Colorectal CancerPhase 3POLAR-MNCT03654729
Preventive Treatment of Oxaliplatin Induced Peripheral Neuropathy in Metastatic Colorectal Cancer (POLAR-M)
A Phase 3 study testing Calmangafodipir (2 µmol/kg) and Calmangafodipir (5 µmol/kg) in people with Colorectal Cancer and Chemotherapy-induced Peripheral Neuropathy, run by Egetis Therapeutics AB (publ) at 98 sites in 13 countries.
Trial summary
This study evaluates the investigational drug PledOx in the prevention of chronic chemotherapy induced peripheral neuropathy (CIPN) induced by the drug oxaliplatin. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Colorectal Cancer, Chemotherapy-induced Peripheral Neuropathy
- What is being tested?
- Calmangafodipir (2 µmol/kg) and Calmangafodipir (5 µmol/kg)
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 291 participants
- Where
- 98 sitesin 13 countries
- Study dates
- 7 Nov 2018to 31 Aug 2020
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Signed informed consent form before any study related assessments and willing to follow all study procedures.
- Male or female aged >=18 years.
- Non-resectable metastatic (stage IV) CRC, pathologically confirmed adenocarcinoma of the colon or rectum.
- No prior chemotherapy (within the previous 12 months) and/or biologic/targeted therapy for mCRC.
- Measurable disease according to RECIST 1.1.
- Patient indicated for at least 3 months of oxaliplatin-based chemotherapy (without any pre-planned treatment breaks) and without any clinically observed neurological disorders.
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- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Adequate hematological parameters: hemoglobin >=100 g/L, absolute neutrophil count (ANC) >=1.5 x 10^9 /L, platelets >=100 x 10^9 /L.
- Adequate renal function: creatinine clearance >50 cc/min using the Cockroft and Gault formula or measured.
- Adequate hepatic function: total bilirubin <=1.5 times the upper limit of normal (ULN) (except in the case of known Gilbert's syndrome); aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <=3 times ULN (AST and ALT <=5 times ULN in case of liver metastases).
- Baseline blood manganese (Mn) level <2.0 times ULN.
- For patients with a history of diabetes mellitus, HbA1c <=7%.
- Negative pregnancy test for females of child-bearing potential.
- For men and females of childbearing potential, use of adequate contraception (oral contraceptives, intrauterine device or barrier method of contraception in conjunction with spermicidal jelly or surgically sterile) while on study drug and for at least 6 months after completion of study therapy.
Who cannot join
- Any unresolved toxicity by Common Terminology Criteria for Adverse Events Version (CTCAE v4.03) > Grade 1 from previous anti-cancer therapy (including radiotherapy), except alopecia.
- Any grade of neuropathy from any cause.
- Any evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated respiratory, cardiac, unresolved bowel obstruction, hepatic or renal disease).
- Chronic infection or uncontrolled serious illness causing immunodeficiency.
- Any history of seizures.
- A surgical incision that is not healed.
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- Significant hemorrhage (>30 mL/bleeding episode in previous 3 months), hemoptysis (>5 mL fresh blood in previous 4 weeks) or thrombotic event (including transient ischemic attack) in the previous 12 months if the patient is expected to receive anti-VEGF/VEGFR therapy.
- Known hypersensitivity to any of the components of mFOLFOX6 and, if applicable, biological therapies to be used in conjunction with the chemotherapy regimen or any of the excipients of these products.
- History of other malignancies (except for adequately treated basal or squamous cell carcinoma or carcinoma in situ) within 5 years, unless the patient has been disease free for that other malignancy for at least 2 years.
- Known dihydropyrimidine dehydrogenase deficiency.
- Pre-existing neurodegenerative disease (e.g., Parkinson's, Alzheimer's, Huntington's) or neuromuscular disorder (e.g., multiple sclerosis, amyotrophic lateral sclerosis, polio, hereditary neuromuscular disease).
- Major psychiatric disorder (major depression, psychosis), alcohol and/or drug abuse.
- Patients with a history of second or third degree atrioventricular block or a family heredity.
- A history of a genetic or familial neuropathy.
- Treatment with any investigational drug within 30 days prior to randomization.
- Pregnancy, lactation or reluctance to using contraception.
- Any other condition that, in the opinion of the Investigator, places the patient at undue risk.
- Previous exposure to mangafodipir or calmangafodipir.
- Welders, mine workers or other workers in occupations (current or past) where high manganese exposure is likely.
