Anti-EGFR Agents in Patients With Right-sided Advanced Colorectal Cancer With Wild-type RAS and AREG/EREG High Status

NCT ID: NCT07094893

Last Updated: 2026-01-14

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: PHASE4
• Total Enrollment: 280 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2026-04-15
• Study Completion Date: 2030-03-31

Brief Summary

The aim of this trial is to assess the feasibility of EREG/AREG assessment as a clinical diagnostic standard, used to guide clinical decision making in right-PTL, RAS-wt aCRC. Further to this, the aim is to determine whether EREG/AREG status identifies right-PTL participants who will benefit from the addition of anti-EGFR therapy to first-line chemotherapy.

Detailed Description

ARIEL-ENGIC is a multi-centre, phase IV, open label, randomised controlled biomarker enrichment trial with an internal pilot phase in which participants with wild-type RAS, right-PTL and EREG/AREG high aCRC will be randomized in a 1:1 ratio to receive chemotherapy (doublet) plus cetuximab versus chemotherapy (doublet or triplet) alone or with bevacizumab.

ARIEL-ENGIC is an international trial in which the UK (recruitment ongoing) and EU (Italy, Germany and Spain) are participating. ARIEL-ENGIC aims to randomize 280 participants at a global level. In Europe 60 centers will be involved and 120 participants (40 pts per Member State involved) will be randomized.

Given the biomarker prevalence, 660 participants will be registered to identify sufficient RAS-wt participants with high tumour EREG/AREG expression.

The ARIEL-ENGIC study has 2 phases, registration and randomization (the main trial). Participants meeting all of the inclusion criteria and none of the exclusion criteria for registration will be considered for trial eligibility and biomarker analysis. Tumour samples will be sent for centralized biomarker (EREG/AREG) assessment. Participants with high tumour EREG/AREG will be eligible for randomisation. Participants eligible for the randomisation phase will be allocated 1:1 to chemotherapy alone or with bevacizumab or chemotherapy plus anti-EGFR agent.

Stratification factors will be:

• Choice of first-line chemotherapy (irinotecan-based doublet; oxaliplatin-based doublet; FOLFOXIRI)
• Tumour location (transverse vs caecum vs ascending)
• Prior adjuvant or neoadjuvant chemotherapy (yes vs no)
• Primary tumour resected
• Country of registration

Conditions

Colorectal Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Doublet or Triplet +/- Bevacizumab

FOLFOX or CAPOX or FOLFIRI or FOLFOXIRI +/- bevacizumab.

Treatment regimen and the dosage of each product in both arms will be at Investigators' discretion and in accordance with European guidelines (ESMO).

Chemotherapy backbone is at investigators' choice as per clinical practice and guidelines according to the labels of each IMP. Choice of regimen will depend upon individual patient characteristics and choices, as judged by their oncologist. The choice of adding or not bevacizumab will be at investigators' evaluation according to its label and after evaluating any contraindication to its administration. The study treatment consists of the first 16 weeks of 1st line induction chemotherapy, followed by continuation of chemotherapy +/- bevacizumab, maintenance treatment or treatment break as per investigator and patient preference.

Group Type: ACTIVE_COMPARATOR

Bevacizumab

Intervention Type: DRUG

Administration according to the labels of each IMP.

Irinotecan (CPT-11)

Intervention Type: DRUG

Administration according to the labels of each IMP.

Oxaliplatin

Intervention Type: DRUG

Administration according to the labels of each IMP.

Leucovorin and 5-FU

Intervention Type: DRUG

Administration according to the labels of each IMP.

Capecitabine

Intervention Type: DRUG

Administration according to the labels of each IMP.

Doublet + Cetuximab

FOLFOX or FOLFIRI + Cetuximab.

Treatment regimen and the dosage of each product in both arms will be at Investigators' discretion and in accordance with European guidelines (ESMO).

Chemotherapy backbone is at investigators' choice as per clinical practice and guidelines according to the labels of each IMP. The study treatment consists of the first 16 weeks of 1st line induction chemotherapy, followed by continuation of chemotherapy + cetuximab, maintenance treatment or treatment break as per investigator and patient preference.

Group Type: EXPERIMENTAL

Cetuximab (EGFR inhibitor)

Intervention Type: DRUG

Administration according to the labels of each IMP.

Irinotecan (CPT-11)

Intervention Type: DRUG

Administration according to the labels of each IMP.

Oxaliplatin

Intervention Type: DRUG

Administration according to the labels of each IMP.

Leucovorin and 5-FU

Intervention Type: DRUG

Administration according to the labels of each IMP.

Interventions

Cetuximab (EGFR inhibitor)

Administration according to the labels of each IMP.

Intervention Type: DRUG

Bevacizumab

Administration according to the labels of each IMP.

