Ignite Creation Date:
2024-05-05 @ 4:42 PM
Last Modification Date:
2024-10-26 @ 9:23 AM
Study NCT ID:
NCT00294359
Status:
COMPLETED
Last Update Posted:
2007-08-22
First Post:
2006-02-21
Brief Title:
The MAX Study Mitomycin C Avastin and Xeloda in Patients With Untreated Metastatic Colorectal Cancer
Sponsor:
Australasian Gastro-Intestinal Trials Group
Organization:
Australasian Gastro-Intestinal Trials Group
Study Overview
Official Title:
The MAX Study A Randomised Phase IIIII Study to Evaluate the Role of Mitomycin C Avastin and Xeloda in Patients With Untreated Metastatic Colorectal Cancer
Status:
COMPLETED
Status Verified Date:
2007-08
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Although it is possible to cure bowel cancer when it is detected at an early stage in many cases it may spread to involve other organs and in these cases is generally incurable Chemotherapy prolongs survival and improves quality of life in such patients but standard chemotherapy for this disease has not been defined
There are several possible chemotherapy treatments for patients with bowel cancer which has spread to other organs However these treatments are only partly effective and only work for a limited period of time Most treatments are associated with a number of possible side effects which may have a detrimental effect on quality of life Thus it is imperative that more effective treatments with the lowest possible risk of side effects are developed
Previous studies have shown that the addition of a new type of antibody treatment bevacizumab to an intensive combination chemotherapy regimen improved survival in patients with advanced bowel cancer and extended the time before tumours began to grow However intensive chemotherapy is likely to only be a suitable treatment for a proportion of patients with bowel cancer because intensive chemotherapy causes a high rate of side effects
This study compares a gentle chemotherapy treatment capecitabine chemotherapy tablets given by mouth with the combination of capecitabine and bevacizumab and the combination of capecitabine bevacizumab and intravenous mitomycin C
It is expected that a gentle chemotherapy treatment or a gentle chemotherapy treatment combined with bevacizumab would be an appropriate treatment for both young and fit patients as well as older and less fit patients who would not easily tolerate intensive chemotherapy
There are several possible chemotherapy treatments for patients with bowel cancer which has spread to other organs However these treatments are only partly effective and only work for a limited period of time Most treatments are associated with a number of possible side effects which may have a detrimental effect on quality of life Thus it is imperative that more effective treatments with the lowest possible risk of side effects are developed
Previous studies have shown that the addition of a new type of antibody treatment bevacizumab to an intensive combination chemotherapy regimen improved survival in patients with advanced bowel cancer and extended the time before tumours began to grow However intensive chemotherapy is likely to only be a suitable treatment for a proportion of patients with bowel cancer because intensive chemotherapy causes a high rate of side effects
This study compares a gentle chemotherapy treatment capecitabine chemotherapy tablets given by mouth with the combination of capecitabine and bevacizumab and the combination of capecitabine bevacizumab and intravenous mitomycin C
It is expected that a gentle chemotherapy treatment or a gentle chemotherapy treatment combined with bevacizumab would be an appropriate treatment for both young and fit patients as well as older and less fit patients who would not easily tolerate intensive chemotherapy
Detailed Description:
Aims - The phase II stage of the study aims to determine the relative toxicity of the combination of capecitabine and bevacizumab and the combination of capecitabine mitomycin C MMC and bevacizumab with that of capecitabine monotherapy and to assess tumour response rate RECIST criteria for each arm
For Phase III stage the primary objective is to compare progression-free survival PFS on the three arms Secondary objectives are to determine treatment related toxicity to determine tumour response rates RECIST criteria to determine overall survival for each treatment arm to compare disease related symptoms and Quality of life and to determine cost effectiveness of bevacizumab containing treatments
Research Plan Synopsis - Trial Design Randomised stratified multicentre phase IIIII study The study will proceed in 2 phases initially a randomised phase II stage evaluating safety after 60 patients approx 20 per arm and 150 patients approx 50 per arm have completed at least 6 weeks treatment This will continue with a randomised phase III stage evaluating activity toxicity and quality of life measures
Treatments Patients will be randomised to treatment in either one of the three arms I Capecitabine as monotherapy 2 Capecitabine and bevacizumab or 3 Capecitabine and bevacizumab and MMC
Drug administration Arm 1 Capecitabine 2500mgm2d in 2 divided doses d1-14 q3weekly Arm 2 Capecitabine administered as per Arm 1 plus Bevacizumab 75 mgkg q3weekly Arm 3 Capecitabine and Bevacizumab administered as per Arm 2 plus Mitomycin C 7 mgm2 q 6weekly maximum dose 14 mg maximum 4 treatments
Analysis A total sample size of 333 patients 111 per group will be required to detect an improvement of at least 31 months in progression free survival from 55 to 86 months using a 2-tailed comparison 25 level of significance 3-year accrual and 1-year follow-up The 12-month survival rate for patients on capecitabine alone is 50 A sample size of 111 per arm will have 80 power to detect an increase of 17 in the 1-year rate from 50 to 67 based on a significance level of 25 3-year accrual and 1-year follow-up For both endpoints PFS and survival the difference between capecitabine alone and the regimen containing MMC is expected to be greater in the order of 45 months which will yield 80 power to detect the difference in PFS
Whilst not a primary comparison the study will nevertheless still have 80 power to detect a 55 month difference between the two experimental arms as a secondary comparison based on a level of significance of 17 Secondary endpoints include treatment related toxicity Toxicity analyses will include treatment-received population which includes all patients who received at least 1 dose of study treatment Toxicity will be described by tabulating the proportions of patients with a worst toxicity grade of 0 1 2 3 or 4 for each of the relevant NCI CTC AE scales
