Gastrointestinal Stromal Tumor
Conditions
Brief summary
A study to assess the safety and efficacy of SU11248 in patients with gastrointestinal stromal tumor (GIST) whose disease has failed imatinib therapy or who were intolerant to imatinib treatment.
Interventions
50 mg taken orally once a day. 6 week treatment cycle (Schedule 4/2) 4 weeks on study drug/2 weeks off study drug.
50 mg taken orally once a day. 6 week treatment cycle (Schedule 4/2) 4 weeks on study drug/2 weeks off study drug.
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * Histologically-proven diagnosis of malignant GIST not amenable to surgery, radiation or combined modality treatment with curative intent * Failed Gleevec treatment or intolerant to Gleevec therapy Key
Exclusion criteria
* Treatment with any chemotherapy, chemoembolization therapy, immunotherapy, or investigational agent since the last dose of Gleevec
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Progression (TTP) as Assessed by Imaging Studies at End of Double-blind Treatment Phase | Day 28 of each 6-week cycle : duration of double-blind treatment phase | Time from randomization to first documentation of objective tumor progression based on the assessment of an independent, third-party imaging laboratory using RECIST (Response Evaluation Criteria in Solid Tumors). |
| Time to Tumor Progression (TTP) as Assessed in the Double-blind Treatment Phase at End of Study | Day 28 of each 6-week cycle : duration of double-blind treatment phase after Last Subject Last Visit (LSLV) | Time from randomization to first documentation of objective tumor progression based on the assessment of an independent, third-party imaging laboratory using RECIST (Response Evaluation Criteria in Solid Tumors). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival Status of Subjects | clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug | Number of subjects alive at end of study. |
| Overall Survival Based on the Rank Preserving Structural Failure Time Method | clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug | time from date of randomization to date of death due to any cause (rank preserving structural failure time method). |
| Best Overall Tumor Response During Double-blind Treatment Phase | Day 28 of each cycle : duration of double-blind treatment phase | Tumor response according to Response Evaluation Criteria in Solid Tumors (RECIST). |
| Confirmed Objective Response (CR or PR) in Subjects | Day 28 of each cycle : duration of double-blind treatment phase | Overall confirmed objective response = confirmed Complete Response (CR) OR confirmed Partial Response (PR) according to RECIST. Confirmed responses were those that persisted on repeat imaging study ≥ 4 weeks after initial documentation of response. |
| Time to Tumor Response (TTR) | Day 28 of each cycle : duration of double-blind treatment phase | Time from date of randomization to first documentation of objective tumor response that was subsequently confirmed. TTR was only calculated for the subgroup of subjects with a confirmed objective tumor response. |
| Overall Survival | clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug | Time from date of randomization to date of death due to any cause. |
| Time to Pain Progression Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI) | Day 1 & 28 of each cycle : duration of double-blind treatment phase | 25th Quartile: Time to Progression. Progression: a) No change (NC) in MPQ-PPI score (0=no pain to 5=excruciating pain) with increase total analgesic use \>= 50% over baseline OR b) Increase score \>= 1 point with either NC in total analgesic use or increase total analgesic use \>= 50% over baseline. (50th Quartile not achieved.) |
| Subjects With Pain Relief Response Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI) | Day 1 & 28 of each cycle : duration of double-blind treatment phase | MPQ-PPI: 0=no pain to 5= excruciating pain. Pain Relief Response= 1) Decrease by \>= 1 points in MPQ-PPI score with either Decrease or No Change in total analgesic use \>= 50% over baseline OR 2) No change in MPQ-PPI score with Decrease total analgesic use \>= 50% over baseline. |
| Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Day 1 & 28 of each cycle : duration of double-blind treatment phase | Change: median score at observation minus median score at baseline. EQ-VAS score on the self-rated thermometer, indicating the patient's own assessment of their health status from 0 (worst) to 100 (best) imaginable health state. |
| Change From Baseline in EQ-5D Health State Profile Index | Day 1 & 28 of each cycle : duration of double-blind treatment phase | Change: median index score at observation minus median index score at baseline. EQ-5D is a generic instrument that describes health status in 5 dimensions (mobility, self-care, pain/discomfort, anxiety/depression, usual activities) with a weighted health Index based on general population values where where 0.0 = death and 1.0 = perfect health. |
| Duration of Performance Status Maintenance | Day 28 of each cycle : duration of double-blind treatment phase | Time from randomization until the last time the performance status was no worse than at baseline or to death due to cancer in the absence of previous documentation of performance status worsening. |
| Progression Free Survival (PFS) | Day 28 of each cycle : duration of double-blind treatment phase | Time from randomization to first documentation of objective tumor progression or to death due to any cause (on treatment or within 28 days of last dose). |
Countries
Australia, Belgium, Canada, France, Italy, Netherlands, Singapore, Spain, Switzerland, United Kingdom, United States
Participant flow
Recruitment details
Enrollment began (medical clinic) in December 2003. Study was unblinded on 27 January 2005 (end of Double-blind treatment). Subjects experiencing disease progression could crossover to Open-label treatment. Open-label data collection ended May 2008.
