A Phase 1b/2 Study of Arfolitixorin Combined With 5-fluorouracil, Oxaliplatin, and Bevacizumab in First-line Treatment of Metastatic Colorectal Cancer

Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1/Phase 2
SUMMARY

This is a clinical research study taking place in Germany. Patients with colorectal cancer at a stage of the disease where metastases occur may take part in the study. A maximum of 60 people will participate in the study. There is already a standard therapy for treatment of colorectal cancer. This therapy contains a combination of the medicines leucovorin, fluorouracil, oxaliplatin and bevacizumab. The sponsoring company is developing the new therapy called arfolitixorin. In this study, patients with colorectal cancer will be given arfolitixorin instead of the standard treatment leucovorin. Different patients will receive treatment with different strengths (doses) of arfolitixorin. Treatment with fluorouracil, oxaliplatin and bevacizumab will also be administrated. The researchers want to find out if arfolitixorin could have an advantage over the standard therapy with leucovorin. They also want to investigate which dose of arfolitixorin is the most optimal dose to give to other patients and also to study if arfolitixorin is safe to use. The product being tested, arfolitixorin, like leucovorin, belongs to a group of substances called folates which are naturally occurring forms of a type of B vitamin. Folates are administered in combination with one or more chemotherapeutic agents to enhance their effect on cancer cells. The main mechanism of action of arfolitixorin is the same as that of leucovorin when used together with fluorouracil. However, leucovorin must first be converted into the active form in the body, whereas arfolitixorin already is in the active form. Leucovorin does not work equally well in all patients. By bypassing the metabolic activation of arfolitixorin, it is assumed that arfolitixorin works in a larger number of patients and has a stronger and longer efficacy in cancer treatment together with fluorouracil. However, the efficacy of arfolitixorin has not yet been proven, and the substance has not been approved for the treatment of colorectal cancer. To date, arfolitixorin has been tested by around 420 volunteers and patients with colorectal cancer in different clinical studies. These studies have shown that arfolitixorin is safe and potentially can be of clinical benefit in patients with colorectal cancer when used in combination with fluorouracil, oxaliplatin and bevacizumab. In the largest clinical study completed so far, arfolitixorin was shown to be equally effective compared to standard therapy with leucovorin, but not more effective. Additional results from this study suggested that the dose of arfolitixorin given did not deliver a sufficiently high amount of active substance into the tumor. Therefore, higher doses of arfolitixorin will be tested in this study to possibly achieve a better clinical effect. Further analyses also indicated that high accuracy regarding the timing and duration of the administration of the different treatments is important to achieve better efficacy of arfolitixorin. Based on the available data, and the risk and benefit assessments performed, the Sponsor deems that it is relevant to further investigate the safety and tolerability, as well as the efficacy of arfolitixorin when given in combination with fluorouracil, oxaliplatin and bevacizumab. The proposed study design is believed to address all the main previous findings with the purpose to increase the efficacy with a remaining safety profile. The study is divided into two parts. In the first part, up to five different doses of arfolitixorin will be investigated to find the optimal dose (i.e. the highest and well tolerated) of arfolitixorin as well as the optimal duration time of administration. The second part of the study will be based on the results from the first part. Two doses of arfolitixorin will be tested for safety, tolerability and anti-tumor effect. In the second part, participants will be randomly assigned to one of two dose groups using a computer program. This so-called randomization procedure is comparable to tossing a coin. All patients that participate in the study will receive treatment with arfolitixorin (+ fluorouracil, oxaliplatin and bevacizumab) every 2 weeks. The treatment will be given as an infusion into a vein. The number of treatment administrations that will be given is not predetermined but depends on the progression of the patient's disease.The treatment will continue every 2 weeks as long as the patient benefits from the treatment. During the study period, the patient's disease and potential response to treatment, including shrinkage of the tumor and/or improvement of symptoms, will be monitored by imaging examinations, using so-called computer tomography (CT) or magnetic resonance imaging (MRI). The patient's state of health will also be monitored by physical examinations, and laboratory tests of urine and blood, as well as assessment of any side effects.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Signed ICF and ability to comply with protocol requirements.

