A Study of NUC-3373 in Combination With Other Agents in Patients With Colorectal Cancer

NCT ID: NCT05678257

Last Updated: 2025-09-12

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

180 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-18

Study Completion Date

2024-08-29

Brief Summary

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This is a randomized, open-label, dose/schedule optimization study comparing NUC-3373/leucovorin (LV)/irinotecan plus bevacizumab (NUFIRI-bev) to 5-FU/LV/irinotecan plus bevacizumab (FOLFIRI-bev) for the treatment of patients with unresectable metastatic colorectal cancer.

A total of 171 patients will be randomized 1:1:1 to either NUFIRI-bev on a weekly NUC-3373 schedule, NUFIRI-bev based on an alternate weekly NUC-3373 schedule, or FOLFIRI bev on an alternate weekly schedule. The main objectives are to assess and compare the efficacy and safety of the 3 regimens. Pharmacokinetics will be assessed on the 2 NUFIRI arms.

Detailed Description

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Conditions

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Colorectal Cancer Colorectal Neoplasms Colorectal Adenocarcinoma Colorectal Cancer Metastatic Neoplasm, Colorectal

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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NUFIRI-bev on a Q1W NUC-3373 schedule

Arm A: Study treatment will be administered in 28-day cycles as follows:

1. Bevacizumab 5 mg/kg on Days 1 and 15:

* 90 minutes for the first dose
* 60 minutes for the second dose (if first dose is tolerated)
* 30 minutes for subsequent doses (if second dose is tolerated)
2. LV 400 mg/m2 (or equivalent levo-LV) over 120 minutes on Days 1, 8, 15, and 22.
3. Irinotecan 180 mg/m2 over 90 minutes (concurrently with the LV infusion) on Days 1 and 15.
4. NUC-3373 1500 mg/m2 over 120 minutes on Days 1, 8, 15, and 22.

Group Type EXPERIMENTAL

Fosifloxuridine Nafalbenamide

Intervention Type DRUG

Intravenous infusion

Leucovorin

Intervention Type DRUG

Intravenous infusion

Irinotecan

Intervention Type DRUG

Intravenous infusion

Bevacizumab

Intervention Type BIOLOGICAL

Intravenous infusion

NUFIRI-bev on a Q2W NUC-3373 schedule

Arm B: Study treatment will be administered in 28-day cycles as follows:

1. Bevacizumab 5 mg/kg on Days 1 and 15:

* 90 minutes for the first dose
* 60 minutes for the second dose (if first dose is tolerated)
* 30 minutes for subsequent doses (if second dose is tolerated)
2. LV 400 mg/m2 (or equivalent levo-LV) over 120 minutes on Days 1 and 15.
3. Irinotecan 180 mg/m2 over 90 minutes (concurrently with the LV infusion) on Days 1 and 15.
4. NUC-3373 1500 mg/m2 over 120 minutes on Days 1 and 15.

Group Type EXPERIMENTAL

Fosifloxuridine Nafalbenamide

Intervention Type DRUG

Intravenous infusion

Leucovorin

Intervention Type DRUG

Intravenous infusion

Irinotecan

Intervention Type DRUG

Intravenous infusion

Bevacizumab

Intervention Type BIOLOGICAL

Intravenous infusion

FOLFIRI-bev on a Q2W schedule

Arm C: Study treatment will be administered in 28-day cycles as follows:

1. Bevacizumab 5 mg/kg on Days 1 and 15:

* 90 minutes for the first dose
* 60 minutes for the second dose (if first dose is tolerated)
* 30 minutes for subsequent doses (if second dose is tolerated)
2. LV 400 mg/m2 (or equivalent levo-LV) over 120 minutes on Days 1 and 15.
3. Irinotecan 180 mg/m2 over 90 minutes (concurrently with the LV infusion) on Days 1 and 15.
4. 5-FU 400 mg/m2 bolus on Days 1 and 15.
5. 5-FU 2400 mg/m2 infusion over 46 hours on Days 1 and 15.

