Tas-102 and Radioembolization With 90Y Resin Microspheres for Chemo-refractory Colorectal Liver Metastases

Randomized studies have demonstrated that Tas-102 has single agent activity against chemotherapy refractory colorectal cancer. A recent pre-clinical study has shown that Tas-102 may have activity as a radiation sensitizer in bladder cancer cell lines. Benefit of single agent Tas-102 against chemotherapy refractory colon cancer and the drug's promise a radiosensitizer make Tas-102 a potential candidate drug for testing in combination with radioembolization using Yttrium-90 resin microspheres in patients with liver-dominant chemotherapy-refractory mCRC. This is a phase I dose escalation study with a dose expansion arm designed to evaluate safety of the combination of Tas-102 and radioembolization using 90Y resin microspheres for patients with chemotherapy-refractory colon or rectal adenocarcinoma metastatic to the liver.

Inclusion criteria

• Male or female, 18 years of age or older, and of any ethnic or racial group.
• Diagnosis of unresectable metastatic colorectal adenocarcinoma with liver-dominant bilobar disease. Diagnosis may be made by histo- or cyto-pathology, or by clinical and imaging criteria.
• Disease progression or intolerance to at least two prior Food and Drug Administration-approved therapeutic regimens.
• If extrahepatic disease is present, it must be asymptomatic.
• If a primary tumor is in place, it must be asymptomatic.
• Measurable target tumors using standard imaging techniques (RECIST v. 1.1 criteria).
• Tumor replacement < 50% of total liver volume.
• Current Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 through screening to first treatment on study.
• Completion of prior systemic therapy at least 14 days prior to enrollment.
• Able to understand informed consent.

Exclusion criteria

• At risk of hepatic or renal failure

• Serum creatinine > 1.5 mg/dl
• Serum bilirubin > 1.3 mg/ml
• Albumin < 2.0 g/dL
• Aspartate and/or alanine aminotransferase level > 5 times upper normal limit
• Any history of hepatic encephalopathy
• Cirrhosis or portal hypertension
• Clinically evident ascites (trace ascites on imaging is acceptable)
• Contraindications to angiography and selective visceral catheterization

• Any bleeding diathesis or coagulopathy that is not correctable by usual therapy or hemostatic agents (e.g. closure device)
• Severe allergy or intolerance to contrast agents, narcotics, or sedatives that cannot be managed medically
• Symptomatic lung disease
• Prior therapy with Tas-102.
• Contraindications to Tas-102

• Absolute neutrophil count < 1,500/μl
• Platelet count < 75,000/μl
• Allergy or intolerance to Tas-102
• Unresolved toxicity of greater than or equal to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Grade 2 due to prior therapies.
• Evidence of potential delivery of

• Greater than 30 Gy absorbed dose of radiation to the lungs during a single 90Y resin microsphere administration; or
• Cumulative delivery of radiation to the lungs > 50 Gy over multiple treatments.
• Evidence of any detectable Tc-99m macro aggregated albumin flow to the stomach or duodenum, after application of established angiographic techniques to stop such flow.
• Previous radiation therapy to the lungs and/or to the upper abdomen
• Any prior arterial liver-directed therapy, including chemoembolization, bland embolization, and 90Y radioembolization
• Any intervention for, or compromise of the ampulla of Vater
• Active uncontrolled infection. Presence of latent or medication-controlled HIV and/or viral hepatitis is allowed.
• Significant extrahepatic disease

• Symptomatic extrahepatic disease (including primary tumor, if unresected).
• Greater than 10 pulmonary nodules (each < 20 mm in diameter) or combined diameter of all pulmonary nodules > 15 cm.
• Peritoneal carcinomatosis
• Life expectancy less than 3 months
• Pregnant or lactating female
• In the investigator's judgment, any co-morbid disease or condition that would place the patient at undue risk and preclude safe use of radioembolization or Tas-102.