Cetuximab And Bevacizumab With Or Without Gemcitabine To Treat Metastatic Pancreatic Cancer

Study Overview

Cetuximab and Bevacizumab With or Without Gemcitabine to Treat Metastatic Pancreatic Cancer

Eligible patients with metastatic pancreatic cancer will be treated with dual agent monoclonal antibody consisting of cetuximab and bevacizumab alone or in combination with gemcitabine

N/A

Metastatic Pancreatic Cancer

BIOLOGICAL: cetuximab
BIOLOGICAL: bevacizumab
DRUG: gemcitabine
BIOLOGICAL: cetuximab

CP02-0555

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates	Results Reporting Dates	Study Record Updates
First Submitted 2006-05-15	Results First Submitted 2009-11-03	Last Update Submitted that met QC Criteria 2011-05-19
First Submitted that Met QC Criteria 2006-05-15	Results First Submitted that Met QC Criteria 2009-11-03	Last Update Posted (ESTIMATED) 2011-05-25
First Posted (ESTIMATED) 2006-05-17	Results First Posted 2009-12-04	Last Verified 2011-05

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

Design Details

Primary Purpose:
Treatment

Allocation:
Randomized

Interventional Model:
Parallel

Masking:
None

Arms and Interventions

Participant Group/Arm	Intervention/Treatment
EXPERIMENTAL: cetuximab + bevacizumab + gemcitabine Cetuximab 400 mg/m2 weekly (over 120 minutes) on day 1 of cycle 1 with subsequent weekly infusions of 250 mg/m2 (over 60 minutes), followed by bevacizumab 10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks, and gemcitabine 1000 mg/m2/minute ov	BIOLOGICAL: cetuximab I.V. infusion of 400 mg/m2 (over 120 minutes) on day 1 of cycle 1 BIOLOGICAL: bevacizumab 10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks. DRUG: gemcitabine 1000 mg/m2 administered intravenously at 10 mg/m2/minute over 100 minutes weekly x 3 of 4 weeks. BIOLOGICAL: cetuximab I.V.infusions of 250 mg/m2 (over 60 minutes) weekly
ACTIVE_COMPARATOR: cetuximab + bevacizumab Cetuximab 400 mg/m2 weekly (over 120 minutes) on day 1 of cycle 1 with subsequent weekly infusions of 250 mg/m2 (over 60 minutes), followed by bevacizumab 10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks. Both medications will be administere	BIOLOGICAL: cetuximab I.V. infusion of 400 mg/m2 (over 120 minutes) on day 1 of cycle 1 BIOLOGICAL: bevacizumab 10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks. DRUG: gemcitabine 1000 mg/m2 administered intravenously at 10 mg/m2/minute over 100 minutes weekly x 3 of 4 weeks. BIOLOGICAL: cetuximab I.V.infusions of 250 mg/m2 (over 60 minutes) weekly

Participant Group/Arm

Intervention/Treatment

EXPERIMENTAL: cetuximab + bevacizumab + gemcitabine

Cetuximab 400 mg/m2 weekly (over 120 minutes) on day 1 of cycle 1 with subsequent weekly infusions of 250 mg/m2 (over 60 minutes), followed by bevacizumab 10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks, and gemcitabine 1000 mg/m2/minute ov

BIOLOGICAL: cetuximab

I.V. infusion of 400 mg/m2 (over 120 minutes) on day 1 of cycle 1

BIOLOGICAL: bevacizumab

10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks.

DRUG: gemcitabine

1000 mg/m2 administered intravenously at 10 mg/m2/minute over 100 minutes weekly x 3 of 4 weeks.

BIOLOGICAL: cetuximab

I.V.infusions of 250 mg/m2 (over 60 minutes) weekly

ACTIVE_COMPARATOR: cetuximab + bevacizumab

BIOLOGICAL: cetuximab

I.V. infusion of 400 mg/m2 (over 120 minutes) on day 1 of cycle 1

BIOLOGICAL: bevacizumab

10 mg/kg (over 60 minutes) on day 1 and repeated every 2 weeks.

DRUG: gemcitabine

1000 mg/m2 administered intravenously at 10 mg/m2/minute over 100 minutes weekly x 3 of 4 weeks.