Trial locations and contacts
98 sites in 13 countries.
98 sites in 13 countries
France12 sites
CHRU de Brest - Hôpital Morvan
Brest
Clinique Pasteur-Lanroze
Brest
Centre Hospitalier Départemental de Vendée - Unité de recherche clinique
La Roche-sur-Yon
Centre Oscar Lambret
Lille
Hôpital Edouard Herriot - HCL
Lyon
Hôpital Nord Franche-Comté Site du Mittan
Montbéliard
Institut de Cancérologie de l'Ouest
Nantes
Hopital l'Archet, CHU de Nice
Nice
Hôpital Robert Debré
Reims
Centre Hospitalier Privé Saint-Grégoire
Saint-Grégoire
Clinique Ste Anne
Strasbourg
Hopitaux Universitaires de Strasbourg
Strasbourg
Italy12 sites
IRCCS Candiolo
Candiolo
Oncologia Istituti Ospitalieri
Cremona
Irccs Irst
Meldola - FC
Azienda Ospedaliero - Universitaria di Modena Policlinico
Modena
Hospital San Gerardo
Monza
Istituto Nazionale Tumori
Naples
IRCCS Policlinico San Matteo
Pavia
Ospedale degli infermi
Ponderano
Ospedale S. Maria delle Croci - Ravenna
Ravenna
IRCCS azienda Ospedaliera S Maria Nuova
Reggio Emilia
San Camillo Forlanini Hospital
Rome
Casa Sollievo della Sofferenza
San Giovanni Rotondo
Japan12 sites
Fujita Health University Hospital
Aichi, 470-1192
Kyushu University Hospital
Fukuoka-shi, Fukuoka, 812-8582
Fukuoka University Hospital
Fukuoka-shi, Fukuoka, 814-0133
Kansai Rosai Hospital
Hyōgo
St. Marianna University School of Medicine Hospital
Kanagawa, 216-8511
Aichi Cancer Center Hospital
Nagoya-shi, Aichi, 464-8681
Osaka University Hospital
Osaka, 565-0871
Osaka International Cancer Institute
Osaka-shi, Osaka, Osaka, 541-8567
National Hospital Organization Osaka National Hospital
Osaka-shi, Osaka, 540-0006
Sapporo Medical University Hospital
Sapporo-shi, Hokkaido, 065-0033
Shizuoka Cancer Center
Shizuoka, 411-8777
The Cancer Institute Hospital Of JFCR
Tokyo, 135-8550
United States11 sites
Hunterdon Hematology Oncology
Flemington, New Jersey, 08822
California Cancer Associates
Fresno, California, 93720
CHI St Francis Cancer Treatment Center
Grand Island, Nebraska, 68803
Monter Cancer Center
Lake Success, New York, 11042
Mid Florida Hematology and Oncology Center
Orange City, Florida, 32763
Willis-Knighton Cancer Center
Shreveport, Louisiana, 71103
Mercy Clinic - Cancer & Hematology
Springfield, Missouri, 65804
Mercy Clinic Oncology and Hematology
St Louis, Missouri, 63141
Scott & White Vasicek Cancer Treatment Center
Temple, Texas, 76508
Montefiore Medical Research
The Bronx, New York, 10461
Cancer Center of Kansas
Wichita, Kansas, 67214
Spain11 sites
Hospital de La Santa Creu I Sant Pau
Barcelona
L´Hospitalet de Llobregat (Barcelona)
Barcelona
Vall d'hebron university hospital
Barcelona
Complejo Hospitalario de Jaén
Jaén
Centro Integral Oncologico Clara Campal
Madrid
H.G.U.Gregorio Marañón
Madrid
Hospital Universitario La Paz
Madrid
Hospital Universitario Puerta de Hierro
Majadahonda
Hospital Universitario Virgen Macarena
Seville
Hospital Quironsalud Valencia
Valencia
Hospital Miguel Servet
Zaragoza
Belgium8 sites
Onze-Lieve-Vrouwziekenuis Aalst
Aalst
Imelda GI Clinical Research Center
Bonheiden
Cliniques Universitaires St-Luc
Brussels
UZ Gent
Ghent
CHU Liège
Liège
AZ Sint Maarten
Mechelen
AZ Delta
Roeselare
CHU UCL Namur - Site Godinne
Yvoir
Czechia6 sites
Nemocnice Benesov
Benešov
Nemocnice Horovice
Hořovice
Nemocnice Na Pleši
Nová Ves pod Pleší
General University Hospital
Prague
Hospital Na Bulovce
Prague
Onkologická Klinika 1. Lf Uk A Tn
Prague
Germany6 sites
Hämatolgisch-onkologische Praxis Augsburg
Augsburg
Onkozentrum Dresden
Dresden
