Carcinoma, Renal Cell
Conditions
Keywords
Renal Cell Cancer (RCC), Cancer
Brief summary
The purpose of this study is to evaluate safety, efficacy (including quality of life), and pharmacokinetics of BAY43-9006 when added to Best Supportive Care in patients with unresectable and/or metastatic renal cell cancer, who have received one prior systemic regimen for advanced disease.
Detailed description
Overall Survival (OS), Patient-reported outcome (PRO)
Interventions
Multi Kinase Inhibitor
Placebo
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients with unresectable and/or metastatic, measurable renal cell carcinoma histologically or cytologically documented * Patients must have had one prior systemic therapy for advanced disease, which was completed at least 30 days but no longer than 8 months prior to randomization * Patients who have at least one uni-dimensional measurable lesion by CT-scan or MRI according to Response Evaluation Criteria in Solid Tumors (RECIST) * Patients who have an Eastern Co-operative Oncology Group (ECOG) performance status of 0 or 1 * Patients who have adequate coagulation, liver and kidney functions
Exclusion criteria
* Patients with rare subtypes of renal cell carcinoma (RCC) such as pure papillary cell tumors, mixed tumor containing predominantly sarcomatoid cells, Bellini carcinoma, medullary carcinoma, or chromophobe oncocytic tumors * Previous malignancy (except for cervical carcinoma in situ, adequately treated basal cell carcinoma,or superficial bladder tumors, or other malignancies curatively treated \> 2 years prior to entry * Cardiac arrhythmias requiring anti-arrhythmics, symptomatic coronary artery disease or ischemia or congestive heart failure * Patients with a history of human immunodeficiency virus (HIV) infection or chronic hepatitis B or C * Patients with a history or presence of metastatic brain or meningeal tumors * Patients with seizure disorder requiring medication (such as anti-epileptics) * History of organ allograft or bone marrow transplant of stem cell rescue * Patients who are pregnant or breast-feeding Women of childbearing potential must have a negative pregnancy test prior to drug administration. Both men and women enrolled in this trial must use adequate birth control * Patients who have three or more of the following: * ECOG performance status greater than or equal to 2, * Abnormally high lactate dehydrogenase, * Abnormally high serum hemoglobin, * Abnormally high corrected serum calcium, * Absence of prior nephrectomy * Excluded therapies and medications, previous and concomitant: * Concurrent anti-cancer chemotherapy, immunotherapy or hormonal therapy except biphosphonates * Significant surgery with 4 weeks of start of study * Investigational drug therapy during or within 30 days * Concomitant treatment with rifampin or St. John's Wort * Prior use of Raf-kinase inhibitors (RKI), MEK or Farnesyl transferase inhibitors * Prior use of Bevacizumab, and all other drugs (investigational or licensed) that target VEGF/VEGF receptors
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Final Overall Survival (OS) - Primary Analysis in the ITT (Intent To Treat) Population | From start of randomization of the first subject (1Dec2003) until the data cut-off (8Sep2006) for the final OS analysis, approximately 33 months later | Overall survival determined as the time (days) from the date of randomization at start of study to the date of death, due to any cause. Outcome measure was assessed regularly, i.e. every 3 weeks for the first 24 weeks during treatment and every 4 weeks thereafter and approximately every 3 months during post-treatment. |
