MoLiMoR - A Study With FOLFIRI-based First-line Therapy With or Without Intermittent Cetuximab

Modulation of the FOLFIRI-based Standard First-line Therapy With Cetuximab, Controlled by Monitoring the RAS (Rat Sarcoma) Mutation Load by Liquid Biopsy in RAS-mutated mCRC (Metastatic Colorectal Cancer): A Randomized Phase II Study With FOLFIRI-based First-line Therapy With or Without Intermittent Cetuximab (MoLiMoR)

Status

Completed

Phases

Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT04554836

Enrollment

Registered

2020-09-18

Start date

2020-12-29

Completion date

2024-06-11

Last updated

2025-06-08

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

Keywords

Left sided Adenocarcinoma of the Colon, RAS mutated

Brief summary

This is an open-label, prospective, randomized, multicenter phase II trial that will evaluate the efficacy and safety of intermittent addition of cetuximab to a FOLFIRI-based first line therapy to patients with RAS (Rat sarcoma)-mutant mCRC (Metastatic colorectal cancer) diagnosis who convert to RAS wild-type using monitoring of the RAS mutation status by liquid biopsy.

Interventions

DRUGCetuximab

Patients in Arm A will receive FOLFIRI +cetuximab.

OTHERFOLFIRI

Irinotecan, Folinic acid (racemic), Fluorouracil (5-FU)

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to 99 Years

Healthy volunteers

Inclusion criteria

* Histologically confirmed, UICC stage IV adenocarcinoma of the left-sided colon or rectum with metastases (metastatic colorectal cancer), primarily non-resectable, confirmed RAS mutations proven in the primary tumor or metastasis (KRAS ans NRAS exon 2, 3, 4) * Age ≥ 18 years on day of signing informed consent * No previous chemotherapy for metastatic disease (1- 2 cycles FOLFIRI or mFOLFIRI are permitted before enrolment until RAS status is determined) * Patients suitable for chemotherapy administration * ECOG (Eastern Cooperative Oncology Group) status 0-1 * Consent to liquid biopsy and mutation analysis * Estimated life expectancy \> 3 months * Presence of at least one measurable reference lesion according to the RECIST 1.1 criteria (chest CT and abdominal CT 4 weeks or less before enrollment) * Adequate bone marrow function defined as: Leukocytes 3.0 x 10 9/L with neutrophils 1.5 x 10 9/L, Thrombocytes 100 x 10 9/L, Hemoglobin 9 g/dL * Adequate hepatic function defined as: Serum bilirubin 1.5 x ULN (Upper limit of normal), ALAT (Alanine-aminotransferase (= SGPT = serum glutamate pyruvate transaminase) and ASAT (aspartate-aminotransferase (= SGOT = serum glutamate oxalacetate transaminase) 2.5 x ULN (Upper limit of normal) (in the presence of hepatic metastases, ALAT and ASAT 5 x ULN) * Adequate renal function: Creatinine clearance ≥ 50 mL/min * Adequate cardiac function defined as Normal ECG and echocardiogram with a left ventricular ejection fraction (LVEF) of 55% * INR (International normalized ratio) \< 1.5 and aPTT (activated Partial thromboplastin time) \< 1.5 x ULN (patients without anticoagulation). Therapeutic anticoagulation is allowed if INR and aPTT have remained stable within the therapeutic range for at least 2 weeks. * Time interval of at least 6 months since last administration of any previous neoadjuvant/adjuvant chemotherapy or radiochemotherapy of the primary tumor in curative treatment intention to start of 1st line treatment * Any relevant toxicities of prior treatments must have resolved to grade ≤ 1 according to the CTCAE (version 5), except alopecia * Women of childbearing potential (WOCBP) should have a negative urine pregnancy test within 72 hours prior to receiving the first dose of study medication. * Highly effective contraception for both male and female patients throughout the study and for at least 3 months after last dose of study medication administration if the risk of conception exists. Highly effective contraception has to be in line with the definition of the CTFG (Clinical Trial Facilitation Group) recommendation * Signed written informed consent and capacity of understanding the informed consent

Exclusion criteria

* Right sided mCRC * Primarily resectable metastases * Previous chemotherapy for the colorectal cancer with the exception of adjuvant treatment, completed at least 6 months before entering the study (1- 2 cycles FOLFIRI or mFOLFIRI are permitted before enrolment) * Patients with known brain metastases * Symptomatic peritoneal carcinosis * Progressive disease before randomization * History of acute or subacute intestinal occlusion, inflammatory bowel disease, immune colitis or chronic diarrhea * Grade II heart failure (NYHA classification), Myocardial infarction, balloon angioplasty (PTCA) with or without stenting, and cerebral vascular accident/stroke within the past 12 months before enrollment, unstable angina pectoris, serious cardiac arrhythmia according to investigator's judgment requiring medication * Active infection with hepatitis B or C * Medical or psychological impairments associated with restricted ability to give consent or not allowing conduct of the study * Additional cancer; Exceptions include adequately treated basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy without evidence of recurrence * Uncontrolled hypertension * Marked proteinuria (nephrotic syndrome) * Arterial thromboembolism or severe hemorrhage within 6 months prior to randomization (with the exception of tumor bleeding before tumor resection surgery) * Hemorrhagic diathesis or tendency towards thrombosis * Participation in a clinical study or experimental drug treatment within 30 days prior to study * Known hypersensitivity or allergic reaction to any of the study medications * Severe, non-healing wounds, ulcers, bone fractures or an infection requiring systemic therapy * Known history of alcohol or drug abuse * Complete dihydropyrimidine dehydrogenase (DPD) deficiency (phenotype and/or genotype test) (Patients with partial DPD deficiency may be included in this clinical trial at the discretion of the investigator and should receive a reduced starting 5-FU dose) * Known glucuronidation deficiency (Gilbert's syndrome) (specific screening not required) * Absent or restricted legal capacity * For female patients only: Pregnancy (absence to be confirmed by ß-HCG test) or lactating