Universitätsklinikum Carl Gustav Carus
Dresden
Agaplesion Markus Krankenhaus
Frankfurt
Onkodok GmbH
Gütersloh
Klinikum Neuperlach
München
South Korea6 sites
Hallym University Sacred Heart Hospital
Anyang-si
Dong-A University Hospital
Busan
Chonnam National University Hwasun Hospital
Gwangju
Seoul National University Bundang Hospital
Seongnam-si
Korea University Guro Hospital
Seoul
Seoul National University Hospital
Seoul
Hungary5 sites
Országos Onkológiai Intézet
Budapest
Semmelweis Egyetem
Budapest
Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház
Miskolc
Tolna Megyei Balassa Janos Korhaz
Szekszárd
Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet
Szolnok
United Kingdom5 sites
Royal Marsden Hospital
London, SW3 6JJ
North Tyneside General Hospital
North Shields, NE29 8NH
Mount Vernon Cancer Centre
Northwood, HA6 2RN
The Royal Marsden Hospital (Surrey)
Sutton, SM2 5PT
York Teaching Hospital
York, YO61 8HE
Taiwan3 sites
KMUH: Kaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung City
CMMC: Chi Mei Medical Center
Tainan
NCKUH: National Cheng Kung University Hospital
Tainan
About this study
Official title: A Phase 3, Double-blind, Multicenter, Placebo-controlled Study of PledOx Used on Top of Modified FOLFOX6 (5-FU/FA and Oxaliplatin) to Prevent Chemotherapy Induced Peripheral Neuropathy (CIPN) in Patients With First-line mCRC
This study evaluates the investigational drug PledOx in the prevention of chronic chemotherapy induced peripheral neuropathy (CIPN) induced by the drug oxaliplatin.
Read the detailed description
Oxaliplatin, in combination with 5-fluorouracil plus folinate (or capecitabine), has increased survival in stage III colorectal cancer and prolonged life in stage IV patients, but its use is compromised because of severe toxicity. Chemotherapy-induced peripheral neuropathy (CIPN) is the most problematic dose-limiting toxicity of oxaliplatin. No treatments have been clinically proven to prevent CIPN. There is a body of evidence that CIPN is caused by cellular oxidative stress. Clinical and preclinical data suggest that the manganese chelate and superoxide dismutase mimetic mangafodipir (MnDPDP) and calmangafodipir ([Ca0.8,Mn0.2]Na3DPDP) are efficacious inhibitors of CIPN and other conditions caused by cellular oxidative stress, without interfering negatively with the tumoricidal activity of chemotherapy.
This is a Phase 3, multicenter, double-blind, placebo-controlled study to establish the efficacious dose of PledOx in prevention of chronic CIPN induced by oxaliplatin.
Patients with metastatic colorectal cancer (mCRC), who are indicated for first-line modified FOLFOX6 (mFOLFOX6) chemotherapy for at least 3 months, without any pre-planned treatment breaks, will be randomized in a 1:1:1 ratio, stratified by region (Asia, non-Asia) and PK sub-study (yes, no), to one of three treatment arms:
- Arm A: PledOx (2 µmol/kg) + mFOLFOX6 chemotherapy
- Arm B: PledOx (5 µmol/kg) + mFOLFOX6 chemotherapy
- Arm C: Placebo + mFOLFOX6 chemotherapy
Before March 2nd., 2020, the Investigational Medicinal Product, (IMP; i.e. PledOx or placebo) was administered by an intravenous infusion on the first day of each chemotherapy (mFOLFOX6) cycle. IMP was not to be administered if mFOLFOX6 was not given to the patient.
If a patient later discontinues oxaliplatin, treatment with 5-FU/folinate may be continued.
The addition of an appropriate biologic therapy (bevacizumab, panitumumab, cetuximab) will be left to the discretion of the Investigator.
