REVERT - taRgeted thErapy for adVanced colorEctal canceR paTients

Prior treatment

• Prior hypersensitivity or toxicity to chemotherapy drugs suggesting an inability to tolerate the proposed treatment.
• History of thromboembolic or cerebrovascular events ≤ 6 months prior to starting study treatment.
• Concurrent neuromuscular disorder associated with elevated CK (e.g., inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy).

Other illness

• Patients should not be candidate for upfront resection of metastatic disease.
• Leptomeningeal disease.
• Known history of acute or chronic pancreatitis.
• History of chronic inflammatory bowel disease or Crohn's disease requiring medical intervention (immunomodulatory or immunosuppressive medications or surgery).
• Impaired cardiovascular function or clinically significant cardiovascular diseases.
• Uncontrolled hypertension defined as persistent elevation of systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 100 mmHg despite current therapy.
• Concurrent or previous other malignancy.

Lab values

• Other severe, acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration or that may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the patient an inappropriate candidate for the study.
• Pregnancy, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test result, or lactating.

Other

• Symptomatic brain metastasis.
• Impaired hepatic function, defined as Child-Pugh class B or C.
• Known contraindication to receive antineoplastic treatment at the planned doses.
• Participation to other clinical trial studies.

• Signed and dated Informed Consent.
• Age ≥ 18 years at time of Informed Consent.
• Histologically- or cytologically-confirmed mCRC.
• Assessed tumour EGFR pathway mutational status (K-RAS, N-RAS), BRAF, HER-2 neu, MSI.
• Sufficient amount of representative tumour specimen (primary or metastatic, archival or newly obtained for confirmatory central laboratory testing of BRAF and KRAS mutational status.
• Dihydropyrimidine dehydrogenase (DPD) before 5-FU infusion.
• Eligibility to receive bevacizumab, cetuximab or panitumumab per locally approved label with regard to tumour RAS status.
• Recurrence of disease after primary radical surgery and adjuvant therapy carried out \> 6 months prior the present trial.
• Evidence of measurable or evaluable non-measurable disease as per RECIST, v1.1
• ECOG PS of 0 or 1.
• Adequate bone marrow function characterized by the following at screening:
  • Absolute neutrophil count (ANC) ≥ 1.5 × 10\^9/L;
  • Platelets ≥ 100 × 10\^9/L;
  • Haemoglobin ≥ 9.0 g/dL.
• Adequate renal function characterized by serum creatinine ≤ 1.5 × upper limit of normal (ULN), or creatinine clearance ≥ 50 mL/min.
• Adequate hepatic function characterized by the following:
  • Serum total bilirubin ≤ 1.5 × ULN and \< 2 mg/dL;
  • Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 × ULN, or ≤ 5 ×ULN in presence of liver metastases.
• Female patients are either postmenopausal for at least 1 year, surgically sterile for at least 6 weeks, or must agree to take appropriate precautions to avoid pregnancy.
• Males must agree to take appropriate precautions to avoid fathering a child from screening through follow-up.