Group Type ACTIVE_COMPARATOR

Leucovorin

Intervention Type DRUG

Intravenous infusion

Irinotecan

Intervention Type DRUG

Intravenous infusion

Bevacizumab

Intervention Type BIOLOGICAL

Intravenous infusion

5-FU

Intervention Type DRUG

Intravenous infusion

Interventions

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Fosifloxuridine Nafalbenamide

Intravenous infusion

Intervention Type DRUG

Leucovorin

Intravenous infusion

Intervention Type DRUG

Irinotecan

Intravenous infusion

Intervention Type DRUG

Bevacizumab

Intravenous infusion

Intervention Type BIOLOGICAL

5-FU

Intravenous infusion

Intervention Type DRUG

Other Intervention Names

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NUC-3373 Nucleotide analogue Folinic acid LV Campto Camptosar Avastin Zirabev 5FU 5-fluorouracil Fluorouracil

Eligibility Criteria

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Inclusion Criteria

1. Provision of written informed consent.
2. Histological or cytological confirmation of colorectal adenocarcinoma (excluding appendiceal and anal canal cancers, as well as signet-ring cell carcinoma) that is unresectable and metastatic.
3. Measurable disease (as defined by RECIST v1.1).
4. Received ≥2 months of a first-line fluoropyrimidine and oxaliplatin-containing regimen for metastatic disease or relapsed within 6 months of completing a fluoropyrimidine and oxaliplatin-containing neoadjuvant/adjuvant therapy. Previous treatment with standard of care chemotherapy regimens in combination with molecular targeted therapies (e.g., VEGF and EGFR pathway inhibitors and immuno-oncology agents) is permitted. Previous treatment with maintenance therapy (e.g., capecitabine) is also allowed. Patients who started on a fluoropyrimidine and oxaliplatin-containing regimen in any setting but must discontinue the oxaliplatin due to.toxicity or allergy (and are now unable to receive oxaliplatin) are considered eligible regardless of the number of cycles of oxaliplatin they received.
5. Known RAS and BRAF status. Patients with wild-type RAS tumours must have received prior treatment with an EGFR inhibitor, unless this was not standard of care according to relevant region-specific treatment recommendations.
6. Known UGT1A1 status, or patient consents to UGT1A1 status testing if unknown.
7. Known DPD activity status, or patient consents to DPD status testing if unknown. See exclusion criterion 1.
8. Age ≥18 years.
9. Minimum life expectancy of ≥12 weeks.
10. Eastern Cooperative Oncology Group (ECOG) Performance status 0 or 1.
11. Adequate bone marrow function as defined by: absolute neutrophil count (ANC) ≥1.5 × 109/L, platelet count ≥100 × 109/L, and haemoglobin ≥9 g/dL. Patients with benign neutropenia may be discussed on a case-by-case basis with the medical monitor.
12. Adequate liver function, as defined by: serum total bilirubin ≤1.5 × ULN), AST and ALT ≤2.5 × ULN (or ≤5 × ULN if liver metastases are present).
13. Adequate renal function assessed as serum creatinine \<1.5 × ULN and glomerular filtration rate ≥50 mL/min (calculated by the Cockcroft-Gault method).
14. Serum albumin ≥3 g/dL.
15. Ability to comply with protocol requirements.
16. Female patients of child-bearing potential must have a negative serum pregnancy test within 7 days prior to the first study drug administration. This criterion does not apply to patients who have had a previous hysterectomy or bilateral oophorectomy. Male patients and female patients of child-bearing potential must agree to practice true abstinence (defined in Section 10.3.1) or to use two forms of contraception, one of which must be highly effective. These forms of contraception must be used from the time of signing consent, throughout the treatment period, and for 6 months following the last dose of any study medication. Oral or injectable contraceptive agents cannot be the sole method of contraception
17. Patients must have been advised to take measures to avoid or minimize exposure of the skin and eyes to UV light, including avoiding sunbathing and solarium use, for the duration of study participation and for a period of 4 weeks following the last dose of study medication