As of March 2nd., all patients have to stop IMP but may continue mFOLFOX 6
- Being tested
- Calmangafodipir (2 µmol/kg), Calmangafodipir (5 µmol/kg), Placebo
- Keywords
- Metastatic, Colorectal, Cancer, Metastatic Colorectal Cancer, Oxaliplatin induced CIPN, CIPN, Oxaliplatin
- Medical subject headings
- Colorectal Neoplasms, Neoplasm Metastasis, Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Calmangafodipir (2 µmol/kg)Drug
Also called PledOx
Solution in 20 mL single dose glass vials
Calmangafodipir (5 µmol/kg)Drug
Also called PledOx
Solution in 20 mL single dose glass vials
PlaceboDrug
Solution in 20 mL single dose glass vials
| Study group | Role | What they receive |
|---|---|---|
| PledOx (2 µmol/kg) | Experimental | Calmangafodipir (2 µmol/kg) on day 1 every two weeks to patients as an intravenous infusion, combined with mFOLFOX6 chemotherapy. Receives: Drug: Calmangafodipir (2 µmol/kg) |
| PledOx (5 µmol/kg) | Experimental | Calmangafodipir (5 µmol/kg) on day 1 every two weeks to patients as an intravenous infusion, combined with mFOLFOX6 chemotherapy. Receives: Drug: Calmangafodipir (5 µmol/kg) |
| Placebo | Placebo comparator | Placebo will be given to patients as an intravenous infusion, on top of mFOLFOX6 chemotherapy. Receives: Drug: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Moderate or Severe Chronic Chemotherapy Induced Peripheral Neuropathy (CIPN)
Percentage of patients (with moderate or severe chronic CIPN) scoring 3 or 4 in at least 1 of the first 4 items of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity-13-item subscale (FACT/GOG-NTX-13; i.e., FACT/GOG-NTX-4) 9 months after the first dose of IMP (i.e. PledOx or placebo administered on Day 1, Cycle 1 of mFOLFOX6 chemotherapy). The FACT/GOG-13 questionnaire includes 13 items that measure the severity and impact of symptoms of neurotoxicity over the past 7 days. Patients rate each item as 0 ("not at all"), 1 (" a little bit"), 2 ("somewhat"), 3 ("quite a bit") or 4 ("very much"). These 13 items are summed to create a total score, ranging from 0 to 52, with a higher score representing a worse outcome. The FACT/GOG-NTX-4 is a 4 item subscale targeting numbness, tingling or discomfort in hands and/or feet.
Measured: 9 months
Secondary outcomes (9)
Mild, Moderate or Severe Chronic Chemotherapy Induced Peripheral Neuropathy (CIPN)
Percentage of patients (with mild, moderate or severe chronic CIPN) scoring 2, 3 or 4 in at least 1 of the first 4 items of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity-13-item subscale (FACT/GOG-NTX-13; i.e., FACT/GOG-NTX-4) 9 months after the first dose of IMP (i.e. PledOx or placebo administered on Day 1, Cycle 1 of mFOLFOX6 chemotherapy). The FACT/GOG-13 questionnaire includes 13 items that measure the severity and impact of symptoms of neurotoxicity over the past 7 days. Patients rate each item as 0 ("not at all"), 1 (" a little bit"), 2 ("somewhat"), 3 ("quite a bit") or 4 ("very much"). These 13 items are summed to create a total score, ranging from 0 to 52, with a higher score representing a worse outcome. The FACT/GOG-NTX-4 is a 4 item subscale targeting numbness, tingling or discomfort in hands and/or feet.
Measured: 9 months
Sensitivity to Touching Cold Items
Mean change from baseline in sensitivity to touching cold items on day 2, Cycle 4 of mFOLFOX6 chemotherapy, as assessed by the Cold Sensitivity Questionnaire (measuring sensitivity when touching or swallowing cold objects/fluid). 10 point scale from 0 meaning no sensitivity/discomfort at all to 10 meaning sensitivity/discomfort as bad as it can be.
Measured: Baseline and 8 weeks
Cumulative Dose of Oxaliplatin During Chemotherapy
Mean cumulative dose of oxaliplatin administered per patient during mFOLFOX6 chemotherapy, 9 months after the first dose of IMP.