Phase II Confidence intervals for the difference in the incidence of bevacizumab and MMC associated grade 34 toxicities on the three arms will be calculated If the incidence of these toxicities in the triple combination regimen CapecitabineMMC bevacizumab exceeds the rate of toxicity experienced in the capecitabinebevacizumab combination by more than 20 then consideration will be given to dose adjustment or stopping recruitment into the triple combination arm
Phase III The PFS for capecitabine chemotherapy alone is expected to be about 55 months and this is expected to increase to 9 months with the addition of bevacizumab which is considered to be clinically meaningful Using an overall 95 confidence level and 80 power and a 25 significance level for each comparison 111 patients per arm are required to detect differences based on a 36-month accrual and 12-month follow-up
Outcomes and Significance - This randomised phase IIIII study aims to compare capecitabine monotherapy with capecitabine plus bevacizumab and capecitabine plus bevacizumab plus MMC in patients with previously untreated metastatic colorectal cancer
The use of either MMC or bevacizumab to 5FU based chemotherapy appears to result in improved activity without substantial increases in toxicity Thus regimens incorporating these agents could have significant activity and be well tolerated These regimens could be suitable as a low toxicity palliative regimen for a broad range of the population of patients with metastatic colorectal cancer including older patients with co-morbidities
As it is anticipated that rates of acute toxicity with each regimen will be lower than those observed with oxaliplatin or CPT-11-based regimens the target population may be more broad ranging than most other studies Thus it may include older patients patients with limited performance status PS2 patients with co-morbidities or patients in whom there are concerns relating to toxicity with oxaliplatin or CPT-11-based combination chemotherapy However it is not restricted to this population and younger fitter patients may also be enrolled in the study as a lower rate of side effects is likely to be associated with improved quality of life
For Phase III stage the primary objective is to compare progression-free survival PFS on the three arms Secondary objectives are to determine treatment related toxicity to determine tumour response rates RECIST criteria to determine overall survival for each treatment arm to compare disease related symptoms and Quality of life and to determine cost effectiveness of bevacizumab containing treatments
Research Plan Synopsis - Trial Design Randomised stratified multicentre phase IIIII study The study will proceed in 2 phases initially a randomised phase II stage evaluating safety after 60 patients approx 20 per arm and 150 patients approx 50 per arm have completed at least 6 weeks treatment This will continue with a randomised phase III stage evaluating activity toxicity and quality of life measures
Treatments Patients will be randomised to treatment in either one of the three arms I Capecitabine as monotherapy 2 Capecitabine and bevacizumab or 3 Capecitabine and bevacizumab and MMC
Drug administration Arm 1 Capecitabine 2500mgm2d in 2 divided doses d1-14 q3weekly Arm 2 Capecitabine administered as per Arm 1 plus Bevacizumab 75 mgkg q3weekly Arm 3 Capecitabine and Bevacizumab administered as per Arm 2 plus Mitomycin C 7 mgm2 q 6weekly maximum dose 14 mg maximum 4 treatments
Analysis A total sample size of 333 patients 111 per group will be required to detect an improvement of at least 31 months in progression free survival from 55 to 86 months using a 2-tailed comparison 25 level of significance 3-year accrual and 1-year follow-up The 12-month survival rate for patients on capecitabine alone is 50 A sample size of 111 per arm will have 80 power to detect an increase of 17 in the 1-year rate from 50 to 67 based on a significance level of 25 3-year accrual and 1-year follow-up For both endpoints PFS and survival the difference between capecitabine alone and the regimen containing MMC is expected to be greater in the order of 45 months which will yield 80 power to detect the difference in PFS
Whilst not a primary comparison the study will nevertheless still have 80 power to detect a 55 month difference between the two experimental arms as a secondary comparison based on a level of significance of 17 Secondary endpoints include treatment related toxicity Toxicity analyses will include treatment-received population which includes all patients who received at least 1 dose of study treatment Toxicity will be described by tabulating the proportions of patients with a worst toxicity grade of 0 1 2 3 or 4 for each of the relevant NCI CTC AE scales
Phase II Confidence intervals for the difference in the incidence of bevacizumab and MMC associated grade 34 toxicities on the three arms will be calculated If the incidence of these toxicities in the triple combination regimen CapecitabineMMC bevacizumab exceeds the rate of toxicity experienced in the capecitabinebevacizumab combination by more than 20 then consideration will be given to dose adjustment or stopping recruitment into the triple combination arm
Phase III The PFS for capecitabine chemotherapy alone is expected to be about 55 months and this is expected to increase to 9 months with the addition of bevacizumab which is considered to be clinically meaningful Using an overall 95 confidence level and 80 power and a 25 significance level for each comparison 111 patients per arm are required to detect differences based on a 36-month accrual and 12-month follow-up
Outcomes and Significance - This randomised phase IIIII study aims to compare capecitabine monotherapy with capecitabine plus bevacizumab and capecitabine plus bevacizumab plus MMC in patients with previously untreated metastatic colorectal cancer
The use of either MMC or bevacizumab to 5FU based chemotherapy appears to result in improved activity without substantial increases in toxicity Thus regimens incorporating these agents could have significant activity and be well tolerated These regimens could be suitable as a low toxicity palliative regimen for a broad range of the population of patients with metastatic colorectal cancer including older patients with co-morbidities
As it is anticipated that rates of acute toxicity with each regimen will be lower than those observed with oxaliplatin or CPT-11-based regimens the target population may be more broad ranging than most other studies Thus it may include older patients patients with limited performance status PS2 patients with co-morbidities or patients in whom there are concerns relating to toxicity with oxaliplatin or CPT-11-based combination chemotherapy However it is not restricted to this population and younger fitter patients may also be enrolled in the study as a lower rate of side effects is likely to be associated with improved quality of life
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None