Maintenance Therapy With 5-FU/FA Plus Panitumumab vs. 5-FU/FA Alone After Prior Induction and Re-induction After Progress for 1st-line Treatment of Metastatic Colorectal Cancer

NCT ID: NCT01991873

Last Updated: 2023-06-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

387 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-04-30

Study Completion Date

2023-02-18

Brief Summary

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This is a phase II, randomized, multi-center, open-label, parallel-group study to evaluate the progression-free survival during maintenance therapy.

Eligible patients will be treated within a 12-week induction therapy. Those patients achieving CR/PR or SD at 12 weeks and qualifying for maintenance treatment and re-induction treatment with all potential drug components, will be randomized in a ratio of 1:1 to receive chemotherapy plus panitumumab or chemotherapy alone during maintenance. In case of progression, re-induction treatment will be started.

Detailed Description

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Conditions

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Metastatic Colorectal Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Maintenance Chemotherapy + Panitumumab

Maintenance therapy:

Panitumumab 6 mg/kg prior to administration of chemotherapy Folinic acid 400 mg/m2 over 2 hours on day 1 5-FU 2400mg/m2 46h continuous infusion day 1 - day 2 Repeat on day 15

Re-induction upon progression:

Panitumumab 6 mg/kg prior to administration of mFOLFOX6 chemotherapy.

mFOLFOX6: Oxaliplatin 85 mg/m2 over 2 hours on day 1 Folinic acid 400 mg/m2 over 2 hours on day 1 5-FU 2400mg/m2 46h continuous infusion day 1 - day 2 Repeat on day 15

Group Type EXPERIMENTAL

Maintenance Chemotherapy

Intervention Type DRUG

Panitumumab (Within maintenance phase)

Intervention Type DRUG

mFOLFOX6 (Within re-induction phase)

Intervention Type DRUG

Panitumumab (Within re-induction phase)

Intervention Type DRUG

Maintenance Chemotherapy w/o Panitumumab

Maintenance therapy:

Folinic acid 400 mg/m2 over 2 hours on day 1 5-FU 2400mg/m2 46h continuous infusion day 1 - day 2 Repeat on day 15

Re-induction upon progression:

Panitumumab 6 mg/kg prior to administration of mFOLFOX6 chemotherapy.

mFOLFOX6 chemotherapy: Oxaliplatin 85 mg/m2 over 2 hours on day 1 Folinic acid 400 mg/m2 over 2 hours on day 1 5-FU 2400mg/m2 46h continuous infusion day 1 - day 2 Repeat on day 15

Group Type EXPERIMENTAL

Maintenance Chemotherapy

Intervention Type DRUG

mFOLFOX6 (Within re-induction phase)

Intervention Type DRUG

Panitumumab (Within re-induction phase)

Intervention Type DRUG

Interventions

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Maintenance Chemotherapy

Intervention Type DRUG

Panitumumab (Within maintenance phase)

Intervention Type DRUG

mFOLFOX6 (Within re-induction phase)

Intervention Type DRUG

Panitumumab (Within re-induction phase)

Intervention Type DRUG

Other Intervention Names

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Folinic acid + 5-FU (5-Fluorouracil) Vectibix Oxaliplatin + Folinic acid + 5-FU (5-Fluorouracil) Vectibix

Eligibility Criteria

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Inclusion Criteria

* Signed written informed consent
* Male or female ≥ 18 years of age
* Histologically proven metastatic colorectal cancer
* Molecular testing showing RAS wild-type in colorectal carcinoma cells
* Life expectancy \> 12 weeks
* At least one measurable lesion according to RECIST 1.1
* Adequate bone marrow, liver, kidney, organ and metabolic function
* Bone marrow function:

* leukocyte count ≥ 3.0 × 109/L
* ANC ≥ 1.5 × 109/L
* platelet count ≥ 100 × 109/L
* hemoglobin ≥ 9 g/dL or 5.59 mmol/L (may be transfused or treated with erythropoietin to maintain/ exceed this level)
* Hepatic function:

* Total bilirubin ≤ 1.5 × UNL
* ALT and AST ≤ 2.5 × UNL (or ≤ 5 × UNL in presence of liver metastases)
* AP ≤ 5 × UNL
* Renal function:

* Creatinine clearance ≥ 50 mL/min according to Cockcroft-Gault formula or serum creatinine ≤ 1.5 × UNL
* Metabolic function:

