A trial looking at panitumumab, irinotecan and ciclosporin for advanced bowel cancer (PICCOLO)

This trial looked at irinotecan alone, irinotecan with panitumumab and irinotecan with ciclosporin for bowel cancer that had continued to grow after one course of chemotherapy. This trial was supported by Cancer Research UK.

Doctors usually treat advanced bowel cancer (colorectal cancer) with chemotherapy. But sometimes the first course of chemotherapy doesn’t work and they need to give a different type of chemotherapy. This is called second line treatment. They often give a drug called irinotecan (Campto) in this situation. But irinotecan doesn’t always work very well and it does cause side effects. Researchers tested 2 new combinations of treatment in this trial to see if they could improve second line treatment.

The first was irinotecan and panitumumab. Panitumumab (Vectibix) is a type of biological therapy called a monoclonal antibody.

Some bowel cancers have changes (mutations) in genes such as K-RAS or B-RAF. Whether these genes are mutated or normal (also called wild type) can affect how well certain treatments work. Doctors hoped that irinotecan and panitumumab together would work better than irinotecan alone for people with normal K-RAS genes.

The second combination was irinotecan and ciclosporin. Ciclosporin is not an anti cancer drug, but it allows you to have a lower dose of irinotecan by changing the way your body gets rid of it. Doctors hoped that this combination would work as well as irinotecan alone and cause fewer side effects.

The aims of this trial were to find out

• If irinotecan and panitumumab together works better than irinotecan alone

• If irinotecan and ciclosporin together work as well as irinotecan alone and causes fewer side effects

• More about the effects these combination of drugs may have on bowel cancer cells