Intervention Type: DRUG

Irinotecan (CPT-11)

Administration according to the labels of each IMP.

Intervention Type: DRUG

Oxaliplatin

Administration according to the labels of each IMP.

Intervention Type: DRUG

Leucovorin and 5-FU

Administration according to the labels of each IMP.

Intervention Type: DRUG

Capecitabine

Administration according to the labels of each IMP.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Age ≥18 years
• Biopsy-confirmed adenocarcinoma of the colon with a right primary tumour location
• aCRC defined as either M1 or locally inoperable disease
• Tumour RAS status either wild-type (by local testing) or unknown
• Fit for combination chemotherapy plus anti-EGFR agent
• Sufficient tumour material for EREG/AREG analysis
• Written informed consent for registration

• Registered in ARIEL-ENGIC
• Local testing confirms tumour RAS-wt status
• ARIEL-ENGIC central testing confirms tumour EREG/AREG high
• Tumour measurable by RECIST v1.1 criteria on CT scan
• Participants have had CT scan within the timeframes stipulated (If there is a contrast reaction, then non-contrast CT with MRI is acceptable, assuming at least one of these modalities shows measurable disease at baseline for ETS evaluation and both modalities are repeated at the trial timepoints at week 8 and 16 and every 8 weeks until disease progression.)
• Pre-randomisation laboratory tests :
• Neutrophils ≥1.5 x109/l and platelet count ≥100 x109/l
• Serum bilirubin ≤ 1.25 x upper limit of normal (ULN), alkaline phosphatase

• 5x ULN, and serum transaminase (either AST or ALT) ≤ 2.5 x ULN
• Estimated creatinine clearance ≥50ml/min (creatinine clearance estimated as per local practice)
• WHO performance status (PS) 0, 1 or 2
• Fit for combination chemotherapy plus anti-EGFR agent
• Life expectancy of at least 12 weeks
• Women of childbearing potential must have a negative blood pregnancy test at the baseline visit.
• Male subjects with female partners of childbearing potential and female subjects of childbearing potential must, therefore, be willing to use adequate contraception
• Written informed consent for randomization.

Exclusion Criteria

• Tumour RAS-mutation present
• Prior chemotherapy for aCRC
• Prior anti-EGFR agent therapy

• Participant has received more than one cycle of chemotherapy since registration
• Participants with history of hypersensitivity to any component of their proposed trial treatment regimen or any of their excipients
• Participants in receipt of live vaccine within four weeks prior to randomisation
• Participants with a history interstitial pneumonitis/idiopathic lung disease (ILD) or pulmonary fibrosis
• Participants with a history of keratitis, ulcerative keratitis or severe dry eye
• Participants with a history of severe skin reaction which in the clinicians' opinion could be exacerbated by EGFR Mab (cf Steven's Johnson Syndrome)
• Complete dihydropyrimidine dehydrogenase (DPYD) deficiency
• Untreated brain metastases or spinal cord compression or primary brain tumours
• History or evidence upon physical examination of CNS disease unless adequately treated
• Active uncontrolled infections or other clinically relevant concomitant illness contraindicating chemotherapy administration
• Clinically significant (e.g. active) cardiovascular disease for example cerebrovascular accidents, myocardial infarction, unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure (CHF), serious cardiac arrhythmia requiring medication
• Treatment with any investigational drug within 30 days prior to enrolment or 2 investigational agent half-lives (whichever is longer)
• Other co-existing malignancies or malignancies diagnosed within the last 5 years that are likely to have an impact upon survival or treatment delivery
• Known human immunodeficiency virus (HIV)
• Has documented presence of hepatitis B surface antigen (HBsAg) at screening or within 3 months prior to enrolment
• Has a positive hepatitis C virus (HCV) antibody test result at screening or within 3 months prior to enrolment. Note: Participants with a positive HCV antibody test result due to prior resolved disease can be randomised, only if a confirmatory HCV RNA test is obtained - Definite contraindications for the use of corticosteroids and antihistamines as premedication.
• Any concomitant drugs contraindicated for use with the trial drugs according to the product information of the pharmaceutical companies.
• Woman pregnant or lactating or expecting to conceive children within the projected duration of the study through 6 months after the last dose of bevacizumab and/or fluorouracil.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Merck Serono International SA

INDUSTRY

Sponsor Role: collaborator

Gruppo Oncologico del Nord-Ovest

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Chiara Cremolini, MD, PhD

Role: STUDY_CHAIR

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa

Central Contacts

Laura Delliponti

Role: CONTACT

laura.delliponti@gmail.com

+39050992192

Ariel Engic

Role: CONTACT

ariel.engic.eu@gmail.com

+39050992192

Other Identifiers

ARIEL-ENGIC

Identifier Type: -

Identifier Source: org_study_id