Using precision medicine to choose chemotherapy for metastatic colorectal cancer

COSENSE-1: A Feasibility Study for Using a Functional Precision Medicine Platform to Select Oxaliplatin-based Versus Irinotecan-based Chemotherapy Regimens for Patients With Metastatic Colorectal Cancer

This study is testing whether a new way to choose the best chemotherapy for people with metastatic colorectal cancer can help them live longer and feel better.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 148 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: St. Olavs Hospital (Academic / other)
• Drugs / interventions: chemotherapy
• Locations: 1 site (Trondheim)
• Trial ID: NCT06907342 on ClinicalTrials.gov

What this trial studies

COSENSE-1 is a phase II, single-arm feasibility study that aims to evaluate the effectiveness of a functional precision medicine platform in selecting between oxaliplatin-based and irinotecan-based chemotherapy regimens for patients with metastatic colorectal cancer. The study will assess the feasibility of generating valid tumouroid response reports and measure treatment efficacy through various endpoints, including progression-free survival and overall survival. Participants will be closely monitored for treatment response and toxicity, with the goal of optimizing the functional assay for clinical practice.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with microsatellite stable metastatic colorectal cancer that is not resectable with curative intent.

Not a fit: Patients with resectable metastatic colorectal cancer or those with other types of colorectal cancer may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could lead to more personalized and effective chemotherapy options for patients with metastatic colorectal cancer.

How similar studies have performed: Other studies have shown promise in using precision medicine approaches for cancer treatment, suggesting potential for success in this novel application.

Eligibility criteria

Inclusion Criteria:

General conditions:

1. Age 18 or older
2. ECOG performance status 0 or 1
3. Obtained informed consent
4. Acceptable organ function (defined in publicly available protocol)
5. Women of child-bearing potential and men must agree to use highly effective contraception (defined in publicly available protocol)

   Disease and treatment specific conditions:
6. Histologically confirmed pMMR/MSS adenocarcinoma originating from the colon or rectum
7. Unresectable metastatic disease (not amenable to radical surgery of the cancer disease at the time of study inclusion)
8. Patient has metastatic or primary lesion available for biopsy
9. Patient has measurable or evaluable disease per RECIST (version 1.1)
10. The oxaliplatin-based regimen FOLFOX (+/- antibody) versus the irinotecan-based regimen FOLFIRI (+/- antibody), are evaluated by an experienced physician, independent of inclusion in the trial, to be equally recommended for the participant as standard of care first-line therapy in the treatment of mCRC, following the Norwegian national guideline on the treatment of colorectal cancer (https://www.helsedirektoratet.no/retningslinjer/kreft-i-tykktarm-og-endetarm-handlingsprogram)
11. Patient is eligible for full (100%) chemotherapy doses at first treatment cycle
12. Treatment with chemotherapy can be scheduled within 28 days from referral

Exclusion Criteria:

1. Patient has metastatic MMR deficient/MSI adenocarcinoma
2. Patient is ineligible for full (100%) chemotherapy doses at first treatment cycle
3. Patient is not equally eligible for FOLFOX (+/- antibody) and FOLFIRI (+/- antibody) chemotherapy regimens, according to the Norwegian national guideline on the treatment of colorectal cancer
4. ECOG performance status 2 or worse
5. Pregnancy or planned pregnancy during the study period, due to the risks of drug treatment to a developing foetus
6. Breastfeeding
7. Patients with psychological, geographical, familial or sociological conditions that can prevent compliance with the study protocol
8. Inability to understand study procedures and comply with them, or disorder that compromises the patient's ability to provide informed consent and/or comply with study procedures
9. Patient fulfils any of the contraindications listed in the SmPC of the relevant IMP
10. Treatment cannot be scheduled within 28 days from referral

    Medical history:
11. Partial or complete dihydropyrimidine dehydrogenase (DPD) deficiency
12. Evidence of CNS metastasis
13. Unresolved toxicities of a previous systemic treatment that, in the opinion of the physician, make the patient unfit for inclusion
14. Antitumoural treatment ≤ 30 days before inclusion. Hormonal substitutive treatment is allowed
15. Preexisting significant cardiovascular disease including uncontrolled/unstable or symptomatic angina, uncontrolled atrial or ventricular arrythmias, LVEF known to be \< 40% or symptomatic congestive heart failure
16. Stroke (including TIA) or acute myocardial infarction within 6 months before the first dose of study treatment
17. Clinically significant peripheral sensory neuropathy
18. Recent (\<6 months before the start of study treatment) pulmonary embolism, deep vein thrombosis, or another significant thromboembolic event
19. History of interstitial pneumonitis or pulmonary fibrosis or evidence of interstitial pneumonitis or pulmonary fibrosis on chest computed tomography (CT)
20. Evidence of previous acute hypersensitivity reaction to any component of the treatment
21. History of any disease that may increase the risks associated with study participation

Where this trial is running

Trondheim

• St. Olavs Hospital — Trondheim, Norway (Recruiting)

Conditions Tumor, Colorectal; Organoids; Tumoroid; Metastatic Colorectal Cancer; Core Needle Biopsy; First-line Treatment