Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol
Background: The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. For instance, in mRAS (mutated RAS) mCRC patients, anti-EGFR drugs (cetuximab an...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-03-01
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| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/1758835921989223 |
| _version_ | 1818576432869146624 |
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| author | Alessandro Ottaiano Stefania Scala Mariachiara Santorsola Anna Maria Trotta Crescenzo D’Alterio Luigi Portella Ottavia Clemente Anna Nappi Nicoletta Zanaletti Alfonso De Stefano Antonio Avallone Vincenza Granata Carmen Notariello Amalia Luce Angela Lombardi Carmine Picone Antonella Petrillo Francesco Perri Fabiana Tatangelo Annabella Di Mauro Vittorio Albino Francesco Izzo Daniela Rega Ugo Pace Massimiliano Di Marzo Paolo Chiodini Gianfranco De Feo Paola Del Prete Gerardo Botti Paolo Delrio Michele Caraglia Guglielmo Nasti |
| author_facet | Alessandro Ottaiano Stefania Scala Mariachiara Santorsola Anna Maria Trotta Crescenzo D’Alterio Luigi Portella Ottavia Clemente Anna Nappi Nicoletta Zanaletti Alfonso De Stefano Antonio Avallone Vincenza Granata Carmen Notariello Amalia Luce Angela Lombardi Carmine Picone Antonella Petrillo Francesco Perri Fabiana Tatangelo Annabella Di Mauro Vittorio Albino Francesco Izzo Daniela Rega Ugo Pace Massimiliano Di Marzo Paolo Chiodini Gianfranco De Feo Paola Del Prete Gerardo Botti Paolo Delrio Michele Caraglia Guglielmo Nasti |
| author_sort | Alessandro Ottaiano |
| collection | DOAJ |
| description | Background: The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. For instance, in mRAS (mutated RAS) mCRC patients, anti-EGFR drugs (cetuximab and panitumumab) are not recommended; in this group of patients, the use of anti-angiogenic drugs (bevacizumab and aflibercept) is predominant. However, at progression to standard bevacizumab-based first-line chemotherapy, still to date, there are no studies to guide oncologists in the choice of the best second-line anti-angiogenic drug (bevacizumab beyond progression versus aflibercept). Methods: ARBITRATION is a prospective, observational study assessing efficacy differences between second-line fluorouracil/irinotecan (FOLFIRI)/bevacizumab versus FOLFIRI/aflibercept at progression to fluoropyrimidines, oxaliplatin and bevacizumab in mRAS mCRC patients. A test power of 80%, a median survival of 9 months from second-line treatment start and a hazard ratio of 0.67 between the two schedules were the basis for statistical design. The final sample will be 220 patients (110 per treatment). The significance will be verified with a two-tailed log-rank test with an alpha value of the I-type error of 5%. Time-to-outcome will be described by Kaplan–Meier curves and prognostic factors studied through multivariable analyses based on the Cox model. Secondary objectives include safety, responses’ duration and progression-free survival. A translational research will be conducted to measure several angiogenic proteins in patients’ serum before starting the therapy in order to evidence any angiogenic factor patterns related to outcome. Discussion: We present a large, prospective, observational study aiming to answer two scientific questions: (1) outcome differences between second-line treatments with FOLFIRI/bevacizumab beyond progression versus FOLFIRI/aflibercept in mRAS mCRC patients, (2) angiogenic factors’ patterns that could associate with efficacy and help oncologists to apply best the therapeutic anti-angiogenic strategies. Trial registration: The ARBITRATION trial (version 0.0, 13 April 2020) has been registered into the clinicaltrials.gov registry on 20 May 2020 with identifier NCT04397601. |
| first_indexed | 2024-12-16T06:13:56Z |
| format | Article |
| id | doaj.art-b9abc8afe3f3424ea7cccc9a5c058f0d |
| institution | Directory Open Access Journal |
| issn | 1758-8359 |
| language | English |
| last_indexed | 2024-12-16T06:13:56Z |