| Final Overall Survival - Secondary Analysis (Placebo Data Censored at 30June2005) in the ITT Population | From start of randomization of the first subject (1Dec2003) until the data cut-off (8Sep2006) for the final OS analysis, approximately 33 months later | Overall survival determined as the time (days) from the date of randomization at start of study to the date of death, due to any cause. Outcome measure was assessed regularly, i.e. every 3 weeks for the first 24 weeks during treatment and every 4 weeks thereafter and approximately every 3 months during post-treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Final Progression-Free Survival (PFS) - Independent Radiological Review | From start of randomization of the first subject (1Dec2003) until the data cut-off (28Jan2005), approximately 14 months later, tumors assessed every 8 weeks. | PFS determined as the time (days) from the date of randomization at start of study to the actual date of disease progression (PD) (radiological or clinical) or death due to any cause, if death occurred before PD. Outcome measure was assessed approximately every 8 weeks using RECIST v1.0 criteria by independent radiologic review. Radiological PD defined as at least 20% increase in sum of longest diameter (LD) of measured lesions taking as reference smallest sum LD recorded since treatment started or appearance of new lesions. |
| Best Overall Response - Independent Radiological Review | From start of randomization of the first subject (1Dec2003) until the data cut-off (28Jan2005), approximately 14 months later, tumors assessed every 8 weeks. | Best overall response was determined according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.0 by independent radiologic review. Categories: complete response (CR, tumor disappears), partial response (PR, sum of lesion sizes decreased), stable disease (SD, steady state of disease), progressive disease (PD, sum of lesion sizes increased) and not evaluated. |
| Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | From start of randomization of the first subject (1Dec2003) until the data cut-off (31May2005), approximately 18 months later, PRO data collected at Day 1 of each cycle and end of treatment. | Primary Analysis for FKSI-10 patient-reported outcome (PRO) measure defined as longitudinal analysis of mean score over the first 5 treatment cycles. FKSI-10 patient responses for each question range from 0=not at all to 4=very much and after reverse coding the range of values for FKSI-10 total score is from 0 to 40; higher score represents better HRQOL. |
| Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | From start of randomization of the first subject (1Dec2003) until the data cut-off (31May2005), approximately 18 months later, PRO data collected at Day 1 of each cycle and end of treatment. | Primary Analysis for FACT-G (using PWB score) patient-reported outcome (PRO) measure defined as longitudinal analysis of mean score over the first 5 treatment cycles. FACT-G (PWB score) patient responses for each question range from 0=not at all to 4=very much and after reverse coding the total FACT-G (PWB score) range of values is from 0 to 28; higher score represents better HRQOL. |
Countries
Argentina, Australia, Belgium, Brazil, Canada, Chile, France, Germany, Hungary, Israel, Italy, Netherlands, Poland, Russia, South Africa, Spain, Ukraine, United Kingdom, United States
Participant flow
Recruitment details
From randomization start on 01 Dec 2003 to 31 May 2005 \[last subject randomized\]. One subject randomized in Placebo did not receive treatment. This study was conducted at 120 centers from 19 countries.
Pre-assignment details
Enrollment included outpatients with documented unresectable and/or metastatic RCC (Renal Cell Carcinoma), and subjects who had 1 prior systemic therapy for advanced disease on which the subject progressed, at least 1 unidimensional measurable lesion, intermediate or low Motzer risk score, life expectancy of 12 weeks.
Participants by arm
| Arm | Count |
|---|---|
| Sorafenib (Nexavar, BAY43-9006) Sorafenib was to be orally administered as 2 x 200 mg tablets bid (twice daily). Dose modification due to toxicity was permitted. | 451 |
| Placebo Subjects received matching placebo tablets administered orally twice a day. \[until \
31 May 2005\] | 452 |
| Total | 903 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Double-Blind (DB, as of ~31May2005) | Adverse Event | 22 | 17 | 0 |
| Double-Blind (DB, as of ~31May2005) | entered Open Label (OL); Sorafenib only | 165 | 114 | 0 |
| Double-Blind (DB, as of ~31May2005) | Lost to Follow-up | 1 | 6 | 0 |
| Double-Blind (DB, as of ~31May2005) | Non-compliant with Study medication | 1 | 2 | 0 |
| Double-Blind (DB, as of ~31May2005) | Protocol driven decision point | 0 | 1 | 0 |
