cancer
Detailed description
PRIMARY OBJECTIVES: I. To determine the relative rate of metastatic colorectal cancer patients who achieve 25-D3 levels \>= 40 ng/ml at 8 weeks, 16 weeks, 24 weeks, and 32 weeks from starting FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) + bevacizumab + high dose vitamin D3 supplementation (cholecalciferol). II. To estimate the median progression-free survival (PFS) of metastatic colorectal cancer patients receiving first-line FOLFOX + bevacizumab + high dose vitamin D3 supplementation. SECONDARY OBJECTIVES: I. To estimate the response rate (RR) and the median overall survival (OS) of metastatic colorectal cancer patients receiving first-line FOLFOX + bevacizumab + high dose vitamin D3 supplementation. II. To describe the safety of this combination by capturing all treatment-related toxicity as per National Cancer Institute-Common Terminology Criteria (NCI-CTC) version 4 guidelines. OUTLINE: Patients receive high-dose cholecalciferol orally (PO) once daily. Patients also receive bevacizumab intravenously (IV) over 10 minutes, leucovorin calcium IV over 2 hours, oxaliplatin\* IV over 2 hours, and fluorouracil IV continuously over 46 hours once a week. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. NOTE: \*Treatment with oxaliplatin is discontinued after course 8. After completion of study treatment, patients are followed up at day 30 and then 3 months thereafter.
Interventions
DRUGleucovorin calcium
Given IV
BIOLOGICALbevacizumab
Given IV
DIETARY_SUPPLEMENTcholecalciferol
Given PO
DRUGfluorouracil
Given IV
DRUGoxaliplatin
Given IV
OTHERpharmacological study
Correlative studies
Sponsors
National Cancer Institute (NCI)
Roswell Park Cancer Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Patients should have untreated metastatic colorectal cancer; prior adjuvant chemotherapy is allowed as long as the development of metastatic disease occurred more than 6 months from completion of adjuvant treatment * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1 * Platelets \>= 100,000/mm\^3 * Absolute neutrophil count (ANC) \>= 1,500/mm\^3 * Hemoglobin \> 9 gm/dl * Calculated creatinine clearance \> 40 ml/min according to the Cockcroft-Gault formula OR per 24 hour urine collection * Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \< 2.5 x institutional upper normal level if no liver metastases and \< 5 x upper limit of normal (ULN) in the setting of liver metastases * Total bilirubin =\< 1.5 x institutional upper normal level * Albumin \>= 2.5 g/dl * Urine protein:creatinine (UPC) ratio \< 1; in the event UPC is \> 1, the patient will require a 24-hr urine protein and will be eligible if 24-hr urine collection has \< 1,000 mg protein * Patients of child-hearing potential must agree to use acceptable contraceptive methods (e.g., double harrier) during treatment * Patient or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board-approved written informed consent form prior to receiving any study-related procedure * Presence of measurable disease defined as a lesion \>= 1 cm by computed tomography (CT); all sites of disease should be evaluated =\< 3 weeks before treatment initiation * Baseline 25-D3 level of \< 40 ng/ml
Exclusion criteria
* Patients may not be receiving any other investigational agents that are not included in this study * Patients with known brain metastases * History of other invasive cancers with the exception of the following: a. Curatively resected or treated non-melanoma skin cancer; b. Curatively treated cervical carcinoma in situ; c. Other primary solid tumors treated curatively and no treatment administered \>= 2 years before enrollment, and in the investigator opinion, it is unlikely that there will be a recurrence =\< 1 year post enrollment * History of allergic reactions attributed to compounds of similar chemical or biologic composition to oxaliplatin, 5-FU, leucovorin, bevacizumab, and vitamin D3 and other agents used in study * History of clinically significant bleeding within 6 months of enrollment * Clinically significant cardiovascular disease within 12 months prior to enrollment, including myocardial infarction, unstable angina, grade 2 or greater peripheral vascular disease, cerebrovascular accident, transient ischemic attack, congestive heart failure or arrhythmias not controlled by outpatient medication, percutaneous transluminal coronary angioplasty/stent * Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated on this study * Major surgery within 28 days prior to enrollment or still recovering from prior surgery * Known dihydropyrimidine dehydrogenase (DpD) deficiency * History or evidence upon physical examination of central nervous system (CNS) disease (e.g., primary