Exclusion Criteria

1. History of hypersensitivity or current contra-indications to 5-FU, FUDR, or capecitabine.
2. History of hypersensitivity or current contra-indication to any of the combination agents required for the study.
3. History of allergic reactions attributed to components of the NUC-3373 drug product formulation.
4. History of hypersensitivity to Chinese Hamster Ovary (CHO) cell products or other recombinant human or humanised antibodies.
5. History of or known central nervous system or leptomeningeal metastases.
6. Symptomatic ascites, ascites currently requiring drainage procedures or ascites requiring drainage over the prior 3 months.
7. Mutant BRAF V600E status.
8. MSI high or dMMR.
9. Prior treatment with irinotecan.
10. Chemotherapy, hormonal therapy, radiotherapy (other than a short cycle of palliative radiotherapy \[e.g., for bone pain\]\*), immunotherapy, biological agents, or exposure to another investigational agent within 21 days (or four times the half-life for molecular targeted agents, whichever is shorter) of first administration of study treatment:
11. Residual toxicities from prior chemotherapy or radiotherapy which have not regressed to Grade ≤1 severity (CTCAE v5.0), except for alopecia and residual Grade 2 neuropathy.
12. History of other malignancies, except adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, surgically excised or potentially curatively treated ductal carcinoma in situ of the breast, or low-grade prostate cancer or patients after prostatectomy. Patients with previous invasive cancers are eligible if treatment was completed \>3 years prior to initiating the current study treatment, and the patient has had no evidence or recurrence since then.
13. Presence of an active bacterial or viral infection (including SARS-CoV-2, Herpes Zoster, Varicella Zoster or chickenpox), known Human Immunodeficiency Virus (HIV) positive or known active hepatitis B or C.
14. Presence of any uncontrolled concurrent serious illness, medical condition or other medical history, including laboratory results, which, in the Investigator's opinion, would be likely to interfere with the patient's ability to participate in the study or with the interpretation of the results (refer to protocol for further details).
15. Any condition that, in the judgment of the Investigator, may affect the patient's ability to provide informed consent and undergo study procedures.
16. Patients with a history of haemoptysis (1/2 teaspoon or more of red blood) within 6 months prior to enrolment.
17. Wound healing complications or surgery within 28 days of starting bevacizumab (wound healing must have been fully completed before starting bevacizumab). Investigators may allow patients to initiate treatment with the other study drugs (i.e., NUC-3373/5-FU, LV and irinotecan) on C1D1 but withhold bevacizumab for at least 15 days, but no longer than 28 days, to allow completion of wound healing in patients who would otherwise be eligible for the study, in line with standard local practice and after discussion with the Medical Monitor. Patients who have not received bevacizumab by C2D1 must be replaced.
18. Unhealed wound, active gastric or duodenal ulcer, or bone fracture.
19. Serious thromboembolic event in the 6 months before inclusion.
20. Patients with a history of haemorrhage within 6 months prior to enrolment.
21. Known inherited or acquired bleeding disorders.
22. Red blood cell (RBC) transfusion dependence, defined as requiring more than 2 units of packed RBC transfusions during the 4-week period prior to screening.
23. Uncontrolled hypertension.
24. Severe proteinuria or nephrotic syndrome.
25. Acute intestinal obstruction or sub-obstruction, history of inflammatory intestinal disease or extended resection of the small intestine. Presence of a colic prosthesis.
26. History of abdominal fistulas, trachea-oesophageal fistulas, any other Grade 4 gastrointestinal perforations, non-gastrointestinal fistulas, or intra-abdominal abscesses 6 months prior to screening.
27. Currently pregnant, lactating or breastfeeding.
28. Required concomitant use of brivudine, sorivudine and analogues.
29. Required concomitant use of St John's Wort.
30. Required concomitant use of drugs known to prolong QT/QTc interval.
31. Required concomitant use of strong CYP3A4 inducers or strong CYP3A4 inhibitors. The use of strong CYP3A4 inducers within 2 weeks of first receipt of study drug or the use of strong CYP3A4 inhibitors within 1 week of first receipt of study drug is also excluded.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NuCana plc

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elisabeth Oelmann, MD, PhD

Role: STUDY_DIRECTOR

NuCana plc

Locations

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Helen F. Graham Cancer Center

Newark, Delaware, United States

Site Status

Georgetown University Medical Center

Washington D.C., District of Columbia, United States

Site Status

University of Florida Health Medical Oncology - Davis Cancer Pavilion

Gainesville, Florida, United States

Site Status

University of Iowa Hospitals and Clinics

Iowa City, Iowa, United States

Site Status

Cancer Center of Kansas

Wichita, Kansas, United States

Site Status

Norton Cancer Institute

Louisville, Kentucky, United States

Site Status

Boston Medical Center

Boston, Massachusetts, United States

Site Status

University of Massachusetts Worcester

Worcester, Massachusetts, United States

Site Status

Barbara Ann Karmanos Cancer Institute

Detroit, Michigan, United States

Site Status

Morristown Medical Center

Morristown, New Jersey, United States

Site Status

The Christ Hospital Cancer Center

Cincinnati, Ohio, United States

Site Status

Texas Oncology - Baylor Charles A. Sammons Cancer Center

Dallas, Texas, United States

Site Status

University of Texas Southwestern Medical Center

Dallas, Texas, United States

Site Status

USOR - Texas Oncology Northeast Texas

Tyler, Texas, United States

Site Status

Fred Hutchinson Cancer Center at Evergreen Health

Kirkland, Washington, United States

Site Status

Northwest Cancer Specialists, P.C. dba Compass Oncology - Vancouver Cancer Center