BIOLOGICAL: cetuximab

I.V.infusions of 250 mg/m2 (over 60 minutes) weekly

Primary Outcome Measures	Measure Description	Time Frame
Progression-free Survival (PFS)	Progression-free survival is the time from randomization until the date of progressive disease (PD) or death from any cause whichever is first reported. Patients who die without a reported prior progression were considered to have progresssed on the day of their death. Patients who did not progress were censored at the day of their last tumor assessment.	Time from randomization to disease progression or death from any cause (Range: 0 -10 months)

Secondary Outcome Measures	Measure Description	Time Frame
Overall Survival (OS)	This measure is defined as the time from randomization to the date of death due to any cause. Survival of living patients or those who lost to follow-up were censored on the last date the patients were known to be alive.	Survival information was collected continuously every 3 months after completion of therapy and/or follow-up (range: 1-19 months).
The Number of Patients With a Best Overall Response of Either a Complete Response (CR) or Partial Response (PR)	The best overall response is the number of patients with a best overall response of CR or PR, as classifed by the investigator according to the RECIST guidelines. A CR is the disappearance of all target lesions and a PR is at least a 30% decrease in the sum of the longest diameters of target lesions, taking as reference the baseline sum longest diameter.	Tumor evaluations were performed every 8 weeks while on cetuximab therapy until PD or recurrence. Patients with a PR or CR had a confirmatory tumor assessment no less than 4 weeks after the initial evaluation.
Percentage of Patients With Carbohydrate Antigen 19-9 (CA19-9) Response at End of Cycle 2 in Patients With Elevated Baseline Values (Equal or Greater Than 2 x Upper Limit of Normal).	CA19-9 is a tumor marker for pancreatic cancer and the level usually increases as the disease is progressing. The CA19-9 response was the percentage of patients whose CA19-9 level was declining, stable or increasing < 10% compared with baseline, divided by the total patients with elevated baseline CA19-9 in that arm.	First day of treatment to the end of Cycle 2, Week 1
Time to Progression (TTP)	Time to progression was defined as the time from randomization until the date of objectively confirmed tumor progression was first reported. The censoring rule was consistent with PFS except death. Patients who died from any cause were censored at the time of death or at last tumor assessment date if the death date was missing. For patients lost to follow-up, they were censored at the last tumor assessment date.	Time from randomization until the date of objective tumor progression was first reported (range: 11 -38 months)
Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)	Reported AEs per patient were coded according to the corresponding preferred term and system organ class in the Medical Dictionary for regulatory Activities dictionary. The National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 3.0 was used to grade all AEs. The collection of AEs began at the time the patient received the first cetuximab dose and continued during the study until 30 days after the last dose of cetuximab. All patients who were enrolled and treated with cetuximab were assessed for safety (mITT population, as treated).	An AE was included in the safety analysis if its onset date occurred anytime during cetuximab treatment or up to 30 days after the last dose of cetuximab.
Change From Baseline in Quality of Life (QoL) Assessment Using the Linear Analog Scale Assessment (LASA), Overall QoL at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Overall QoL question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Overall Mental Well Being, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Overall Mental Well Being question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Overall Physical Well Being, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Overall Physical Well Being question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Overall Emotional Well Being, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Overall Emotional Well Being question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Level of Social Activity, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Level of Social Activity question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Overall Spiritual Well Being, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Overall Spiritual Well Being question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up while receiving study drug
Change From Baseline in QoL Assessment Using LASA, Frequency of Pain, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Frequency of Pain question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Severity of Pain, Average, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Severity of Pain question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A positive score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up while receiving study drug
Change From Baseline in QoL Assessment Using LASA, Level of Fatigue, Average, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Level of Fatigue question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A positive score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Level of Support, Friends and Family, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Level of Support, Friends and Family question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Financial Concerns, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Financial Concerns Question question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in QoL Assessment Using LASA, Legal Concerns, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. The primary analysis of pancreatic cancer symptoms was conducted using the LASA QoL questionnaire and was considered exploratory. The Legal Concerns question change from baseline to Cycle 2 Week 4 is reported. The best overall score is 10 and the worst is 0. A negative score indicates worsening from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in Assessment of Pain Using the Brief Pain Inventory (BPI) Short Form, Worst Pain, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. Analysis of pain using the BPI was considered exploratory. The Worst Pain (change from baseline) to Cycle 2 Week 4 is reported. The worst pain is 10 and no pain is 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in Assessment of Pain Using BPI Short Form, Least Pain, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. Analysis of pain using the BPI was considered exploratory. The Least Pain (change from baseline) to Cycle 2 Week 4 is reported. The worst pain is 10 and no pain is 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in Assessment of Pain Using BPI Short Form, Average Pain, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. Analysis of pain using the BPI was considered exploratory. The Average Pain (change from baseline) to Cycle 2 Week 4 is reported. The worst pain was 10 and no pain is 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in Assessment of Pain Using BPI Short Form, Pain Right Now, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. Analysis of pain using the BPI was considered exploratory. The Pain Right Now question (change from baseline) to Cycle 2 Week 4 is reported. The worst pain is 10 and no pain is 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up
Change From Baseline in Assessment of Pain Using BPI Short Form, Interference, at Cycle 2 Week 4	Accrual on the trial was stopped earlier than planned due to insufficient efficacy on both arms. Analysis of pain using the BPI was considered exploratory. The Interference question (change from baseline) to Cycle 2 Week 4 is reported. Complete interference is scored as 10 and no interference is scored as 0. A negative score indicates improvement from baseline.	Screening, and then every 8 weeks while receiving study drug to 30-day follow-up

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person’s general health condition or prior treatments.

