Colorectal Cancer With Non Resectable Hepatic Metastasis
Conditions
Keywords
Metastatic colorectal Cancer
Brief summary
Treatment of patients with colorectal cancer having liver metastases is currently based on systemic chemotherapy. Triple therapy with 5FU, oxaliplatin and irinotecan intravenously was effective in terms of response and secondary resectability, however it is particularly toxic. Hepatic intra-arterial chemotherapy (HIA) has been the subject of several studies. It has shown good efficacy with oxaliplatin and FUDR. However, the procedure is difficult to set up and reserved for experienced centers. The objective of this protocol is to use a triple therapy based on 5FU and oxaliplatin associated to irinotecan which is administered by hepatic intra-arterial route, loaded onto microbeads (DEBIRI). Furthermore, the procedure for chemo-embolization DEBIRI is limited to 2 sessions, and therefore could be more easily generalized.
Interventions
DRUGHIA DEBIRI + systemic FOLFOX
Sponsors
Biocompatibles UK Ltd
Federation Francophone de Cancerologie Digestive
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically proven colorectal adenocarcinoma, * Liver metastases radiologically or histologically proven * At least one measurable liver lesions by RECIST v1.1 * Age ≥ 18 years * WHO Index \< or = 2 * Life expectancy ≥ 3 months * No extrahepatic disease except lung nodules if number \< or = 3 and size \< 10 mm each * Healthy liver \<60% * Primary tumor resected or still in place * No prior chemotherapy for metastases treatment (except a perioperative chemotherapy, if the last cycle was administered at least 12 months ago) * Adjuvant chemotherapy after resection of the primary authorized if the last cycle was administered at least 12 months ago * Normal hepatic function: total bilirubin ≤ 1.5 N; AST ≤ 5N; ALT ≤ 5N and PAL ≤ 5N * TP ≥ 60% * Adequate hematologic function: ANC ≥ 1500/mm3, platelets ≥ 100 000/mm3, Hb ≥ 9g/dl * Good renal function: creatinine clearance ≥ 60 mL / min * No cardiac dysfunction: no cardiovascular events in the last 6 months or no NYHA ≥ 2
Exclusion criteria
* Patient eligible for curative treatment (resection and / or radiofrequency ablation) by a multidisciplinary decision (including the opinion of a liver surgeon) * Pregnant or lactating woman or patients of both sexes and of childbearing age not using adequate contraception * History of cancer, except skin cancer (other than melanoma), carcinoma in situ of the cervix uteri treated curative. Other cancers treated with curative intent are permitted provided they did not relapse over the last 5 years * Peripheral neuropathy * Inflammatory Bowel Diseases * Intestinal obstruction * Chronic liver disease (viral, alcoholic or metabolic) * Immune Deficiency Syndromes (history of transplantation, infection with HIV) * Known to have contraindications to 5FU, oxaliplatin, folinic acid, irinotecan or to contrast products * Patients with known contraindications against hepatic embolization procedures: Presence of biliary-digestive anastomosis or biliary stent Cruoric or tumor thrombosis of the portal vein * Patient who for psychological, social, family or geographical reasons could not be followed up regularly * Legal disability (persons deprived of liberty or under guardianship) * Patient is not affiliated to a social security scheme * Participation in another concurrent study investigating the effect of treatment and this until 4 weeks after the end of the concurrent study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival Rate at 9 Months | at 9 months after inclusion | The primary endpoint was to evaluate the rate of patients alive without progression at 9 months after the start of treatment. Events to be considered for the endpoint were: * Progression : defined as radiological progression according to RECIST V1.1 criteria, as assessed by the investigator. * Death Patients who progressed or died (from any cause) within 9 months of starting treatment were considered as failure for the primary endpoint. The first event which occured will be taken into accoun |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | up to 4 years after patient's inclusion | It was defined as the time interval between the date of inclusion and the date of death (whatever the cause). Patients lost to follow-up or alive at the time of analysis were censored at the date of last news. |
Countries
France
Participant flow
Recruitment details
Fifty eight patients were included in the study between May 2013 and December 2016.
Participants by arm
| Arm | Count |
|---|---|
| HIA DEBIRI + Systemic FOLFOX Intra-arterial hepatic beads loaded with irinotecan with systemic FOLFOX
HIA DEBIRI + systemic FOLFOX | 57 |
| Total | 57 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Protocol Violation | 1 |
Baseline characteristics
| Characteristic | HIA DEBIRI + Systemic FOLFOX | — |
|---|---|---|
| Age, Continuous | 63.14 years STANDARD_DEVIATION 8.57 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment France | 57 participants | — |
| Sex: Female, Male Female | 25 Participants | — |
| Sex: Female, Male Male | 32 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 31 / 57 |
| other Total, other adverse events | 57 / 57 |
| serious Total, serious adverse events | 27 / 57 |
Outcome results
Primary
Progression-free Survival Rate at 9 Months
The primary endpoint was to evaluate the rate of patients alive without progression at 9 months after the start of treatment. Events to be considered for the endpoint were: * Progression : defined as radiological progression according to RECIST V1.1 criteria, as assessed by the investigator. * Death Patients who progressed or died (from any cause) within 9 months of starting treatment were considered as failure for the primary endpoint. The first event which occured will be taken into accoun
Time frame: at 9 months after inclusion
Population: Primary endpoint was on mITT population meaning all the patients included in the study with at least one radiological assessments within the 9 months following the inclusion
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| HIA DEBIRI + Systemic FOLFOX | Progression-free Survival Rate at 9 Months | Patients alive without any progression | 30 Participants |
| HIA DEBIRI + Systemic FOLFOX | Progression-free Survival Rate at 9 Months | Patients with progression or death | 26 Participants |
Secondary
Overall Survival
It was defined as the time interval between the date of inclusion and the date of death (whatever the cause). Patients lost to follow-up or alive at the time of analysis were censored at the date of last news.
Time frame: up to 4 years after patient's inclusion
Population: Endpoint was analyzed on the ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| HIA DEBIRI + Systemic FOLFOX | Overall Survival | 37.4 months |