Measured: 9 months
Vibration Sensitivity on the Lateral Malleolus
Mean change from baseline in vibration sense, on the lateral malleolus (left and right), using a graduated tuning fork, at 9 months after the first dose of IMP. When the tuning fork was struck against the ball of the thumb, the base of the tuning fork was placed over the appropriate bony surface (i.e., lateral malleolus left and right) and the patient was asked to indicate the moment when the vibration was no longer detected. The intensity at which the patient no longer detected the vibration is reported on a scale of 0 (minimum score, representing the maximum vibration amplitude) to 8 (maximum score, representing the minimum vibration amplitude)
Measured: Baseline and 9 months
Worst Pain in Hands or Feet
Mean change from baseline in worst pain in hands or feet in the past week, using the Pain Assessment (Numerical Rating Scale (NRS)), at 9 months after the first dose of IMP. The NRS is a 10 point scale with 0 as no pain at all and 10 as pain as bad as you can imagine and evaluates the intensity of pain in hands and feet during the past week. A higher value means worse outcome.
Measured: Baseline and 9 months
Functional Impairment (in the Non-dominant Hand)
Mean change from baseline in the time to complete the grooved Pegboard with the non-dominant hand, at 9 months after the first dose of IMP.
Measured: Baseline and 9 months
Overall Response Rate (ORR)
Percentage of patients with an overall response (complete response or partial response) according to RECIST v1.1 for target lesions and assessed by CT (preferred) or MRI. Complete response=disappearance of all target lesions; partial response >=30% decrease in the sum of the longest diameter of target lesions.
Measured: 12, 15 and 18 months
Progression-free Survival (PFS)
Patients with progression-free survival
Measured: Analyses at 12 and 24 months were planned; the analysis was performed once based on available data at cut-off 31 August 2020 as the study was terminated early by the Sponsor
Overall Survival (OS)
Patients with overall survival
Measured: An analysis at 36 months was planned. The analysis was performed based on available data at cut-off 31 August 2020 as the study was terminated early by the Sponsor
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Aug 2018
- Study start7 Nov 2018
- Primary completion31 Aug 2020
- Study completion31 Aug 2020
Why it stopped: On 23 January 2020, the Sponsor announced that the United States (US) Food and Drug Administration (FDA) had issued a clinical hold in the US of the POLAR program.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Colorectal CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This is a Phase 3, multicenter, double-blind, placebo-controlled study to establish the efficacious dose of PledOx in prevention of chronic chemotherapy induced peripheral neuropathy (CIPN) induced by oxaliplatin. Patients with metastatic colorectal cancer (mCRC), who are indicated for first-line modified FOLFOX6 (mFOLFOX6) chemotherapy for at least 3 months, without any pre-planned treatment breaks, will be randomized in a 1:1:1 ratio, stratified by region (Asia, non-Asia) and PK sub-study (yes, no) to one of three treatment arms: * Arm A: PledOx (2 µmol/kg) + mFOLFOX6 chemotherapy * Arm B: PledOx (5 µmol/kg) + m * Arm C: Placebo + mFOLFOX6 chemotherapy
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 291 participants (actual)
Sponsor and investigators
- Lead sponsor
- Egetis Therapeutics AB (publ)
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- Solasia Pharma K.K.
- Responsible party
- Sponsor
- Investigators
- Stefan Carlsson, MD, Study director, Chief Medical Officer
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03654729
- Sponsor's protocol ID
- PP06490
- Acronym
- POLAR-M
- Status last verified
- Nov 2021
- First submitted
- 29 Aug 2018
- Last updated
- 17 Dec 2021
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Pfeiffer P, Lustberg M, Nasstrom J, Carlsson S, Persson A, Nagahama F, Cavaletti G, Glimelius B, Muro K. Calmangafodipir for Prevention of Oxaliplatin-Induced Peripheral Neuropathy: Two Placebo-Controlled, Randomized Phase 3 Studies (POLAR-A/POLAR-M). JNCI Cancer Spectr. 2022 Nov 1;6(6):pkac075. doi: 10.1093/jncics/pkac075.
PubMed 36308441
Study at a glance
From the registry record, last updated by the sponsor on 17 Dec 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase 3, Double-blind, Multicenter, Placebo-controlled Study of PledOx Used on Top of Modified FOLFOX6 (5-FU/FA and Oxaliplatin) to Prevent Chemotherapy Induced Peripheral Neuropathy (CIPN) in Patients With First-line mCRC
- ClinicalTrials.gov ID
- NCT03654729
- Acronym / sponsor ID
- POLAR-M / PP06490
- Keywords
- Metastatic, Colorectal, Cancer, Metastatic Colorectal Cancer, Oxaliplatin induced CIPN, CIPN, Oxaliplatin
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: On 23 January 2020, the Sponsor announced that the United States (US) Food and Drug Administration (FDA) had issued a clinical hold in the US of the POLAR program.
