ctDNA-guided choice of cetuximab versus bevacizumab with trifluridine/tipiracil for RAS/BRAF wild-type metastatic colorectal cancer
ctDNA-Guided Rechallenge With Cetuximab Plus Trifluridine/Tipiracil Versus Bevacizumab Plus Trifluridine/Tipiracil for RAS/BRAF Wild-Type Refractory Metastatic Colorectal Cancer: A Randomized Clinical Trial
This trial tests whether a ctDNA blood test can help choose cetuximab plus trifluridine/tipiracil versus bevacizumab plus trifluridine/tipiracil for people with RAS/BRAF wild-type metastatic colorectal cancer who have progressed after prior treatments.
Quick facts
| Phase | Phase1; Phase2 |
|---|---|
| Study type | Interventional |
| Enrollment | 64 (estimated) |
| Ages | 18 Years to 75 Years |
| Sex | All |
| Sponsor | Sun Yat-sen University Academic / other |
| Drugs / interventions | cetuximab, bevacizumab, panitumumab |
| Locations | 1 site (Guangzhou, Guangdong) |
| Trial ID | NCT07012954 on ClinicalTrials.gov |
What this trial studies
This randomized phase 1/2 trial uses circulating tumor DNA (ctDNA) to confirm current RAS/BRAF wild-type status and guide a rechallenge strategy in patients with metastatic colorectal cancer who previously benefited from anti-EGFR therapy. Eligible patients are randomized to receive either cetuximab plus trifluridine/tipiracil or bevacizumab plus trifluridine/tipiracil, with routine ctDNA and radiographic monitoring. The design builds on prior phase II work suggesting EGFR rechallenge can work in molecularly selected patients and aims to compare efficacy and safety between the two combination regimens. Key outcomes include progression-free survival and response rates in ctDNA-confirmed RAS/BRAF wild-type patients.
Who should consider this trial
Good fit: Adults with histologically confirmed metastatic colorectal adenocarcinoma who were initially RAS/BRAF wild-type, previously derived clinical benefit from cetuximab-based first-line therapy with PFS ≥ 6 months, have progressed after later lines, are ≥4 months from last cetuximab, have measurable disease, and show RAS/BRAF wild-type status by blood ctDNA and adequate organ function are ideal candidates.
Not a fit: Patients whose ctDNA shows RAS, BRAF, or EGFR extracellular domain resistance mutations, who have poor organ function, uncontrolled ascites/coagulopathy, or who cannot wait ≥4 months since prior cetuximab are unlikely to benefit from the rechallenge approach.
Why it matters
Potential benefit: If successful, this approach could offer a personalized option to extend disease control by reintroducing anti-EGFR therapy in patients whose ctDNA shows no resistance mutations.
How similar studies have performed: Earlier phase II and retrospective analyses such as CRICKET, CHRONOS, and VELO have shown promising signals that ctDNA-guided anti-EGFR rechallenge can produce responses, but the approach still requires larger randomized confirmation.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Histologically confirmed colorectal adenocarcinoma * Initial RAS/BRAF wild-type status * Received first-line treatment with FOLFOX, FOLFIRI, or FOLFOXIRI combined with cetuximab, with documented clinical benefit (CR/PR/SD) and progression-free survival (PFS) ≥ 6 months * Disease progression occurred during or within 3 months after cetuximab-based first-line therapy * Experienced further tumor progression after receiving second-line or subsequent treatments * At least 4 months have elapsed since the last administration of cetuximab * At least one measurable lesion according to RECIST v1.1 * RAS/BRAF wild-type status confirmed by blood-based ctDNA testing * Normal hematologic function (platelets \> 90 × 10⁹/L; white blood cells \> 3 × 10⁹/L; neutrophils \> 1.5 × 10⁹/L; hemoglobin \> 10.0 g/100 ml) * Serum bilirubin ≤ 1.5 × upper limit of normal (ULN), transaminases ≤ 5 × ULN * No ascites, normal coagulation function, serum albumin ≥ 35 g/L * Child-Pugh class A liver function * Serum creatinine below ULN or calculated creatinine clearance \> 50 ml/min (using the Cockcroft-Gault formula) * ECOG performance status of 0-1 * Expected survival \> 3 months * Signed written informed consent * Willing and able to undergo follow-up until death, study completion, or study termination Exclusion Criteria: * Presence of RAS or BRAF gene mutations * Severe arterial embolism or ascites * Bleeding tendency or coagulation disorders * Hypertensive crisis or hypertensive encephalopathy * Severe and uncontrolled systemic complications such as infections or diabetes * Clinically significant cardiovascular diseases, including cerebrovascular accident (within 6 months prior to enrollment), myocardial infarction (within 6 months prior to enrollment), uncontrolled hypertension despite appropriate medical therapy, unstable angina, congestive heart failure (NYHA class II-IV), or arrhythmias requiring medical treatment History of or physical examination indicating central nervous system diseases (e.g., primary brain tumor, epilepsy not controlled with standard therapy, any brain metastases, or history of stroke) * History of other malignancies within the past 5 years (excluding adequately treated basal cell carcinoma of the skin, carcinoma in situ of the cervix, and/or thyroid cancer) * Known allergy to any of the study drugs * Pregnant or breastfeeding women * Women of childbearing potential (within 2 years of last menstruation) or men with reproductive potential who are not using or refuse to use effective non-hormonal contraception (e.g., intrauterine device, barrier method with spermicidal gel, or sterilization) * Inability or unwillingness to comply with the study protocol * Any other disease, functional impairment caused by metastatic lesions, or suspicious findings on physical examination that may indicate contraindications to study treatment or place the patient at high risk of treatment-related complications
Where this trial is running
Guangzhou, Guangdong
- Sun Yat-sen University Cancer Center — Guangzhou, Guangdong, China (Recruiting)
Study contacts
- Study coordinator: Deshen Wang, PhD
- Email: wangdsh@sysucc.org.cn
- Phone: 87342487
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.