Ages Eligible for Study:
ALL

Sexes Eligible for Study:
18 Years

Accepts Healthy Volunteers:

The patient has provided signed written informed consent.
The patient is ≥18 years of age.
The patient has histologically or cytologically-confirmed pancreatic adenocarcinoma not amenable to curative treatment with surgery or has documented or suspected extrapancreatic metastases.
The patient has either (a) measurable disease as defined by Response Evaluation Criteria in Solid Tumors Version 1.0 (RECIST) or (b) non-measurable disease with an elevated baseline CA19-9 level (≥2 x the upper limit of normal [ULN]).
The patient's Eastern Cooperative Oncology Group (ECOG) performance status is ≤2.
The patient has adequate hematologic function as defined by an absolute neutrophil count (ANC) ≥1500/mm3 and a platelet count ≥100,000/mm3 obtained within 2 weeks prior to the first dose of study medication.
The patient has adequate hepatic function as defined by a total bilirubin ≤2.0 mg/dL and transaminases ≤5.0 x ULN obtained within 2 weeks prior to the first dose of study medication.
The patient has adequate renal function as defined by serum creatinine ≤2.0 x ULN and urine dipstick for proteinuria ≤1+ obtained within 2 weeks prior to the first dose of study medication. If urine dipstick is ≥2+, then a 24-hour urine for protein must demonstrate < 1000 mg of protein in 24 hours to allow participation in the study. Urinalysis is also acceptable.
If the patient is on full-dose anticoagulation therapy (eg, warfarin or low molecular weight [LMW] heparin), the following criteria must be met:

The patient has an in-range International Normalized Ratio ([INR]usually between 2 and 3) on a stable dose of oral anticoagulant or be on a stable dose of LMW heparin
The patient has no active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)
If the patient is not on full-dose anticoagulation therapy, the following criteria must be met:

The patient has adequate coagulation function as defined by INR ≤1.5
The patient has a partial thromboplastin (PTT) ≤ULN obtained within 2 weeks prior to the first dose of study medication
If a woman, the patient agrees to use an accepted and effective method of contraception (hormonal or barrier methods, abstinence) prior to study entry and for the duration of the study. If a male and sexually active, the patient agrees to use effective contraception.
The patient is accessible for treatment and follow-up. Patients enrolled in this trial must be treated at the participating center.

Endocrine tumors or lymphoma of the pancreas
Known brain metastases
Prior therapy with an epidermal growth factor receptor (EGFR) inhibitor or vascular endothelial growth factor (VEGF) inhibitor
Prior chemotherapy, hormonal therapy, or radiation therapy for advanced pancreatic cancer, patients who received chemotherapy and/or radiation therapy in the adjuvant setting will be eligible as long as the adjuvant therapy was completed >6 months prior
Concurrent malignancy other than non-melanomatous skin cancer or carcinoma in situ of the cervix
Concurrent treatment with other anti-cancer therapy, including other chemotherapy, immunotherapy, hormonal therapy, radiotherapy, chemoembolization, or targeted therapy
Ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations
History of arterial thrombotic events within 9 months
History of uncontrolled hypertension (>150/100 mmHg) not on a stable regimen of anti-hypertensive therapy
History of significant bleeding events or upper or lower gastrointestinal bleeding within 9 months
History of gastrointestinal perforation within 12 months
Serious non-healing wound ulcer, bone fracture, or major surgical procedure with 28 days
If a woman, is pregnant or lactating
An employee of the investigator or study center as well as family members of the employees

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

STUDY_CHAIR: E-mail: ClinicalTrials@ ImClone.com, Eli Lilly and Company

Publications

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Ko AH, Youssoufian H, Gurtler J, Dicke K, Kayaleh O, Lenz HJ, Keaton M, Katz T, Ballal S, Rowinsky EK. A phase II randomized study of cetuximab and bevacizumab alone or in combination with gemcitabine as first-line therapy for metastatic pancreatic adenocarcinoma. Invest New Drugs. 2012 Aug;30(4):1597-606. doi: 10.1007/s10637-011-9691-8. Epub 2011 Jun 1.

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