| Double-Blind (DB, as of ~31May2005) | Protocol Violation | 1 | 1 | 0 |
| Double-Blind (DB, as of ~31May2005) | Subject did not receive treatment | 0 | 1 | 0 |
| Double-Blind (DB, as of ~31May2005) | Unknown reason. | 1 | 0 | 0 |
| Double-Blind (DB, as of ~31May2005) | Withdrawal by Subject | 6 | 11 | 0 |
| Open Label-Sorafenib Only [30Jun2008] | Adverse Event | 17 | 0 | 19 |
| Open Label-Sorafenib Only [30Jun2008] | Did not enter OL/ Sorafenib only phase | 35 | 0 | 83 |
| Open Label-Sorafenib Only [30Jun2008] | Lost to Follow-up | 2 | 0 | 2 |
| Open Label-Sorafenib Only [30Jun2008] | Missing | 3 | 0 | 1 |
| Open Label-Sorafenib Only [30Jun2008] | No record of treatment discontinuation | 19 | 0 | 9 |
| Open Label-Sorafenib Only [30Jun2008] | Per Investigator, not protocol driven | 1 | 0 | 1 |
| Open Label-Sorafenib Only [30Jun2008] | Study terminated by Sponsor | 37 | 0 | 28 |
| Open Label-Sorafenib Only [30Jun2008] | Switched to commercial drug | 1 | 0 | 1 |
| Open Label-Sorafenib Only [30Jun2008] | Switched to commercial drug (code error) | 0 | 0 | 3 |
| Open Label-Sorafenib Only [30Jun2008] | Withdrawal by Subject | 19 | 0 | 9 |
Baseline characteristics
| Characteristic | Sorafenib (Nexavar, BAY43-9006) | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 58.0 Years | 59.0 Years | 59.0 Years |
| Age, Customized <65 years | 304 Participants | 328 Participants | 632 Participants |
| Age, Customized >= 65 years | 147 Participants | 124 Participants | 271 Participants |
| Cancer Subtypes Clear Cell | 449 Participants with carcinoma type | 447 Participants with carcinoma type | 896 Participants with carcinoma type |
| Cancer Subtypes Granular | 1 Participants with carcinoma type | 2 Participants with carcinoma type | 3 Participants with carcinoma type |
| Cancer Subtypes Papillary | 1 Participants with carcinoma type | 3 Participants with carcinoma type | 4 Participants with carcinoma type |
| ECOG Performance Status (PS) Missing | 2 Participants by scale | 2 Participants by scale | 4 Participants by scale |
| ECOG Performance Status (PS) PS 0 | 219 Participants by scale | 211 Participants by scale | 430 Participants by scale |
| ECOG Performance Status (PS) PS 1 | 223 Participants by scale | 235 Participants by scale | 458 Participants by scale |
| ECOG Performance Status (PS) PS 2 | 7 Participants by scale | 4 Participants by scale | 11 Participants by scale |
| Motzer Category (Low, intermediate or high) Intermediate | 217 Participants | 232 Participants | 449 Participants |
| Motzer Category (Low, intermediate or high) Low | 234 Participants | 219 Participants | 453 Participants |
| Motzer Category (Low, intermediate or high) Missing | 0 Participants | 1 Participants | 1 Participants |
| Sex: Female, Male Female | 136 Participants | 112 Participants | 248 Participants |
| Sex: Female, Male Male | 315 Participants | 340 Participants | 655 Participants |
| TNM Classification at study entry Stage III | 18 Participants | 14 Participants | 32 Participants |
| TNM Classification at study entry Stage IV | 433 Participants | 438 Participants | 871 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 407 / 451 | 346 / 451 | 425 / 452 | 200 / 216 |
| serious Total, serious adverse events | 154 / 451 | 110 / 451 | 245 / 452 | 124 / 216 |
Outcome results
Final Overall Survival (OS) - Primary Analysis in the ITT (Intent To Treat) Population
Overall survival determined as the time (days) from the date of randomization at start of study to the date of death, due to any cause. Outcome measure was assessed regularly, i.e. every 3 weeks for the first 24 weeks during treatment and every 4 weeks thereafter and approximately every 3 months during post-treatment.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (8Sep2006) for the final OS analysis, approximately 33 months later
Population: Evaluations based on ITT population. Subjects alive at time of analysis were censored at last date of follow-up (FU) (last visit or contact or at data cut-off date). In case of incomplete date, day was missing, day 15 was used.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Final Overall Survival (OS) - Primary Analysis in the ITT (Intent To Treat) Population | 542 days |
