title: BATON-CRC: A Phase II Randomized Trial Comparing Tivozanib Plus mFOLFOX6 with Bevacizumab Plus mFOLFOX6 in Stage IV Metastatic Colorectal Cancer.
abstract: OBJECTIVE
  Tivozanib, a selective inhibitor of VEGFR-1, -2, and -3, plus mFOLFOX6 in an advanced gastrointestinal cancer phase Ib study had encouraging antineoplastic activity and a tolerable safety profile. This randomized, open-label, phase II trial of tivozanib/mFOLFOX6 versus bevacizumab/mFOLFOX6 in patients with previously untreated metastatic colorectal cancer (mCRC) evaluated tivozanib activity versus bevacizumab.
  
  
  METHODS
  Treatment-naïve patients received mFOLFOX6 every 2 weeks of each 28-day cycle plus either tivozanib orally 1.5 mg once daily for 21 days or bevacizumab intravenously 5 mg/kg every 2 weeks. Investigator-assessed progression-free survival (PFS) was the primary endpoint; some secondary endpoints included safety, overall survival, overall response rate (ORR), duration of response, time to treatment failure, and biomarker subgroup analyses.
  
  
  RESULTS
  A prespecified interim futility analysis demonstrated that the futility boundary for superiority of tivozanib/mFOLFOX6 over bevacizumab/mFOLFOX6 for PFS in the intent-to-treat population was crossed; median PFS was 9.4 versus 10.7 months [HR = 1.091; confidence interval (CI), 0.693-1.718; P = 0.706]. Tivozanib/mFOLFOX6 resulted in PFS and ORR comparable with bevacizumab/mFOLFOX6; interim analyses biomarker results revealed no significant PFS association. Post hoc final analyses demonstrated a potential difference in tivozanib-specific PFS in patients with low neuropilin-1 (NRP-1), but not in patients with high NRP-1. Tivozanib/mFOLFOX6 was tolerable and adverse events were comparable with both bevacizumab/mFOLFOX6 and previous tivozanib studies.
  
  
  CONCLUSIONS
  The efficacy of tivozanib/mFOLFOX6 was comparable with but not superior to bevacizumab/mFOLFOX6 in patients with previously untreated mCRC. Since data from the prespecified interim analysis did not demonstrate superiority, this resulted in discontinuation of the study. The safety and tolerability profile of tivozanib/mFOLFOX6 was consistent with other tivozanib trials. NRP-1 is a potential predictive biomarker for tivozanib activity, but these results require further validation. Clin Cancer Res; 22(20); 5058-67. ©2016 AACR.
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois. a-benson@northwestern.edu.
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.affiliation: Masaryk Memorial Cancer Institute, Brno, Czech Republic.
authors.forename: Igor
authors.initials: I
authors.lastname: Kiss
authors.affiliation: University College London Cancer Institute, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Bridgewater
authors.affiliation: Eramus MC Cancer Institute, Rotterdam, the Netherlands.
authors.forename: Ferry A L M
authors.initials: FA
authors.lastname: Eskens
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Sasse
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vossen
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Jihong
authors.initials: J
authors.lastname: Chen
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Chip
authors.initials: C
authors.lastname: Van Sant
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Ball
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Anne
authors.initials: A
authors.lastname: Keating
authors.affiliation: Astellas Pharma Global Development, Northbrook, Illinois.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krivoshik
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D039942:Neuropilin-1 / Q000097:blood; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011804:Quinolines / Q000009:adverse effects / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D014408:Biomarkers, Tumor; D009944:Organoplatinum Compounds; D010671:Phenylurea Compounds; D011804:Quinolines; D039942:Neuropilin-1; C553176:tivozanib; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D002955:Leucovorin; D005472:Fluorouracil