Colon Cancer Clinical Trial
Oxaliplatin With or Without Gefitinib in Treating Patients With Metastatic or Locally Recurrent Colorectal Cancer
Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Biological therapies such as gefitinib may interfere with the growth of the tumor cells and slow the growth of colorectal cancer. Combining chemotherapy with gefitinib may kill more tumor cells.
PURPOSE: Phase I/II trial to compare the effectiveness of chemotherapy with or without gefitinib in treating patients who have metastatic or locally recurrent colorectal cancer.
Full Description
OBJECTIVES:
Determine the recommended phase II dose of gefitinib when administered in combination with oxaliplatin in patients with metastatic or locally recurrent colorectal cancer.
Determine the dose-limiting toxicity of this regimen in these patients.
Compare the time to progression, objective response rate, and median and overall survival in patients treated with oxaliplatin with or without gefitinib.
Compare the toxicity of these regimens in these patients.
OUTLINE: This is a phase I dose-escalation study of gefitinib followed by a phase II randomized, multicenter study. Patients are stratified according to ECOG performance status (0 vs 1-2).
Phase I: Patients receive oxaliplatin IV over 2 hours on day 1 and oral gefitinib once daily on days 1-21. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of gefitinib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Phase II: Patients are randomized to one of two treatment arms.
Arm I: Patients receive oxaliplatin IV over 2 hours on day 1.
Arm II: Patients receive oxaliplatin as in arm I and oral gefitinib once daily at the MTD on days 1-21.
In both arms, treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients in arm II with stable or responding disease after 6 courses may continue to receive gefitinib alone until disease progression.
PROJECTED ACCRUAL: Approximately 77 patients (9 for phase I and 68 for phase II) will be accrued for this study within 12-14 months.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed adenocarcinoma of the colon or rectum that is not amenable to potentially curative surgical resection
Metastatic or locally recurrent disease
Tumor in liver or lung accessible to needle biopsy by ultrasound or CT scan guidance
At least 1 measurable lesion
At least 20 mm by conventional techniques, including physical examination, CT scan, or MRI OR
At least 10 mm by spiral CT scan
Lesions on colonoscopic examination or barium studies, bone metastases, CNS lesions, and ascites are not considered measurable
Failed prior therapy with fluorouracil, leucovorin calcium, and irinotecan given either sequentially or in combination
No known brain metastases
PATIENT CHARACTERISTICS:
Age:
18 and over
Performance status:
ECOG 0-2
Life expectancy:
At least 3 months
Hematopoietic:
WBC at least 3,000/mm^3
Absolute neutrophil count at least 1,500/mm^3
Platelet count at least 100,000/mm^3
Hepatic:
Bilirubin no greater than 1.5 mg/dL
AST/ALT no greater than 2.5 times upper limit of normal
Renal:
Creatinine no greater than 1.5 mg/dL OR
Creatinine clearance at least 60 mL/min
Cardiovascular:
No symptomatic congestive heart failure
No unstable angina pectoris
No cardiac arrhythmia
Other:
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No peripheral neuropathy greater than grade 1
No other concurrent uncontrolled illness that would preclude study
No concurrent psychiatric illness or social situation that would preclude study
No ongoing or active infection
No prior allergic reaction to compounds of similar chemical or biologic composition to oxaliplatin or gefitinib
No other concurrent malignancy except non-melanoma skin cancer or carcinoma in situ of the cervix unless considered to be at less than 30% risk of relapse after completion of therapy
PRIOR CONCURRENT THERAPY:
Biologic therapy:
No prior epidermal growth factor inhibitor
At least 24 hours since prior colony-stimulating factors
No concurrent colony-stimulating factors during first course of study therapy
Chemotherapy:
See Disease Characteristics
No more than 2 prior chemotherapy regimens for metastatic disease
Prior adjuvant chemotherapy allowed
At least 4 weeks since prior cytotoxic chemotherapy and recovered
No prior cisplatin or oxaliplatin
Endocrine therapy:
Not specified
Radiotherapy:
At least 4 weeks since prior radiotherapy and recovered
Surgery:
See Disease Characteristics
At least 4 weeks since prior surgery
Other:
At least 30 days since prior investigational agents
Recovered from prior therapy
No concurrent anti-retroviral therapy for HIV
No other concurrent investigational or commercial agents or therapies for malignancy
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There are 12 Locations for this study
Chicago Illinois, 60637, United States
Chicago Illinois, 60640, United States
Decatur Illinois, 62526, United States
Evanston Illinois, 60201, United States
Harvey Illinois, 60426, United States
LaGrange Illinois, 60525, United States
Maywood Illinois, 60153, United States
Peoria Illinois, 61602, United States
Springfield Illinois, 62701, United States
Fort Wayne Indiana, 46885, United States
South Bend Indiana, 46601, United States
Saint Joseph Michigan, 49085, United States
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