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Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Multicenter phase II study of FOLFIRI plus bevacizumab after discontinuation of oxaliplatin-based regimen for advanced or recurrent colorectal cancer (CR0802)

Authors: Mitsukuni Suenaga, Tomohiro Nishina, Nobuyuki Mizunuma, Hisateru Yasui, Takashi Ura, Tadamichi Denda, Junichi Ikeda, Taito Esaki, Hogara Nishisaki, Yoshinao Takano, Yasuyuki Sugiyama, Kei Muro

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

To investigate the efficacy and safety of FOLFIRI plus bevacizumab regimen with irinotecan (180 mg/m2) in patients with advanced or recurrent colorectal cancer who were of the wild-type or heterozygous group for UGT1A1*28 and *6 polymorphisms and discontinued to oxaliplatin-based regimen, prospectively.

Methods

The study population consisted of patients who had discontinued oxaliplatin-based regimen for any reason. The primary endpoint was the response rate. FOLFIRI and bevacizumab regimen [irinotecan: 180 mg/m2, 5-fluorouracil infusion: 2400 mg/m2, 5-fluorouracil bolus: 400 mg/m2, levofolinate calcium: 200 mg/m2, bevacizumab: 5 mg/kg] was repeated every 2 weeks for up to 24 cycles.

Results

Ninety-four patients were enrolled; 93 patients were evaluated on safety, 94 patients on efficacy. The response rate was 10.1% (95% confidence interval (CI): 4.7-18.3%). The median time to treatment failure, progression-free survival, and overall survival were 4.1 months (95% CI: 2.8-4.8 months), 5.4 months (95% CI: 4.1-6.2 months), and 14.5 months (95% CI: 11.8-17.0 months), respectively. The treatment-related death was 1.1%, and the early death ≤30 days after the last study treatment was 1.1%. The incidence of grade 3 or higher adverse events was 60.2% for neutropenia, 23.7% for leukopenia, 9.7% for diarrhea, 6.5% for anorexia, and 5.4% for fatigue. All these adverse events and other adverse events were controllable.

Conclusions

FOLFIRI plus bevacizumab regimen with an initial irinotecan dose of 180 mg/m2 exhibited an adequate antitumor effect and was confirmed to be manageable and tolerable in Japanese patients with advanced or recurrent colorectal cancer, who had discontinued oxaliplatin-based regimen.

