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RecruitingNCT05863195

Testing Pump Chemotherapy in Addition to Standard of Care Chemotherapy Versus Standard of Care Chemotherapy Alone for Patients With Unresectable Colorectal Liver Metastases: The PUMP Trial

A Randomized Phase III Study of Systemic Therapy With or Without Hepatic Arterial Infusion for Unresectable Colorectal Liver Metastases: The PUMP Trial

Status
Recruiting
Phase
Phase 3
Study type
Interventional
Enrollment
408 (estimated)
Sponsor
ECOG-ACRIN Cancer Research Group · Network
Sex
All
Age
18 Years
Healthy volunteers
Not accepted

Summary

This phase III trial compares hepatic arterial infusion (HAI) (pump chemotherapy) in addition to standard of care chemotherapy versus standard of care chemotherapy alone in treating patients with colorectal cancer that has spread to the liver (liver metastases) and cannot be removed by surgery (unresectable). HAI uses a catheter to carry a tumor-killing chemotherapy drug called floxuridine directly into the liver. HAI is already approved by the Food and Drug Administration (FDA) for use in metastatic colorectal cancer to the liver, but it is only available at a small number of hospitals, and most of the time it is not used until standard chemotherapy stops working. Standard chemotherapy drugs work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding HAI to standard chemotherapy may be effective in shrinking or stabilizing unresectable colorectal liver metastases.

Detailed description

PRIMARY OBJECTIVE: I. To determine if patients with persistently unresectable colorectal liver metastases (CRLM) after treatment with first-line chemotherapy have improved overall survival (OS) with hepatic arterial infusion (HAI) and systemic chemotherapy versus systemic chemotherapy alone. SECONDARY OBJECTIVES: I. To determine whether there is a direct association between hepatic progression free survival (hPFS) and overall survival (OS) when patients are treated with HAI combined with systemic chemotherapy for unresectable CRLM. II To determine the impact on progression free survival (overall, hepatic and extrahepatic) for patients with unresectable CRLM treated with HAI in combination with systemic chemotherapy. III. To determine objective response rate (ORR) in the liver, defined as the proportion of patients achieving complete or partial response by Response Evaluation Criteria is Solid Tumors (RECIST) 1.1. IV. To determine the rate of conversion to resectable disease, defined as the proportion of patients who successfully convert from unresectable to resectable status and undergo R0/R1 resection/ablation. V. To determine the rate in which patients are intended to be treated with HAI but are deemed ineligible at the time of planned pump insertion due to detection of occult extrahepatic disease or unsuitable arterial anatomy (Intra-Operative Ineligibility, IOI). VI. To determine the extent to which patient and disease-specific factors correlate with short- and long-term risk of HAI-specific complications. OUTLINE: Patients are randomized to 1 of 2 arms. ARM A: Patients undergo surgery to place the HAI pump, followed by single photon emission computed tomography/computed tomography (SPECT/CT) on study. Patients then receive floxuridine via the HAI pump on study. Patients also receive one of the following standard chemotherapy regimens per the treating physician: FOLFOX (fluorouracil intravenously \[IV\], oxaliplatin IV, and leucovorin IV), FOLFIRI (fluorouracil IV, irinotecan IV, and leucovorin IV), or OX/IRI (oxaliplatin IV and irinotecan IV) with or without cetuximab IV and/or panitumumab IV on study. Patients also undergo CT scans throughout the trial. ARM B: Patients receive one of the following standard chemotherapy regimens per the treating physician: FOLFOXIRI (fluorouracil IV, oxaliplatin IV, irinotecan IV, and leucovorin IV), FOLFOX, FOLFIRI, or OX/IRI with or without cetuximab IV, panitumumab IV, and/or bevacizumab IV on study. Patients also undergo CT scans throughout the trial.

Conditions

Interventions

TypeNameDescription
BIOLOGICALBevacizumabGiven IV
BIOLOGICALCetuximabGiven IV
PROCEDUREComputed TomographyUndergo SPECT/CT and/or CT
DRUGFloxuridineGiven via HAI pump
DRUGFluorouracilGiven IV
PROCEDUREImplantationUndergo surgery to place the HAI pump
PROCEDUREIntrahepatic Infusion ProcedureUndergo HAI
DRUGIrinotecanGiven IV
DRUGLeucovorinGiven IV
DRUGOxaliplatinGiven IV
BIOLOGICALPanitumumabGiven IV
PROCEDURESingle Photon Emission Computed TomographyUndergo SPECT/CT

Timeline

Start date
2023-10-19
Primary completion
2029-06-30
Completion
2034-06-30
First posted
2023-05-17
Last updated
2026-03-23

Locations

39 sites across 1 country: United States

Regulatory

Source: ClinicalTrials.gov record NCT05863195. Inclusion in this directory is not an endorsement.