brain tumor, seizures not controlled with standard medical therapy, any brain metastases, or history of stroke) * Serious, nonhealing wound, ulcer, or bone fracture * Uncontrolled hypertension (systolic blood pressure \> 150 mmHg or diastolic blood pressure \> 95 mmHg despite medications) * History of arterial thrombosis within the last 12 months * History of visceral arterial ischemia * Subjects unwilling or unable to comply with study requirements * Any condition that in the Investigator's opinion deems the patient an unsuitable candidate to receive study drug * Received an investigational agent within 30 clays prior to enrollment * Treatment with vitamin D replacement with doses exceeding an average of 1000 IU/day (vitamin D3) within 60 days prior to enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Median PFS | Up to 12 months | The estimated distributions of PFS will be obtained using the product-limit based Kaplan-Meier method. The corresponding 95% confidence intervals for the estimated probability will be computed using the method proposed in Clopper and Pearson. |
| Rate of Sufficient Cholecalciferol | By week 16 | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| RR of Patients Receiving Study Treatment | Up to 3 years | — |
| Toxicity Rates as Assessed by NCI CTCAE Version 4 | Up to 30 days post-treatment | — |
| OS of Patients Receiving Study Treatment | Up to 3 years | The estimated distribution of OS will be obtained using the product-limit based Kaplan-Meier method. |
| PFS of Patients Receiving Study Treatment | Defined as the time from the start of the study treatment until the date of progression or death from any cause, whichever comes first, assessed up to 3 years | The estimated distributions of PFS will be obtained using the product-limit based Kaplan-Meier method. 3 Year Survival Rate |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (FOLXFOX, Bevacizumab, Cholecalciferol) Patients receive high-dose cholecalciferol once daily. Patients also receive bevacizumab IV over 10 minutes, leucovorin calcium IV over 2 hours, oxaliplatin\* IV over 2 hours, and fluorouracil IV continuously over 46 hours once a week. Courses repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. NOTE: \*Treatment with oxaliplatin is discontinued after course 8
leucovorin calcium: Given IV
bevacizumab: Given IV
cholecalciferol: Given PO
fluorouracil: Given IV
oxaliplatin: Given IV
pharmacological study: Correlative studies | 10 |
| Total | 10 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Administrative Decision | 1 |
| Overall Study | Disease Progression | 9 |
Baseline characteristics
| Characteristic | Treatment (FOLXFOX, Bevacizumab, Cholecalciferol) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 2 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants |
| Age, Continuous | 57 years STANDARD_DEVIATION 8.43 |
| Sex: Female, Male Female | 7 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 10 / 10 |
| serious Total, serious adverse events | 4 / 10 |
Outcome results
Primary
Median PFS
The estimated distributions of PFS will be obtained using the product-limit based Kaplan-Meier method. The corresponding 95% confidence intervals for the estimated probability will be computed using the method proposed in Clopper and Pearson.
Time frame: Up to 12 months
Population: Due to the study's early termination and inadequate number of patients, no patients were analyzed.
Primary
Rate of Sufficient Cholecalciferol
Time frame: By week 16
Population: Due to the study's early termination and inadequate number of patients, no patients were analyzed.
Secondary
OS of Patients Receiving Study Treatment
The estimated distribution of OS will be obtained using the product-limit based Kaplan-Meier method.
Time frame: Up to 3 years
Population: Due to the study's early termination and inadequate number of patients, no patients were analyzed.
Secondary
PFS of Patients Receiving Study Treatment
The estimated distributions of PFS will be obtained using the product-limit based Kaplan-Meier method. 3 Year Survival Rate
Time frame: Defined as the time from the start of the study treatment until the date of progression or death from any cause, whichever comes first, assessed up to 3 years
Population: Due to the study's early termination and inadequate number of patients, no patients were analyzed.
Secondary
RR of Patients Receiving Study Treatment
Time frame: Up to 3 years
Population: Trial terminated early. Too few patients to analyze.
Secondary
Toxicity Rates as Assessed by NCI CTCAE Version 4
Time frame: Up to 30 days post-treatment
Population: Due to the study's early termination and inadequate number of patients, no patients were analyzed.