| publishDate | 2021-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj.art-b9abc8afe3f3424ea7cccc9a5c058f0d2022-12-21T22:41:20ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592021-03-011310.1177/1758835921989223Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocolAlessandro OttaianoStefania ScalaMariachiara SantorsolaAnna Maria TrottaCrescenzo D’AlterioLuigi PortellaOttavia ClementeAnna NappiNicoletta ZanalettiAlfonso De StefanoAntonio AvalloneVincenza GranataCarmen NotarielloAmalia LuceAngela LombardiCarmine PiconeAntonella PetrilloFrancesco PerriFabiana TatangeloAnnabella Di MauroVittorio AlbinoFrancesco IzzoDaniela RegaUgo PaceMassimiliano Di MarzoPaolo ChiodiniGianfranco De FeoPaola Del PreteGerardo BottiPaolo DelrioMichele CaragliaGuglielmo NastiBackground: The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. For instance, in mRAS (mutated RAS) mCRC patients, anti-EGFR drugs (cetuximab and panitumumab) are not recommended; in this group of patients, the use of anti-angiogenic drugs (bevacizumab and aflibercept) is predominant. However, at progression to standard bevacizumab-based first-line chemotherapy, still to date, there are no studies to guide oncologists in the choice of the best second-line anti-angiogenic drug (bevacizumab beyond progression versus aflibercept). Methods: ARBITRATION is a prospective, observational study assessing efficacy differences between second-line fluorouracil/irinotecan (FOLFIRI)/bevacizumab versus FOLFIRI/aflibercept at progression to fluoropyrimidines, oxaliplatin and bevacizumab in mRAS mCRC patients. A test power of 80%, a median survival of 9 months from second-line treatment start and a hazard ratio of 0.67 between the two schedules were the basis for statistical design. The final sample will be 220 patients (110 per treatment). The significance will be verified with a two-tailed log-rank test with an alpha value of the I-type error of 5%. Time-to-outcome will be described by Kaplan–Meier curves and prognostic factors studied through multivariable analyses based on the Cox model. Secondary objectives include safety, responses’ duration and progression-free survival. A translational research will be conducted to measure several angiogenic proteins in patients’ serum before starting the therapy in order to evidence any angiogenic factor patterns related to outcome. Discussion: We present a large, prospective, observational study aiming to answer two scientific questions: (1) outcome differences between second-line treatments with FOLFIRI/bevacizumab beyond progression versus FOLFIRI/aflibercept in mRAS mCRC patients, (2) angiogenic factors’ patterns that could associate with efficacy and help oncologists to apply best the therapeutic anti-angiogenic strategies. Trial registration: The ARBITRATION trial (version 0.0, 13 April 2020) has been registered into the clinicaltrials.gov registry on 20 May 2020 with identifier NCT04397601.https://doi.org/10.1177/1758835921989223 |
| spellingShingle | Alessandro Ottaiano Stefania Scala Mariachiara Santorsola Anna Maria Trotta Crescenzo D’Alterio Luigi Portella Ottavia Clemente Anna Nappi Nicoletta Zanaletti Alfonso De Stefano Antonio Avallone Vincenza Granata Carmen Notariello Amalia Luce Angela Lombardi Carmine Picone Antonella Petrillo Francesco Perri Fabiana Tatangelo Annabella Di Mauro Vittorio Albino Francesco Izzo Daniela Rega Ugo Pace Massimiliano Di Marzo Paolo Chiodini Gianfranco De Feo Paola Del Prete Gerardo Botti Paolo Delrio Michele Caraglia Guglielmo Nasti Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol Therapeutic Advances in Medical Oncology |
| title | Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol |
| title_full | Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol |
| title_fullStr | Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol |
| title_full_unstemmed | Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol |
| title_short | Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol |
| title_sort | aflibercept or bevacizumab in combination with folfiri as second line treatment of mras metastatic colorectal cancer patients the arbitration study protocol |
| url | https://doi.org/10.1177/1758835921989223 |
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