Vancouver, Washington, United States

Site Status

Strasbourg Oncology Liberale - Clinique Sainte-Anne

Strasbourg, Alsace, France

Site Status

Hôpital Européen Marseille

Marseille, Bouches-du-Rhône, France

Site Status

Centre Georges-François Leclerc

Dijon, Bourgogne-Franche-Comté, France

Site Status

Centre Hospitalier Régional et Universitaire de Besançon - Hôpital Jean-Minjoz

Besançon, Doubs, France

Site Status

Institut Bergonié

Bordeaux, Gironde, France

Site Status

Centre Hospitalier Universitaire de Poitiers

Poitiers, Vienne, France

Site Status

Centre Hospitalier UniversitaireNantes - Hôtel Dieu

Nantes, , France

Site Status

Hôpital Européen Georges-Pompidou

Paris, Île-de-France Region, France

Site Status

Hôpital Foch

Suresnes, Île-de-France Region, France

Site Status

München Klinik Neuperlach

München, Bavaria, Germany

Site Status

Krankenhaus Nordwest

Frankfurt am Main, Hesse, Germany

Site Status

Universitätsklinik Ulm - Oberen Eselsberg

Ulm, Tübingen, Germany

Site Status

Charité Campus Virchow-Klinikum

Berlin, , Germany

Site Status

Azienda Ospedaliera Universitaria - Università degli Studi della Campania Luigi Vanvitelli

Napoli, Campania, Italy

Site Status

Fondazione IRCCS Istituto Nazionale dei Tumori

Milan, Lombardy, Italy

Site Status

Ospedale Santa Maria delle Croci di Ravenna

Faenza, Ravenna, Italy

Site Status

Azienda Ospedaliero Universitaria Careggi

Florence, Tuscany, Italy

Site Status

Istituto Oncologico Veneto - IRCCS

Padua, Veneto, Italy

Site Status

Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona

Ancona, , Italy

Site Status

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

Milan, , Italy

Site Status

Azienda Ospedaliera Regionale San Carlo

Potenza, , Italy

Site Status

Institut Català d'Oncologia - ICO Badalona - Hospital Universitari Germans Trias i Pujol

Badalona, Barcelona, Spain

Site Status

Complejo Hospitalario Universitario de Santiago (CHUS)

Santiago de Compostela, La Coruña, Spain

Site Status

Hospital Universitario Fundación Alcorcón

Alcorcón, Madrid, Spain

Site Status

Hospital Universitario Puerta de Hierro

Majadahonda, Madrid, Spain

Site Status

Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

Site Status

Hospital Universitari Vall d'Hebrón

Barcelona, , Spain

Site Status

Hospital Duran i Reynals

Barcelona, , Spain

Site Status

Hospital de León

León, , Spain

Site Status

Hospital Universitari Arnau de Vilanova

Lleida, , Spain

Site Status

Hospital General Universitario Gregorio Marañón

Madrid, , Spain

Site Status

MD Anderson Cancer Center Madrid

Madrid, , Spain

Site Status

Hospital Universitario 12 de Octubre

Madrid, , Spain

Site Status

Hospital Universitario Virgen de la Victoria

Málaga, , Spain

Site Status

Hospital Universitario Virgen del Rocío

Seville, , Spain

Site Status

Queen's Hospital

Romford, Essex, United Kingdom

Site Status

University College London Hospitals NHS Foundation Trust

London, Greater London, United Kingdom

Site Status

Royal Free London NHS Foundation Trust

London, Greater London, United Kingdom

Site Status

Guy's and Saint Thomas' NHS Foundation Trust

London, Greater London, United Kingdom

Site Status

The Christie NHS Foundation Trust

Manchester, Lancashire, United Kingdom

Site Status

Mount Vernon Cancer Centre - East and North Hertfordshire NHS Trust

Northwood, Middlesex, United Kingdom

Site Status

Velindre University NHS Trust

Cardiff, , United Kingdom

Site Status

NHS Greater Glasgow and Clyde

Glasgow, , United Kingdom

Site Status

Countries

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United States France Germany Italy Spain United Kingdom

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2022-001459-17

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

NuTide:323

Identifier Type: -

Identifier Source: org_study_id

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