Advanced Metastatic (Stage IV) Colorectal Cancer
Conditions
Keywords
Metastatic colorectal cancer, stage IV, FOLFOX6, Chemotherapy, PledOx, Mangafodipir, Febrile neutropenia, Oxidative stress, Antioxidant, neutropenia, neuropathy
Brief summary
The present trial is designed to determine whether pre-treatment with PledOx lowers the frequency and severity of side effects from FOLFOX6 administration in patients with metastatic colorectal cancer. The efficacy of PledOx will be assessed when added to FOLFOX6 chemotherapy as first line treatment of metastatic colorectal cancer. This study was performed in multiple parts/phases. Part 1 was an open dose-escalation study with the doses 2, 5 and 10 micromol/kg of calmangafodipir. No study outcomes were planned for this part. In part 2a, participants randomly received either Placebo, 2 or 10 micromol/kg of calmangafodipir. In part 2b, participants randomly received either Placebo, 2 or 5 micromol/kg of calmangafodipir. The overall intent of the study was to compare the effect of antioxidant agent PledOx against placebo in one of three different doses/combinations (2 micromol/kg, 5/10 micromol/kg, 2/5/10 micromol/kg vs. placebo, in the first 8 cycles of FOLFOX6 treatment
Detailed description
Globally, nearly 800 000 colorectal cancers are believed to occur annually. Approximately about half of the patients with colorectal cancer develop metastatic disease. These patients are often offered chemotherapy with the FOLFOX6 regimen (FOL = FOLic acid; F = Fluorouracil (5-FU); OX = OXaliplatin) The use of FOLFOX6 is, however, hampered by a high incidence and severity of adverse reactions. In the current trial patients will receive the antioxidant agent PledOx in one of two different doses, or placebo, in the first 8 cycles of FOLFOX6 treatment.
Interventions
DRUGPledOx (2 µmol/kg)
PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles.
DRUGPledOx (5 µmol/kg)
PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles
DRUGPledOx (10 µmol/kg)
PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles
DRUGPlacebo (0,9% NaCl)
Placebo (0,9% NaCl) is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles.
Sponsors
Pharma Consulting Group AB
Egetis Therapeutics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Intervention model description
The study is a three arm study, however, we changed the high dose in the secord part of the study, from 10 micromol/kg (part 2a) to 5 mictomol/kg (part 2b)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Advanced metastatic colorectal (stage IV) cancer verified by biopsy * Patients may have received up to three previous treatment lines of chemotherapy, which may include fluoropyrimidine, irinotecan and targeted therapies. The last dose of antitumor drug must be given at least 4 weeks prior to inclusion and all toxicity (except alopecia and fatigue) resolved. Patients may also be chemotherapy-naïve, have received prior adjuvant treatment but no previous treatment with oxaliplatin * CT-scan or MRI of thorax, abdomen and pelvis; within ≤4 weeks before start of chemotherapy * Evaluable disease and one measurable site of disease according to RECIST 1.1 criteria (at least 10mm for CT-scan or MRI) * Neurological examination with no significant pathological findings * ≥18 years * WHO performance status 0≤2 and Life expectancy ≥ 3 months * Adequate haematological function, Hb ≥ 100 g/L, ANC ≥ 1.5 x 109/L, platelets ≥ 100 x 109/L * Adequate renal and hepatic functions: creatinine clearance \>50 cc/min, total bilirubin ≤ 1.5 times ULN, ASAT and ALAT ≤ 3 times ULN (ASAT and ALAT ≤ 5 times ULN in case of liver metastases) * INR ≤1.5 times ULN, unless receiving therapeutic anticoagulation * Negative pregnancy test for females of child-producing potential * Written informed consent given
Exclusion criteria
* Tumours other than colorectal adenocarcinomas (within the previous 5 years) except for curatively treated non melanoma skin cancer or in situ carcinoma of the cervix * Evidence of central nervous system metastases * Unresolved bowel obstruction or sub-obstruction, uncontrolled Crohn's disease or ulcerative colitis * History of cardiac disease with a New York Heart Association (NYHA) Class II or greater congestive heart failure, myocardial infarction or unstable angina in the past six (6) months prior to Day 1 of treatment and serious arrhythmias requiring medication for treatment * Prolonged QTC interval \>450 msec * Known history of stroke or cerebrovascular accident in the past six (6) months * Severe diarrhoea * Chronic infection or uncontrolled serious illness causing immunodeficiency * Any uncontrolled serious illness or medical condition * Received mangafodipir at any time * Welders, mine workers or other workers in occupations (current or past) where high manganese exposure is likely * Pre-existing neurodegenerative disease (Parkinson's, Alzheimer's, Huntington's etc.) or neuromuscular disorder (Multiple sclerosis, Amyotrophic lateral sclerosis, Polio, hereditary neuromuscular disease) * Major psychiatric disorder (major depression, psychosis) * Participation in another clinical study with an investigational medicinal product within 1 month prior to inclusion. * Blood manganese concentration values \>18.3 μg/L at screening
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia) | Every second week during cycle 1-8, for up to 16 weeks | Percentage of patients, over cycle 1 to 8, with neuropathy grade 2 or higher (according to the Oxaliplatin Specific Sanofi Scale (OSSS) criteria related paraesthesiae/dysaesthesiae) |
Countries
Bulgaria, Denmark, Georgia, Germany, Portugal, Serbia, Sweden, United States
Participant flow
Pre-assignment details
186 participants were enrolled and 186 started the study, however, two patients had too high basal manganese levels (detected after first treatment cycle) and were excluded from further treatment (screening failures) but are part of the safety population. 184 patients are part of the treatment population (11 in part 1 and 173 in part 2)
Participants by arm
| Arm | Count |
|---|---|
| FOLFOX6 + 0,9% NaCl (Part 2a+2b) Placebo= 0.9% NaCl; FOLFOX6=Combination of FOLinic Acid, 5-Fluorouracil (5-FU), and Oxaliplatin.