Trial registration

Literature
3.
go back to reference Köhne CH, Schöffski P, Wilke H, Käufer C, Andreesen R, Ohl U, et al. Effective biomodulation by leucovorin of high-dose infusion fluorouracil given as a weekly 24-hour infusion: results of a randomized trial in patients with advanced colorectal cancer. J Clin Oncol. 1998;16:418–26.PubMed Köhne CH, Schöffski P, Wilke H, Käufer C, Andreesen R, Ohl U, et al. Effective biomodulation by leucovorin of high-dose infusion fluorouracil given as a weekly 24-hour infusion: results of a randomized trial in patients with advanced colorectal cancer. J Clin Oncol. 1998;16:418–26.PubMed
4.
go back to reference De Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMed De Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMed
5.
go back to reference Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.CrossRefPubMed Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.CrossRefPubMed
6.
go back to reference Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR Study. J Clin Oncol. 2004;22:229–37.CrossRefPubMed Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR Study. J Clin Oncol. 2004;22:229–37.CrossRefPubMed
7.
go back to reference Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351:337–45.CrossRefPubMed Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351:337–45.CrossRefPubMed
8.
go back to reference Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy- refractory metastatic colorectal cancer. J Clin Oncol. 2007;25:1658–64.CrossRefPubMed Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy- refractory metastatic colorectal cancer. J Clin Oncol. 2007;25:1658–64.CrossRefPubMed
9.
go back to reference Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.CrossRefPubMedPubMedCentral Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.CrossRefPubMedPubMedCentral
10.
go back to reference Grothey A, Sugrue MM, Purdie DM, Dong W, Sargent D, Hedrick E, et al. Bevacizumab beyond first progression is associated with prolonged overall survival in metastatic colorectal cancer: results from a large observational cohort study (BRiTE). J Clin Oncol. 2008;26:5326–34.CrossRefPubMed Grothey A, Sugrue MM, Purdie DM, Dong W, Sargent D, Hedrick E, et al. Bevacizumab beyond first progression is associated with prolonged overall survival in metastatic colorectal cancer: results from a large observational cohort study (BRiTE). J Clin Oncol. 2008;26:5326–34.CrossRefPubMed
11.
go back to reference Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14:29–37.CrossRefPubMed Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14:29–37.CrossRefPubMed
12.
go back to reference Cohn AL, Bekaii-Saab T, Bendell JC, Hurwitz H, Kozloff M, Roach N, et al. Clinical outcomes in bevacizumab (BV)-treated patients (pts) with metastatic colorectal cancer (mCRC): results from ARIES observational cohort study (OCS) and confirmation of BRiTE data on BV beyond progression (BBP) [abstract]. J Clin Oncol. 2010;28:3596. Cohn AL, Bekaii-Saab T, Bendell JC, Hurwitz H, Kozloff M, Roach N, et al. Clinical outcomes in bevacizumab (BV)-treated patients (pts) with metastatic colorectal cancer (mCRC): results from ARIES observational cohort study (OCS) and confirmation of BRiTE data on BV beyond progression (BBP) [abstract]. J Clin Oncol. 2010;28:3596.
13.
go back to reference Innocenti F, Undevia SD, Iyer L, Chen PX, Das S, Kocherginsky M, et al. Genetic variants in the UDP-glucuronosyltransferase 1A1 gene predict the risk of severe neutropenia of irinotecan. J Clin Oncol. 2004;22:1382–8.CrossRefPubMed Innocenti F, Undevia SD, Iyer L, Chen PX, Das S, Kocherginsky M, et al. Genetic variants in the UDP-glucuronosyltransferase 1A1 gene predict the risk of severe neutropenia of irinotecan. J Clin Oncol. 2004;22:1382–8.CrossRefPubMed
14.
go back to reference Toffoli G, Cecchin E, Corona G, Russo A, Buonadonna A, D'Andrea M, et al. The role of UGT1A1*28 polymorphisms in the pharmacodynamics and pharmacokinetics of irinotecan in patients with metastatic colorectal cancer. J Clin Oncol. 2006;24:3061–8.CrossRefPubMed Toffoli G, Cecchin E, Corona G, Russo A, Buonadonna A, D'Andrea M, et al. The role of UGT1A1*28 polymorphisms in the pharmacodynamics and pharmacokinetics of irinotecan in patients with metastatic colorectal cancer. J Clin Oncol. 2006;24:3061–8.CrossRefPubMed
15.
go back to reference Satoh T, Ura T, Yamada Y, Yamazaki K, Tsujinaka T, Munakata M, et al. Genotype-directed, dose-finding study of irinotecan in cancer patients with UGT1A1*28 and/or UGT1A1*6 polymorphisms. Cancer Sci. 2011;102:1868–73.CrossRefPubMed Satoh T, Ura T, Yamada Y, Yamazaki K, Tsujinaka T, Munakata M, et al. Genotype-directed, dose-finding study of irinotecan in cancer patients with UGT1A1*28 and/or UGT1A1*6 polymorphisms. Cancer Sci. 2011;102:1868–73.CrossRefPubMed