| Placebo | Final Overall Survival (OS) - Primary Analysis in the ITT (Intent To Treat) Population | 461 days |
Final Overall Survival - Secondary Analysis (Placebo Data Censored at 30June2005) in the ITT Population
Overall survival determined as the time (days) from the date of randomization at start of study to the date of death, due to any cause. Outcome measure was assessed regularly, i.e. every 3 weeks for the first 24 weeks during treatment and every 4 weeks thereafter and approximately every 3 months during post-treatment.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (8Sep2006) for the final OS analysis, approximately 33 months later
Population: Evaluations based on ITT population. Subjects alive at time of analysis were censored at last date of FU (last visit or contact or at data cut-off date). In case of incomplete date, missing day, day 15 was used. Placebo censored at 30June2005, approximate time of crossover of placebo subjects to sorafenib. NA - not estimable due to censored data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Final Overall Survival - Secondary Analysis (Placebo Data Censored at 30June2005) in the ITT Population | 542 days |
| Placebo | Final Overall Survival - Secondary Analysis (Placebo Data Censored at 30June2005) in the ITT Population | 436 days |
Best Overall Response - Independent Radiological Review
Best overall response was determined according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.0 by independent radiologic review. Categories: complete response (CR, tumor disappears), partial response (PR, sum of lesion sizes decreased), stable disease (SD, steady state of disease), progressive disease (PD, sum of lesion sizes increased) and not evaluated.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (28Jan2005), approximately 14 months later, tumors assessed every 8 weeks.
Population: Evaluations of best overall response based on the valid for response population, where as per protocol, subjects were to have first post-baseline tumor evaluation performed at the end of Cycle 1 (6 weeks post-randomization). Of the ITT population that met this criteria as of the 28Jan2005 data cut, 672 subjects were valid for response.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Best Overall Response - Independent Radiological Review | Partial Response | 2.1 percentage of participants |
| Sorafenib (Nexavar, BAY43-9006) | Best Overall Response - Independent Radiological Review | Progressive Disease | 8.7 percentage of participants |
| Sorafenib (Nexavar, BAY43-9006) | Best Overall Response - Independent Radiological Review | Stable Disease | 77.9 percentage of participants |
| Sorafenib (Nexavar, BAY43-9006) | Best Overall Response - Independent Radiological Review | Not Evaluated | 11.3 percentage of participants |
| Sorafenib (Nexavar, BAY43-9006) | Best Overall Response - Independent Radiological Review | Complete Response | 0.0 percentage of participants |
| Placebo | Best Overall Response - Independent Radiological Review | Not Evaluated | 14.5 percentage of participants |
| Placebo | Best Overall Response - Independent Radiological Review | Complete Response | 0.0 percentage of participants |
| Placebo | Best Overall Response - Independent Radiological Review | Partial Response | 0.0 percentage of participants |
| Placebo | Best Overall Response - Independent Radiological Review | Stable Disease | 55.2 percentage of participants |
| Placebo | Best Overall Response - Independent Radiological Review | Progressive Disease | 30.3 percentage of participants |
Final Progression-Free Survival (PFS) - Independent Radiological Review
PFS determined as the time (days) from the date of randomization at start of study to the actual date of disease progression (PD) (radiological or clinical) or death due to any cause, if death occurred before PD. Outcome measure was assessed approximately every 8 weeks using RECIST v1.0 criteria by independent radiologic review. Radiological PD defined as at least 20% increase in sum of longest diameter (LD) of measured lesions taking as reference smallest sum LD recorded since treatment started or appearance of new lesions.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (28Jan2005), approximately 14 months later, tumors assessed every 8 weeks.