Placebo (0,9% NaCl): Placebo (0,9% NaCl) is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles. | 60 |
| FOLFOX6 + PledOx 2 µmol/kg (Part 1, 2a+2b) PledOx active ingredient= Calmangafodipir; FOLFOX6=Combination of FOLinic Acid, 5-Fluorouracil (5-FU), and Oxaliplatin.
PledOx (2 µmol/kg): PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles. | 62 |
| FOLFOX6 + PledOx 5 µmol/kg (Part 1, 2b) PledOx active ingredient= Calmangafodipir; FOLFOX6=Combination of FOLinic Acid, 5-Fluorouracil (5-FU), and Oxaliplatin.
PledOx (5 µmol/kg): PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles. | 48 |
| FOLFOX6 + PledOx 10 µmol/kg (Part 1, 2a) PledOx active ingredient= Calmangafodipir; FOLFOX6=Combination of FOLinic Acid, 5-Fluorouracil (5-FU), and Oxaliplatin.
PledOx (10 µmol/kg): PledOx is administered intravenously for up to 5 minutes, about 10 min prior to start of FOLFOX6 chemotherapy which will be administered day 1 and 2 every second week for up to 8 cycles. | 16 |
| Total | 186 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Part 1 (Dose Escalation) | High basal Mn | 0 | 2 | 0 | 0 |
Baseline characteristics
| Characteristic | FOLFOX6 + 0,9% NaCl (Part 2a+2b) | Total | FOLFOX6 + PledOx 10 µmol/kg (Part 1, 2a) | FOLFOX6 + PledOx 5 µmol/kg (Part 1, 2b) | FOLFOX6 + PledOx 2 µmol/kg (Part 1, 2a+2b) |
|---|---|---|---|---|---|
| Age, Continuous | 62 years | 62.6 years | 61.3 years | 62.6 years | 63.5 years |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 2 Participants | 0 Participants | 2 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 2 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 2 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) White | 58 Participants | 180 Participants | 16 Participants | 45 Participants | 61 Participants |
| Sex: Female, Male Female | 46 Participants | 125 Participants | 7 Participants | 26 Participants | 46 Participants |
| Sex: Female, Male Male | 14 Participants | 61 Participants | 9 Participants | 22 Participants | 16 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 2 / 60 | 0 / 13 | 1 / 57 | 1 / 45 | 1 / 11 |
| other Total, other adverse events | 49 / 60 | 10 / 13 | 45 / 57 | 35 / 45 | 9 / 11 |
| serious Total, serious adverse events | 6 / 60 | 2 / 13 | 7 / 57 | 3 / 45 | 2 / 11 |
Outcome results
Primary
Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia)
Percentage of patients, over cycle 1 to 8, with neuropathy grade 2 or higher (according to the Oxaliplatin Specific Sanofi Scale (OSSS) criteria related paraesthesiae/dysaesthesiae)
Time frame: Every second week during cycle 1-8, for up to 16 weeks
Population: Full analysis set
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Placebo | Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia) | 14 Participants |
| FOLFOX6 + PledOx 2 µmol/kg | Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia) | 11 Participants |
| FOLFOX6 + PledOx 5+10 µmol/kg | Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia) | 6 Participants |
| FOLFOX6 + PledOx 2+5+10 µmol/kg | Number of Patients With Neuropathy Grade 2 or Higher (According to the Oxaliplatin Specific Sanofi Scale (OSSS) Criteria Related Paraesthesia/Dysaesthesia) | 17 Participants |
p-value: 0.31Cochran-Mantel-Haenszel
p-value: 0.15Cochran-Mantel-Haenszel
p-value: 0.16Cochran-Mantel-Haenszel