16.
go back to reference Giantonio BJ, Catalano PJ, Meropol NJ, O'Dwyer PJ, Mitchell EP, Alberts III SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.CrossRefPubMed Giantonio BJ, Catalano PJ, Meropol NJ, O'Dwyer PJ, Mitchell EP, Alberts III SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.CrossRefPubMed
17.
go back to reference Bennouna J, Borg C, Delord JP, Husseini F, Trillet-Lenoir V, Faroux R, et al. Bevacizumab combined with chemotherapy in the second-line treatment of metastatic colorectal cancer: results from the phase II BEVACOLOR study. Clin Colorectal Cancer. 2012;11:38–44.CrossRefPubMed Bennouna J, Borg C, Delord JP, Husseini F, Trillet-Lenoir V, Faroux R, et al. Bevacizumab combined with chemotherapy in the second-line treatment of metastatic colorectal cancer: results from the phase II BEVACOLOR study. Clin Colorectal Cancer. 2012;11:38–44.CrossRefPubMed
18.
go back to reference Horita Y, Yamada Y, Kato K, Hirashima Y, Akiyoshi K, Nagashima K, et al. Phase II clinical trial of second-line FOLFIRI plus bevacizumab for patients with metastatic colorectal cancer: AVASIRI trial. Int J Clin Oncol. 2012;17:604–9.CrossRefPubMed Horita Y, Yamada Y, Kato K, Hirashima Y, Akiyoshi K, Nagashima K, et al. Phase II clinical trial of second-line FOLFIRI plus bevacizumab for patients with metastatic colorectal cancer: AVASIRI trial. Int J Clin Oncol. 2012;17:604–9.CrossRefPubMed
19.
go back to reference Suenaga M, Matsusaka S, Ueno M, Yamamoto N, Shinozaki E, Mizunuma N, et al. Predictors of the efficacy of FOLFIRI plus bevacizumab as second-line treatment in metastatic colorectal cancer patients. Surg Today. 2011;41:1067–74.CrossRefPubMed Suenaga M, Matsusaka S, Ueno M, Yamamoto N, Shinozaki E, Mizunuma N, et al. Predictors of the efficacy of FOLFIRI plus bevacizumab as second-line treatment in metastatic colorectal cancer patients. Surg Today. 2011;41:1067–74.CrossRefPubMed
20.
go back to reference Kubicka S, Greil R, André T, Bennouna J, Sastre J, Van Cutsem E, et al. Bevacizumab plus chemotherapy continued beyond first progression in patients with metastatic colorectal cancer previously treated with bevacizumab plus chemotherapy: ML18147 study KRAS subgroup findings. Ann Oncol. 2013;24:2342–9.CrossRefPubMed Kubicka S, Greil R, André T, Bennouna J, Sastre J, Van Cutsem E, et al. Bevacizumab plus chemotherapy continued beyond first progression in patients with metastatic colorectal cancer previously treated with bevacizumab plus chemotherapy: ML18147 study KRAS subgroup findings. Ann Oncol. 2013;24:2342–9.CrossRefPubMed
21.
go back to reference Bokemeyer C, Van Cutsem E, Rougier P, Ciardiello F, Heeger S, Schlichting M, et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: pooled analysis of the CRYSTAL and OPUS randomised clinical trials. Eur J Cancer. 2012;48:1466–75.CrossRefPubMed Bokemeyer C, Van Cutsem E, Rougier P, Ciardiello F, Heeger S, Schlichting M, et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: pooled analysis of the CRYSTAL and OPUS randomised clinical trials. Eur J Cancer. 2012;48:1466–75.CrossRefPubMed
22.
go back to reference Ishibashi K, Matsuda C, Tamagawa H, Munemoto Y, Tanaka C, Fukunaga M, et al. Randomized phase II study of oxaliplatin reintroduction and biweekly XELOX in previously treated patients with metastatic colorectal cancer (mCRC): ORION study [abstract]. Ann Oncol. 2013;49 Suppl 2:S559. Ishibashi K, Matsuda C, Tamagawa H, Munemoto Y, Tanaka C, Fukunaga M, et al. Randomized phase II study of oxaliplatin reintroduction and biweekly XELOX in previously treated patients with metastatic colorectal cancer (mCRC): ORION study [abstract]. Ann Oncol. 2013;49 Suppl 2:S559.
23.
go back to reference Suenaga M, Mizunuma N, Matsusaka S, Shinozaki E, Ozaka M, Ogura M, et al. A phase II study of oxaliplatin reintroduction in patients pretreated with oxaliplatin and irinotecan for advanced colorectal cancer (RE-OPEN study): Reports of interim analysis [abstract]. J Clin Oncol. 2012;30:214. Suenaga M, Mizunuma N, Matsusaka S, Shinozaki E, Ozaka M, Ogura M, et al. A phase II study of oxaliplatin reintroduction in patients pretreated with oxaliplatin and irinotecan for advanced colorectal cancer (RE-OPEN study): Reports of interim analysis [abstract]. J Clin Oncol. 2012;30:214.
Metadata
Title
Multicenter phase II study of FOLFIRI plus bevacizumab after discontinuation of oxaliplatin-based regimen for advanced or recurrent colorectal cancer (CR0802)
Authors
Mitsukuni Suenaga
Tomohiro Nishina
Nobuyuki Mizunuma
Hisateru Yasui
Takashi Ura
Tadamichi Denda
Junichi Ikeda
Taito Esaki
Hogara Nishisaki
Yoshinao Takano
Yasuyuki Sugiyama
Kei Muro
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1175-3

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