* Magnesium ≥ lower limit of normal
* Calcium ≥ lower limit of normal
* ECOG performance status 0 - 1
* Women of child-bearing potential must have a negative pregnancy test

Exclusion Criteria

* Previous treatment for colorectal cancer in the metastatic setting
* Previous EGFR-targeting therapy \< 6 months after end of adjuvant therapy
* Known brain metastases unless adequately treated (surgery or radiotherapy) with no evidence of progression and neurologically stable off anticonvulsants and steroids
* Chronic inflammatory bowel disease
* Peripheral neuropathy ≥ NCI-CTCAE V 4.03 grade 2
* Other previous malignancies with the exception of a history of previous curatively treated basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix or other curatively treated malignant disease without recurrence after at least 5 years of follow-up
* Significant disease that, in the investigator's opinion, would exclude the patient from the study
* History of cardiac disease; defined as:

* Congestive heart failure \> New York Heart Association (NYHA) class 2
* Active coronary artery disease (myocardial infarction more than 6 months prior to start of study treatment is allowed)
* Cardiac arrhythmias requiring anti-arrhythmic therapy (beta-blockers or digoxin are permitted)
* Uncontrolled hypertension (defined as blood pressure ≥ 160 mmHg systolic and/or ≥ 90 mmHg diastolic on medication)
* Patients with interstitial lung disease, e.g., pneumonitis or pulmonary fibrosis or evidence of interstitial lung disease on baseline chest CT scan
* Known HIV, hepatitis B or C infection
* Known hypersensitivity reaction to any of the study components
* Radiotherapy, major surgery or any investigational drug 30 days before registration
* Pregnancy or lactation or planning to be pregnant during treatment and within 6 months after the end of treatment
* Subject (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for at least an additional 6 months after the end of treatment
* Known alcohol or drug abuse
* Any condition that is unstable or could jeopardize the safety of the patient and his compliance in the study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ClinAssess GmbH

INDUSTRY

Sponsor Role collaborator

Amgen

INDUSTRY

Sponsor Role collaborator

AIO-Studien-gGmbH

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Tanja Trarbach, Dr. med.

Role: PRINCIPAL_INVESTIGATOR

Zentrum für Tumorbiologie und Integrative Medizin, Klinikum Wilhelmshaven

Locations

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St.-Antonius-Hospital Eschweiler

Eschweiler, , Germany

Site Status

Zentrum für Tumorbiologie und Integrative Medizin, Klinikum Wilhelmshaven

Wilhelmshaven, , Germany

Site Status

Countries

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Germany

References

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Ballhausen A, Swoboda S, Horst D, Fruehauf S, Graeven U, Muller L, Trarbach T, Fischer von Weikersthal L, Goekkurt E, Heinemann V, Kasper S, Kurreck A, Alig AHS, Reinacher-Schick AC, Bullinger L, Stahler A, Stintzing S, Jarosch A, Modest DP. Spatial Tumor Immune Microenvironment as a Prognostic and Predictive Biomarker in Anti-EGFR-Based Maintenance for RAS wt Metastatic CRC-The PanaMa (AIO KRK0212) Trial. Clin Cancer Res. 2025 Oct 1;31(19):4049-4058. doi: 10.1158/1078-0432.CCR-25-0879.

Reference Type DERIVED
PMID: 40736443 (View on PubMed)

Stahler A, Karthaus M, Fruehauf S, Graeven U, Muller L, Fischer von Weikersthal L, Caca K, Goekkurt E, Ballhausen A, Sommerhauser G, Alig AHS, Held S, Jarosch A, Horst D, Reinacher-Schick A, Kasper S, Heinemann V, Stintzing S, Trarbach T, Modest DP. Panitumumab plus 5-fluorouracil and folinic acid or 5-fluorouracil and folinic acid alone as maintenance therapy in RAS wild-type metastatic colorectal cancer (PanaMa, AIO KRK 0212): final efficacy analysis of a randomised, open-label, phase 2 trial. EClinicalMedicine. 2024 Dec 16;79:103004. doi: 10.1016/j.eclinm.2024.103004. eCollection 2025 Jan.