- Enrolment
- 291 participants (actual)
- Lead sponsor
- Egetis Therapeutics AB (publ)Industry (pharma, biotech, devices)
- Collaborators
- Solasia Pharma K.K.
- Study start
- 7 Nov 2018 (actual)
- Primary completion
- 31 Aug 2020 (actual)
- Study completion
- 31 Aug 2020 (actual)
- First posted
- 31 Aug 2018 (actual)
- Results
- Posted 17 Dec 2021
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study evaluates the investigational drug PledOx in the prevention of chronic chemotherapy induced peripheral neuropathy (CIPN) induced by the drug oxaliplatin.
Detailed description
Oxaliplatin, in combination with 5-fluorouracil plus folinate (or capecitabine), has increased survival in stage III colorectal cancer and prolonged life in stage IV patients, but its use is compromised because of severe toxicity. Chemotherapy-induced peripheral neuropathy (CIPN) is the most problematic dose-limiting toxicity of oxaliplatin. No treatments have been clinically proven to prevent CIPN. There is a body of evidence that CIPN is caused by cellular oxidative stress. Clinical and preclinical data suggest that the manganese chelate and superoxide dismutase mimetic mangafodipir (MnDPDP) and calmangafodipir ([Ca0.8,Mn0.2]Na3DPDP) are efficacious inhibitors of CIPN and other conditions caused by cellular oxidative stress, without interfering negatively with the tumoricidal activity of chemotherapy.
This is a Phase 3, multicenter, double-blind, placebo-controlled study to establish the efficacious dose of PledOx in prevention of chronic CIPN induced by oxaliplatin.
Patients with metastatic colorectal cancer (mCRC), who are indicated for first-line modified FOLFOX6 (mFOLFOX6) chemotherapy for at least 3 months, without any pre-planned treatment breaks, will be randomized in a 1:1:1 ratio, stratified by region (Asia, non-Asia) and PK sub-study (yes, no), to one of three treatment arms:
- Arm A: PledOx (2 µmol/kg) + mFOLFOX6 chemotherapy
- Arm B: PledOx (5 µmol/kg) + mFOLFOX6 chemotherapy
- Arm C: Placebo + mFOLFOX6 chemotherapy
Before March 2nd., 2020, the Investigational Medicinal Product, (IMP; i.e. PledOx or placebo) was administered by an intravenous infusion on the first day of each chemotherapy (mFOLFOX6) cycle. IMP was not to be administered if mFOLFOX6 was not given to the patient.
If a patient later discontinues oxaliplatin, treatment with 5-FU/folinate may be continued.
The addition of an appropriate biologic therapy (bevacizumab, panitumumab, cetuximab) will be left to the discretion of the Investigator.
As of March 2nd., all patients have to stop IMP but may continue mFOLFOX 6
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 3
- Model description
- This is a Phase 3, multicenter, double-blind, placebo-controlled study to establish the efficacious dose of PledOx in prevention of chronic chemotherapy induced peripheral neuropathy (CIPN) induced by oxaliplatin. Patients with metastatic colorectal cancer (mCRC), who are indicated for first-line modified FOLFOX6 (mFOLFOX6) chemotherapy for at least 3 months, without any pre-planned treatment breaks, will be randomized in a 1:1:1 ratio, stratified by region (Asia, non-Asia) and PK sub-study (yes, no) to one of three treatment arms: * Arm A: PledOx (2 µmol/kg) + mFOLFOX6 chemotherapy * Arm B: PledOx (5 µmol/kg) + m * Arm C: Placebo + mFOLFOX6 chemotherapy
| Arm | Type | Receives |
|---|---|---|
| PledOx (2 µmol/kg) | Experimental | Drug: Calmangafodipir (2 µmol/kg)Calmangafodipir (2 µmol/kg) on day 1 every two weeks to patients as an intravenous infusion, combined with mFOLFOX6 chemotherapy. |
| PledOx (5 µmol/kg) | Experimental | Drug: Calmangafodipir (5 µmol/kg)Calmangafodipir (5 µmol/kg) on day 1 every two weeks to patients as an intravenous infusion, combined with mFOLFOX6 chemotherapy. |
| Placebo | Placebo comparator | Drug: PlaceboPlacebo will be given to patients as an intravenous infusion, on top of mFOLFOX6 chemotherapy. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (14 listed)
- Signed informed consent form before any study related assessments and willing to follow all study procedures.
