Ras-wildtype Colorectal Cancer
Conditions
Keywords
Can preemptive treatment of panitumumab mediated skin, toxicity with oral doxycycline be replaced by local treatment with erythromycin?, Panitumumab
Brief summary
80 - 90 % of the patients treated with anti-EGFR antibodies (panitumumab or cetuximab) experience skin toxicity, mostly acne like skin rash. A standardized treatment of skin rash is neither established as standard arm for clinical trials nor as guideline for the treatment of skin toxicity in clinical practice. While an improvement of QoL has been demonstrated for panitumumab and cetuximab in comparison to best supportive care the data basis for patient related outcomes regarding skin toxicity deriving from randomized trials is still small. Recent surveys among German oncologist revealed that physicians are reluctant to use oral antibiotics as preemptive treatment . Only 19 out of 110 oncologists stated that they are thinking about using preemptive treatment in patients with acne-like skin rash. Thus, in the present trial two main questions will be addressed: (i) Can preemptive treatment with oral doxycycline be replaced by a sequential skin treatment strategy (i.e. local treatment with erythromycin followed by doxycycline in case of inefficacy = development of acne) without compromising treatment efficacy of skin toxicity treatment? (ii) Comparison of general and skin related QoL between both treatment arms.
Interventions
DRUGErythromycin
Comparison of efficacy of Arm A erythromycin cream 2% daily at bedtime (doxycycline 100mg b.i.d.if skin toxicity CTC° ≥2) and Arm B doxycycline 100mg b.i.d. in patients with Metastatic Colorectal cancer (Ras wild-type)being treated with panitumumab.
DRUGDoxycycline
Comparison of efficacy of Arm A erythromycin cream 2% daily at bedtime (doxycycline 100mg b.i.d.if skin toxicity CTC° ≥2) and Arm B doxycycline 100mg b.i.d. in patients with Metastatic Colorectal cancer (Ras wild-type)being treated with panitumumab.
Sponsors
AIO-Studien-gGmbH
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients with wild-type RAS (KRAS and NRAS) status of metastatic colorectal cancer treatment with panitumumab according to label * RAS wild-type tested in * KRAS exon 2 (codons 12/13) * KRAS exon 3 (codons 59/61) * KRAS exon 4 (codons 117/146) * NRAS exon 2 (codons 12/13) * NRAS exon 3 (codons 59/61) * NRAS exon 4 (codons 117/146) 2. treatment with pre-emptive study medication shall begin the day before treatment start with panitumumab 3. Willingness to cope with biweekly quality of life questionnaires 4. Written Informed consent 5. Aged at least 18 years 6. ECOG Performance Status 0-2 7. Life expectancy of at least 12 weeks 8. Adequate haematological, hepatic, renal and metabolic function parameters: * Leukocytes \> 3000/mm³ * ANC ≥ 1500/mm³ * Platelets ≥ 100,000/mm³ * Haemoglobin \> 9 g/dl * Serum creatinine ≤ 1.5 x ULN * Bilirubin ≤ 1.5 x ULN * GOT-GPT ≤ 2.5 x ULN (in case of liver metastases GOT / GPT ≤ 5 x ULN) * AP ≤ 5 x ULN * Magnesium, Calcium and potassium within normal ranges (may be substituted before study entry)
Exclusion criteria
1. Subject pregnant or breast feeding, or planning to become pregnant within 6 months after the end of treatment. 2. Subject (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment (adequate: oral contraceptives, intrauterine device or barrier method in conjunction with spermicidal jelly). 3. Serious concurrent diseases 4. On-treatment participation in a clinical study in the period 30 days prior to inclusion 5. Clinically significant cardiovascular disease in (incl. myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) ≤ 1 year before enrolment. 6. History of interstitial lung disease, e.g. pneumonitis or pulmonary fibrosis or evidence of interstitial lung disease on baseline chest CT scan. 7. History of HIV infection. 8. Other previous or concurrent malignancy (≤ 5 years prior to enrolment in study) except non-melanoma skin cancer or cervical carcinoma FIGO stage 0- 1 if the patient is continuously disease-free 9. Known allergic reactions on panitumumab, doxycycline or erythromycin 10. Previous treatment with anti-cancer agents directed against EGFR (e.g. cetuximab, panitumumab, erlotinib, gefitinib, lapatinib) 11. Skin rash existing before or due to other reasons than panitumumab treatment 12. Other dermatologic disease that may interfere with correct grading of panitumumab induced skin rash 13. Parallel treatment with anti-tumor agents other than panitumumab
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patients developing no skin toxicity ≥ grade 2 | 8 weeks | Percentage of patients developing no skin toxicity ≥ grade 2 at any time during their first 8-weeks of treatment with panitumumab. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of life | 8 weeks | Quality of life will be assessed by standardized skin-related (DLQI) and global quality of life (EORTC QLQ C30. For correlation analyses between the different quality of life scores, the non-parametric test according to Spearman will preferably be applied. |
| Assess Skin toxicity | 8 weeks | Assess different skin toxicity grading scales (i.e. NCI CTC v. 4.0; WoMo score; MESTT) |
| Correlation between skin-related and global quality of life | 8 weeks | Description of correlation between skin-related and global quality of life using EORTC-QLQ C30 and SF-36. |
| late skin toxicity | from week 8 to 12 | Describe the development of late skin toxicity after 8 weeks |
| Skin-toxicity related dose reductions of panitumumab | 8 weeks | Rate of skin-toxicity induced dose reductions (including withdrawal) of panitumumab |
Countries
Germany
Outcome results
None listed