Population: Evaluations based on ITT population as of 28Jan2005 data cut; 769 subjects randomized at that time. PFS determined as time from randomization to actual date of disease progression (PD) (radiological or clinical) or death, if death occurred before PD. Subjects without PD or death at time of analysis were censored at last date of tumor assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Final Progression-Free Survival (PFS) - Independent Radiological Review | 167 days |
| Placebo | Final Progression-Free Survival (PFS) - Independent Radiological Review | 84 days |
Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment
Primary Analysis for FKSI-10 patient-reported outcome (PRO) measure defined as longitudinal analysis of mean score over the first 5 treatment cycles. FKSI-10 patient responses for each question range from 0=not at all to 4=very much and after reverse coding the range of values for FKSI-10 total score is from 0 to 40; higher score represents better HRQOL.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (31May2005), approximately 18 months later, PRO data collected at Day 1 of each cycle and end of treatment.
Population: Evaluations based on ITT population with a PRO assessment. Day 1, Cycle 1 served as baseline assessment.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 3, Day 1 | 27.27 Scores on a scale | Standard Error 0.22 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 5, Day 1 | 26.27 Scores on a scale | Standard Error 0.3 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 2, Day 1 | 27.77 Scores on a scale | Standard Error 0.23 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycles 1-5 (Overall) | 27.19 Scores on a scale | Standard Error 0.23 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 4, Day 1 | 26.77 Scores on a scale | Standard Error 0.25 |
| Placebo | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycles 1-5 (Overall) | 27.20 Scores on a scale | Standard Error 0.23 |
| Placebo | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 2, Day 1 | 27.78 Scores on a scale | Standard Error 0.22 |
| Placebo | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 3, Day 1 | 27.28 Scores on a scale | Standard Error 0.23 |
| Placebo | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 4, Day 1 | 26.78 Scores on a scale | Standard Error 0.26 |
| Placebo | Health-related Quality of Life (HRQOL) by FKSI-10 (Functional Assessment of General Therapy Kidney Symptom Index 10) Assessment | Cycle 5, Day 1 | 26.28 Scores on a scale | Standard Error 0.31 |
Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment
Primary Analysis for FACT-G (using PWB score) patient-reported outcome (PRO) measure defined as longitudinal analysis of mean score over the first 5 treatment cycles. FACT-G (PWB score) patient responses for each question range from 0=not at all to 4=very much and after reverse coding the total FACT-G (PWB score) range of values is from 0 to 28; higher score represents better HRQOL.
Time frame: From start of randomization of the first subject (1Dec2003) until the data cut-off (31May2005), approximately 18 months later, PRO data collected at Day 1 of each cycle and end of treatment.
Population: Evaluations based on ITT population with a PRO assessment. Day 1, Cycle 1 served as baseline assessment.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 3, Day 1 | 20.77 Scores on a scale | Standard Error 0.17 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 5, Day 1 | 19.89 Scores on a scale | Standard Error 0.24 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 4, Day 1 | 20.33 Scores on a scale | Standard Error 0.19 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycles 1-5 (Overall) | 20.70 Scores on a scale | Standard Error 0.17 |
| Sorafenib (Nexavar, BAY43-9006) | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 2, Day 1 | 21.21 Scores on a scale | Standard Error 0.17 |
| Placebo | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycles 1-5 (Overall) | 20.65 Scores on a scale | Standard Error 0.19 |
| Placebo | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 2, Day 1 | 21.16 Scores on a scale | Standard Error 0.19 |
| Placebo | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 3, Day 1 | 20.72 Scores on a scale | Standard Error 0.19 |
| Placebo | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 4, Day 1 | 20.28 Scores on a scale | Standard Error 0.22 |
| Placebo | Health-related Quality of Life (HRQOL) by Physical Well-Being (PWB) Score of the FACT-G (Functional Assessment of Cancer Therapy-General Version) Assessment | Cycle 5, Day 1 | 19.84 Scores on a scale | Standard Error 0.26 |