A randomized phase III clinical trial of sequential capecitabine or 5-FU plus bevacizumab (Cape/5-FU+Bmab) followed by Cape/5-FU plus oxaliplatin plus Bmab (CapeOX/mFOLFOX6+Bmab) versus combination CapeOX/mFOLFOX6+Bmab in advanced colorectal cancer: The C-cubed (C3) study.

Authors

null

Hitoshi Ojima

Gunma Prefectural Cancer Center, Gunma, Japan

Hitoshi Ojima , Hideyuki Mishima , Akira Sawaki , Takeshi Nagasaka , Mototsugu Shimokawa , Michio Inukai , Katsunori Shinozaki , Hiroaki Tanioka , Junichiro Nasu , Tomohiro Nishina , Shoichi Hazama , Masazumi Okajima , Akihito Tsuji , Yasushi Tsuji , Yoshinori Munemoto , Shigeki Yamaguchi , Yoshiyuki Yamaguchi

Organizations

Gunma Prefectural Cancer Center, Gunma, Japan, Aichi Medical University, Nagakute, Japan, Fujita Health University Hospital, Aichi, Japan, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan, National Kyushu Cancer Center, Fukuoka, Japan, Okayama Saiseikai General Hospital, Okayama, Japan, Hiroshima Prefectural Hospital, Hiroshima, Japan, Okayama Rosai Hospital, Okayama, Japan, Shikoku Cancer Center, Matsuyama, Japan, Yamaguchi University Graduate School of Medicine, Ube, Japan, Hiroshima City Asa Hospital, Hiroshima, Japan, Kagawa University, Kagawa, Japan, Tonan Hospital, Sapporo, Japan, Fukui-ken Saiseikai Hospital, Fukui, Japan, Saitama Medical University, Hidaka-shi, Japan, Kawasaki Medical School, Kurashiki-shi, Japan

Research Funding

Pharmaceutical/Biotech Company

Background: Less intensive regimens, focusing on survival and disease control, may be better first-line treatments in unresectable metastatic colorectal cancer (mCRC). Several randomized trials suggested that sequential cytotoxic agents in mCRC may improve overall survival compared with combination chemotherapy. This study investigated whether sequential treatment with Bmab-based first-line therapy with oxaliplatin has superior efficacy to combination treatment for unresectable mCRC. Methods: This study is a two-arm, multicenter, open-label, randomized phase III trial in Japan, comparing the efficacy and safety of sequential Cape/5-FU+Bmab with escalation to CapeOX/mFOLFOX6+Bmab versus combination CapeOX/mFOLFOX6+Bmab as the first-line treatment of mCRC. The primary endpoint is Time to failure of strategy (TFS). In the sequential arm (Arm A: oxaliplatin ‘wait-and-go’), treatment escalation from Cape/5-FU+Bmab to CapeOX/mFOLFOX6+Bmab is recommended for progressive disease. In the combination arm (Arm B: oxaliplatin ‘stop-and-go’), de-escalation from CapeOX/mFOLFOX6+Bmab to Cape/5-FU+Bmab is possible after 12 weeks of treatment. Re-escalation to CapeOX/mFOLFOX6+Bmab after progressive disease is considered only for patients who received de-escalation of oxaliplatin, not caused by oxaliplatin-associated toxicity, after 12 weeks of treatment. A target sample size of 304 evaluable patients is considered sufficient to detect a hazard ratio of 0.69 for the TFS of the sequential ‘wait-and-go’ approach compared with the combination ‘stop-and go’ approach with 80% power and a 2-sided significance level of 5%. From December 2014 to September 2016, 311 patients were enrolled across 81 centers in Japan. The follow-up period is until March 2018, and results are expected in 2019, and results are expected in 2019. Clinical trial information: 000015405.

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Abstract Details

Meeting

2018 Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Cancers of the Colon, Rectum, and Anus

Sub Track

Translational Research

Clinical Trial Registration Number

000015405

Citation

J Clin Oncol 36, 2018 (suppl 4S; abstr TPS872)

DOI

10.1200/JCO.2018.36.4_suppl.TPS872

Abstract #

TPS872

Poster Bd #

P24

Abstract Disclosures