• Histologically confirmed RAS mutant, MSS/pMMR, colorectal adenocarcinoma with metastatic disease, eligible for first-line therapy with 5-FU, oxaliplatin, and bevacizumab regimen.

• Tumor specimen (formalin-fixed, paraffin-embedded \[FFPE\]) available.

• Adequate heart function as defined as:

‣ Heart rate ≤100 bpm.

⁃ Blood pressure ≤140/90.

⁃ QTc ≤430 ms (males) or ≤450 ms (females).

⁃ Ejection fraction (EF) \>50%.

• Acceptable hematologic laboratory values defined as:

‣ Hemoglobin ≥90 g/L.

⁃ Absolute neutrophil count ≥1.5 × 109/L.

⁃ Platelets ≥100 × 109/L.

• Adequate organ function as defined by the following laboratory values:

‣ Total serum bilirubin ≤1.5 × upper limit of normal (ULN).

⁃ ALT and AST ≤3 × ULN (≤5 × ULN in case of hepatic metastases).

⁃ Creatinine ≤1.5 × ULN, or creatinine clearance ≥50 mL/min (as measured according to Cockcroft-Gault equation).

• Age ≥18 years at the time of signing the ICF.

• Radiographically measurable disease per RECIST (version 1.1) within 28 days of treatment allocation.

• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

• Life expectancy of \>12 weeks.

• Female patients must be surgically sterile, postmenopausal, or have negative results for a pregnancy test at screening, on a serum or urine sample obtained within 72 hours prior to initiation of study treatment.

• Female patients of childbearing potential must agree to use highly effective contraceptive measures while on study treatment (ARFOX + bevacizumab) and for at least 15 months (or longer if according to local labels) after study treatment discontinuation. Highly effective methods are those that achieve a failure rate of less than 1% per year when used consistently and correctly (as per the Clinical Trial Coordination Group \[CTCG\] Recommendations related to contraception and pregnancy testing in clinical trials, Version 1.2, 07 Mar 2024).

• Female patients should agree to refrain from egg cell donation while on study treatment (ARFOX + bevacizumab) and for at least 15 months after the last dose of study treatment.

• Male patients with female partners of childbearing potential must agree to use adequate contraceptive measures while on study treatment (ARFOX + bevacizumab) and for at least 12 months (or longer if according to local labels) after study treatment discontinuation.

• Male patients should agree to refrain from sperm donation while on study treatment (ARFOX + bevacizumab) and for at least 12 months after the last dose of study treatment.

Locations
Other Locations
Germany
Charité - Universitaetsmedizin Berlin
RECRUITING
Berlin
Contact Information
Primary
Roger Tell, MD, PhD
roger.tell@isofolmedical.com
+46760293911
Time Frame
Start Date: 2025-04-10
Estimated Completion Date: 2029-03-31
Participants
Target number of participants: 60
Treatments
Experimental: High dose level
The higher dose level of arfolitixorin in Phase 2 will be the maximum tolerated dose as determined in Phase 1b. The arfolitixorin will be given as i.v. infusion. Patients in this study will receive the IMP arfolitixorin combined with 5-FU, oxaliplatin, and bevacizumab (ARFOX + bevacizumab). The duration of the infusion will be determined in Phase 1b.
Experimental: Low dose level
The lower dose level of arfolitixorin in Phase 2 will be a dose level below the maximum tolerated dose as determined in Phase 1b. The arfolitixorin will be given as i.v. infusion. Patients in this study will receive the IMP arfolitixorin combined with 5-FU, oxaliplatin, and bevacizumab (ARFOX + bevacizumab). The duration of the infusion will be determined in Phase 1b.
Related Therapeutic Areas
Sponsors
Collaborators: Charite University, Berlin, Germany
Leads: Isofol Medical AB

This content was sourced from clinicaltrials.gov

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