- Male or female aged >=18 years.
- Non-resectable metastatic (stage IV) CRC, pathologically confirmed adenocarcinoma of the colon or rectum.
- No prior chemotherapy (within the previous 12 months) and/or biologic/targeted therapy for mCRC.
- Measurable disease according to RECIST 1.1.
Key exclusion criteria (19 listed)
- Any unresolved toxicity by Common Terminology Criteria for Adverse Events Version (CTCAE v4.03) > Grade 1 from previous anti-cancer therapy (including radiotherapy), except alopecia.
- Any grade of neuropathy from any cause.
- Any evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated respiratory, cardiac, unresolved bowel obstruction, hepatic or renal disease).
- Chronic infection or uncontrolled serious illness causing immunodeficiency.
- Any history of seizures.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Calmangafodipir (2 µmol/kg)Also: PledOxSolution in 20 mL single dose glass vials | Drug | PledOx (2 µmol/kg) |
| Calmangafodipir (5 µmol/kg)Also: PledOxSolution in 20 mL single dose glass vials | Drug | PledOx (5 µmol/kg) |
| PlaceboSolution in 20 mL single dose glass vials | Drug | Placebo |
Primary outcome
Moderate or Severe Chronic Chemotherapy Induced Peripheral Neuropathy (CIPN)
Time frame: 9 months
Percentage of patients (with moderate or severe chronic CIPN) scoring 3 or 4 in at least 1 of the first 4 items of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity-13-item subscale (FACT/GOG-NTX-13; i.e., FACT/GOG-NTX-4) 9 months after the first dose of IMP (i.e. PledOx or placebo administered on Day 1, Cycle 1 of mFOLFOX6 chemotherapy). The FACT/GOG-13 questionnaire includes 13 items that measure the severity and impact of symptoms of neurotoxicity over the past 7 days. Patients rate each item as 0 ("not at all"), 1 (" a little bit"), 2 ("somewhat"), 3 ("quite a bit") or 4 ("very much"). These 13 items are summed to create a total score, ranging from 0 to 52, with a higher score representing a worse outcome. The FACT/GOG-NTX-4 is a 4 item subscale targeting numbness, tingling or discomfort in hands and/or feet.
9 secondary outcomes
Mild, Moderate or Severe Chronic Chemotherapy Induced Peripheral Neuropathy (CIPN)
Time frame: 9 months
Sensitivity to Touching Cold Items
Time frame: Baseline and 8 weeks
Cumulative Dose of Oxaliplatin During Chemotherapy
Time frame: 9 months
Vibration Sensitivity on the Lateral Malleolus
Time frame: Baseline and 9 months
Worst Pain in Hands or Feet
Time frame: Baseline and 9 months
Functional Impairment (in the Non-dominant Hand)
Time frame: Baseline and 9 months
Overall Response Rate (ORR)
Time frame: 12, 15 and 18 months
Progression-free Survival (PFS)
Time frame: Analyses at 12 and 24 months were planned; the analysis was performed once based on available data at cut-off 31 August 2020 as the study was terminated early by the Sponsor
Overall Survival (OS)
Time frame: An analysis at 36 months was planned. The analysis was performed based on available data at cut-off 31 August 2020 as the study was terminated early by the Sponsor
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Dec 2021.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 36308441Pfeiffer P, Lustberg M, Nasstrom J, Carlsson S, Persson A, Nagahama F, Cavaletti G, Glimelius B, Muro K. Calmangafodipir for Prevention of Oxaliplatin-Induced Peripheral Neuropathy: Two Placebo-Controlled, Randomized Phase 3 Studies (POLAR-A/POLAR-M). JNCI Cancer Spectr. 2022 Nov 1;6(6):pkac075. doi: 10.1093/jncics/pkac075.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Stefan Carlsson, MD study director
Chief Medical Officer
98 sites in 13 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Calmangafodipir (2 µmol/kg) and Calmangafodipir (5 µmol/kg) in people with Colorectal Cancer and Chemotherapy-induced Peripheral Neuropathy, run by Egetis Therapeutics AB (publ) at 98 sites in 13 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 14 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 17 Dec 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 98 sites in France, Italy, Japan, United States, Spain and 8 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 17 Dec 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Moderate or Severe Chronic Chemotherapy Induced Peripheral Neuropathy (CIPN) (time frame: 9 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03654729, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Dec 2021.