Reference Type DERIVED
PMID: 39802302 (View on PubMed)

Stahler A, Kind AJ, Sers C, Mamlouk S, Muller L, Karthaus M, Fruehauf S, Graeven U, Fischer von Weikersthal L, Sommerhauser G, Kasper S, Hoppe B, Kurreck A, Held S, Heinemann V, Horst D, Jarosch A, Stintzing S, Trarbach T, Modest DP. Negative Hyperselection of Resistance Mutations for Panitumumab Maintenance in RAS Wild-Type Metastatic Colorectal Cancer (PanaMa Phase II Trial, AIO KRK 0212). Clin Cancer Res. 2024 Apr 1;30(7):1256-1263. doi: 10.1158/1078-0432.CCR-23-3023.

Reference Type DERIVED
PMID: 38289994 (View on PubMed)

Ballhausen A, Karthaus M, Fruehauf S, Graeven U, Muller L, Konig AO, von Weikersthal LF, Sommerhauser G, Alig AHS, Goekkurt E, Meyer-Knees JW, Kurreck A, Stahler A, Held S, Kasper S, Heinrich K, Heinemann V, Stintzing S, Trarbach T, Modest DP. Health-related quality of life in patients with RAS wild-type metastatic colorectal cancer treated with fluorouracil and folinic acid with or without panitumumab as maintenance therapy: a prespecified secondary analysis of the PanaMa (AIO KRK 0212) trial. Eur J Cancer. 2023 Sep;190:112955. doi: 10.1016/j.ejca.2023.112955. Epub 2023 Jun 28.

Reference Type DERIVED
PMID: 37454537 (View on PubMed)

Stahler A, Hoppe B, Na IK, Keilholz L, Muller L, Karthaus M, Fruehauf S, Graeven U, Fischer von Weikersthal L, Goekkurt E, Kasper S, Kind AJ, Kurreck A, Alig AHS, Held S, Reinacher-Schick A, Heinemann V, Horst D, Jarosch A, Stintzing S, Trarbach T, Modest DP. Consensus Molecular Subtypes as Biomarkers of Fluorouracil and Folinic Acid Maintenance Therapy With or Without Panitumumab in RAS Wild-Type Metastatic Colorectal Cancer (PanaMa, AIO KRK 0212). J Clin Oncol. 2023 Jun 1;41(16):2975-2987. doi: 10.1200/JCO.22.02582. Epub 2023 Apr 5.

Reference Type DERIVED
PMID: 37018649 (View on PubMed)

Sommerhauser G, Kurreck A, Beck A, Fehrenbach U, Karthaus M, Fruehauf S, Graeven U, Mueller L, Koenig AO, V Weikersthal LF, Goekkurt E, Haas S, Stahler A, Heinemann V, Held S, Alig AHS, Kasper S, Stintzing S, Trarbach T, Modest DP. Depth of response of induction therapy and consecutive maintenance treatment in patients with RAS wild-type metastatic colorectal cancer: An analysis of the PanaMa trial (AIO KRK 0212). Eur J Cancer. 2023 Jan;178:37-48. doi: 10.1016/j.ejca.2022.09.011. Epub 2022 Oct 25.

Reference Type DERIVED
PMID: 36399909 (View on PubMed)

Modest DP, Karthaus M, Fruehauf S, Graeven U, Muller L, Konig AO, Fischer von Weikersthal L, Caca K, Kretzschmar A, Goekkurt E, Haas S, Kurreck A, Stahler A, Held S, Jarosch A, Horst D, Reinacher-Schick A, Kasper S, Heinemann V, Stintzing S, Trarbach T. Panitumumab Plus Fluorouracil and Folinic Acid Versus Fluorouracil and Folinic Acid Alone as Maintenance Therapy in RAS Wild-Type Metastatic Colorectal Cancer: The Randomized PANAMA Trial (AIO KRK 0212). J Clin Oncol. 2022 Jan 1;40(1):72-82. doi: 10.1200/JCO.21.01332. Epub 2021 Sep 17.

Reference Type DERIVED
PMID: 34533973 (View on PubMed)

Related Links

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http://www.aio-portal.de

Homepage of the AIO (Arbeitsgemeinschaft Internistische Onkologie in der Deutschen Krebsgesellschaft e.V.)

Other Identifiers

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2012-005422-30

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

PanaMa_DE-2009-0003

Identifier Type: OTHER

Identifier Source: secondary_id

AIO-KRK-0212

Identifier Type: -

Identifier Source: org_study_id

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