Cetuximab, Bevacizumab & 5FU/Leucovorin vs. Oxaliplatin, Bevacizumab & 5FU/Leucovorin in Metastatic Colorectal Cancer

INCLUSION CRITERIA:

• Histologically or cytologically confirmed colorectal cancer with metastatic disease

• Measurable disease

• Previously irradiated lesions will be considered evaluable, if they progressed sinceradiation

• Has disease other than limited to surgically resectable liver-only or lung-onlymetastatic disease

• Not received prior chemo and/or biotherapy for metastatic disease

• Not received oxaliplatin, bevacizumab, or cetuximab in the adjuvant setting

• May have received 5-FU, leucovorin, and/or irinotecan in the adjuvant setting, howevermust have remained free of disease recurrence (including free of abnormal CEA level)for 1- year or more

• Is >18 years of age

• ECOG performance status 0 or 1

• Normal organ & marrow function

• Use of an acceptable method of birth control

• Not pregnant or breast feeding

• Paraffin tissue block(s) or 12 (minimum) unstained slides available, for assessment ofpotential predictive markers related to the EGFR, VEGF, DNA repair, andfluoropyrimidine catabolism pathways. If no block is available, slides (typically 7 to 10 um sections, air dried on uncharged slides) may be sent

• Signed a Patient Informed Consent Form

• Signed a Patient Authorization Form (HIPAA) Form

EXCLUSION CRITERIA:

• Had prior chemotherapy for metastatic colorectal cancer

• Received any prior treatment with oxaliplatin, bevacizumab, or cetuximab in theadjuvant treatment of their colorectal cancer

• Currently receiving any other investigational anticancer agents or has participated inan experimental drug study within the past 4 weeks

• History of primary CNS tumors, seizures not well-controlled with standard medicaltherapy, or stroke

• Sustained hypertension, as characterized by persistent blood pressures greater than 150/100 despite medical management

• New York Heart Association (NYHA) Grade II or greater congestive heart failure or hashad angioplasty or placement of coronary stents within the past 6 months

• Clinically significant peripheral vascular disease

• History of serious allergic reactions attributed to compounds of similar chemical orbiologic composition to bevacizumab, cetuximab, oxaliplatin, fluorouracil, leucovorin,or other agents used in the study

• Received prior cetuximab or other EGFR-directed therapy, or history of prioranti-cancer murine or chimeric monoclonal antibody therapy; prior humanized and humanmonoclonal antibody therapy is also excluded.

• Received prior treatment with bevacizumab or other agents specifically targeting VEGFor VEGF receptors

• Uncontrolled intercurrent illness including, not limited to, ongoing or activeinfection requiring parenteral antibiotics, symptomatic congestive heart failure,uncontrolled hypertension, clinically significant cardiac arrhythmia, or psychiatricillness/social situations that would limit compliance with study requirements in theopinion of the Investigator/Treating Physician

• Serious or non-healing active wound ulcer, or active bone fracture

• Major surgical procedure, open biopsy, or significant traumatic injury within 28 daysprior to Day 1 of protocol treatment

• Minor surgical procedures such as fine needle aspirations or core biopsies within 7days prior to Day 1

• History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscesswithin 6 months prior to Day 1

• Current or recent use of a thrombolytic agent within last 30 days. Use for clearanceof central line catheter is permitted.

• Evidence of bleeding diathesis (disorder) or clinically significant coagulopathy (Notethat deep venous thrombosis is not regarded as a reason for exclusion from this trial)

• Hypersensitivity to Chinese hamster ovary cell products or other recombinant humanantibodies

• History of arterial thromboembolic events within 6 months

• Urine protein:creatinine ratio greater than 1.0 at screening

• Pregnant or lactating woman

• Known to be HIV positive or receiving combination anti-retroviral therapy

• Unable to comply with study requirements