Design outcomes

Primary

Measure	Time frame	Description
Progression Free Survival (PFS)	From date of randomization up to 24 months	Evaluation of efficacy in terms of progression free survival (PFS)

Secondary

Measure	Time frame	Description
Overall Survival (OS)	From date of randomization up to 24 months.	In experimental and control arms
Time to Failure of Treatment Strategy (TFTS)	After randomization up to 24 months.	In experimental and control arms
PFS (Progression Free Survival) Rate	1 year after date of randomization	In experimental and control arms
Depth of Response	From the start of the first line treatment in the study up to 24 months.	In terms of reduction of tumor mass in experimental and control arms
Objective Response Rate (ORR)	From the start of the first line treatment in the study up to 24 months.	Defined as patients with partial or complete response (CR or PR) in experimental and control arms
Safety Profile	From the date of signature of Informed Consent to 24 months.	According to CTCAE (Common Terminology Criteria of Adverse Events), Version 5.0 criteria in experimental and control arms.
Identification of Driver Mutations.	From the start of the first line treatment in the study up to 24 months.	In patients with progressive disease (PD) under cetuximab therapy who remain RAS (Rat sarcoma) wild-type in liquid biopsy.
Comparison the Efficacy in Terms of Progression Free Survival (PFS)	From the start of the first line treatment in the study up to 24 months.	In patients with conversion to RAS (RAt sarcoma) wild-type in both ddPCR (Droplet Digital PCR) BEAMing with those patients showing conversion to RAS wild-type in ddPCR but not in BEAMing.
Metastasis Resections.	From the start of the first line treatment in the study up to 24 months.	In experimental and control arms.

Countries

Germany

Participant flow

Recruitment details

Between September 2020 and July 2021 20 sites in Germany and 1 site in Austria screened patients. Of these, 4 sites randomized patients. 1. Onkologisches Zentrum Donauwörth, Onkologisches Zentrum, Dachau 2. Kliniken Essen-Mitte Evang. Huyssens-Stiftung, Klinik für internistische Onkologie/Hämatologie, Essen 3. Universitätsklinikum Knappschaftskrankenhaus Bochum, Medizinische Klinik - Innere Medizin, Bochum 4. Evangelisches Krankenhaus Hamm, Innere Medizin II, Hamm

Participants by arm

Arm	Count
FOLFIRI + Cetuximab Patients in Arm A will receive FOLFIRI + cetuximab until progressive disease (PD), unacceptable toxicity, withdrawal of informed consent or death, whatever occurs first. The recurrence of RAS-mutation without PD to switch back to FOLFIRI. In case of repeated conversion to RAS wild-type without PD, treatment will shift to FOLFIRI + cetuximab again, and so on. Switches of treatment will proceed until progressive disease (PD), unacceptable toxicity, withdrawal of informed consent or death, whatever occurs first. \[FOLFIRI = Irinotecan, Folinic acid (racemic), Fluorouracil (5-FU)\] Cetuximab: Patients in Arm A will receive FOLFIRI +cetuximab. FOLFIRI: Irinotecan, Folinic acid (racemic), Fluorouracil (5-FU)	4
FOLFIRI Patients in Arm B will continue therapy with FOLFIRI until PD, unacceptable toxicity, withdrawal of informed consent or death, whatever occurs first. FOLFIRI: Irinotecan, Folinic acid (racemic), Fluorouracil (5-FU)	2
Total	6

Baseline characteristics

Characteristic	FOLFIRI + Cetuximab	FOLFIRI	Total
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	3 Participants	0 Participants	3 Participants
Age, Categorical Between 18 and 65 years	1 Participants	2 Participants	3 Participants
Age, Continuous	68.5 years	46 years	61 years
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants	0 Participants	0 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	4 Participants	2 Participants	6 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Region of Enrollment Germany	4 participants	2 participants	6 participants
Sex: Female, Male Female	1 Participants	0 Participants	1 Participants
Sex: Female, Male Male	3 Participants	2 Participants	5 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	3 / 4	2 / 2
other Total, other adverse events	4 / 4	2 / 2
serious Total, serious adverse events	3 / 4	0 / 2

Outcome results

Primary

Progression Free Survival (PFS)

Evaluation of efficacy in terms of progression free survival (PFS)

Time frame: From date of randomization up to 24 months

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
FOLFIRI + Cetuximab	Progression Free Survival (PFS)	0 Participants
FOLFIRI	Progression Free Survival (PFS)	0 Participants

Secondary

Comparison the Efficacy in Terms of Progression Free Survival (PFS)

In patients with conversion to RAS (RAt sarcoma) wild-type in both ddPCR (Droplet Digital PCR) BEAMing with those patients showing conversion to RAS wild-type in ddPCR but not in BEAMing.