Pre-assignment details
361 subjects randomized to double-blind treatment in 2:1 ratio (sunitinib vs. Placebo). 255 subjects continued on or crossed over to Open-label treatment.
Participants by arm
| Arm | Count |
|---|---|
| Sunitinib Double-Blind Treatment Starting dose: 50 mg orally once daily as a single agent for 4 consecutive weeks followed by a 2-week off-treatment period to form a complete cycle of 6 weeks. (Schedule 4/2). Subjects received best supportive care in addition to the study treatment. | 243 |
| Placebo Double-Blind Treatment Starting daily dose of 1 capsule, size- and color-matched to the sunitinib 50-mg capsule for 4 consecutive weeks followed by a 2-week off-treatment period to form a complete cycle of 6 weeks (Schedule 4/2). Subjects received best supportive care in addition to the study treatment. Subjects were provided the opportunity to receive open-label sunitinib at the time of confirmed disease progression or study unblinding. | 118 |
| Total | 361 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Double-Blind Treatment | Adverse Event | 23 | 4 | 0 |
| Double-Blind Treatment | Decision of Sponsor | 0 | 1 | 0 |
| Double-Blind Treatment | Lack of Efficacy | 58 | 6 | 0 |
| Double-Blind Treatment | Lost to Follow-up | 1 | 0 | 0 |
| Double-Blind Treatment | No study medication taken | 2 | 0 | 0 |
| Double-Blind Treatment | Withdrawal by Subject | 7 | 4 | 0 |
| Open-Label Treatment | Adverse Event | 0 | 0 | 51 |
| Open-Label Treatment | Decision of Sponsor | 0 | 0 | 8 |
| Open-Label Treatment | enrolled in a separate continuation | 0 | 0 | 9 |
| Open-Label Treatment | Lack of Efficacy | 0 | 0 | 174 |
| Open-Label Treatment | Protocol Violation | 0 | 0 | 1 |
| Open-Label Treatment | Withdrawal by Subject | 0 | 0 | 12 |
Baseline characteristics
| Characteristic | Sunitinib Double-Blind Treatment | Placebo Double-Blind Treatment | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0.0 Participants |
| Age, Categorical >=65 years | 73 Participants | 37 Participants | 110.0 Participants |
| Age, Categorical Between 18 and 65 years | 170 Participants | 81 Participants | 251.0 Participants |
| Sex: Female, Male Female | 91 Participants | 71 Participants | 162.0 Participants |
| Sex: Female, Male Male | 152 Participants | 47 Participants | 199.0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 223 / — | 110 / — | 254 / — |
| serious Total, serious adverse events | 83 / — | 27 / — | 122 / — |
Outcome results
Time to Tumor Progression (TTP) as Assessed by Imaging Studies at End of Double-blind Treatment Phase
Time from randomization to first documentation of objective tumor progression based on the assessment of an independent, third-party imaging laboratory using RECIST (Response Evaluation Criteria in Solid Tumors).
Time frame: Day 28 of each 6-week cycle : duration of double-blind treatment phase
Population: From the Intent to Treat (ITT) population, 82 subjects on sunitinib treatment were observed to have disease progression during blinded phase and were included in TTP analysis. 67 subjects on placebo were observed to have disease progression during blinded phase.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Time to Tumor Progression (TTP) as Assessed by Imaging Studies at End of Double-blind Treatment Phase | 27.3 weeks |
| Placebo Double-Blind Treatment | Time to Tumor Progression (TTP) as Assessed by Imaging Studies at End of Double-blind Treatment Phase | 6.4 weeks |
Time to Tumor Progression (TTP) as Assessed in the Double-blind Treatment Phase at End of Study
Time from randomization to first documentation of objective tumor progression based on the assessment of an independent, third-party imaging laboratory using RECIST (Response Evaluation Criteria in Solid Tumors).
Time frame: Day 28 of each 6-week cycle : duration of double-blind treatment phase after Last Subject Last Visit (LSLV)
Population: From the Intent to Treat (ITT) population, 91 subjects on sunitinib treatment were observed to have disease progression during blinded phase and were included in TTP analysis. 73 subjects on placebo were observed to have disease progression during blinded phase.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Time to Tumor Progression (TTP) as Assessed in the Double-blind Treatment Phase at End of Study | 26.6 weeks |
| Placebo Double-Blind Treatment | Time to Tumor Progression (TTP) as Assessed in the Double-blind Treatment Phase at End of Study | 6.4 weeks |
Best Overall Tumor Response During Double-blind Treatment Phase
Tumor response according to Response Evaluation Criteria in Solid Tumors (RECIST).
Time frame: Day 28 of each cycle : duration of double-blind treatment phase
Population: ITT population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Complete Response (CR) | 0 participants |
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Partial Response (PR) | 16 participants |
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Stable Disease | 128 participants |
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Progressive Disease | 45 participants |
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Unable to Evaluate | 1 participants |
| Sunitinib Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Missing | 53 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Unable to Evaluate | 0 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Complete Response (CR) | 0 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Progressive Disease | 44 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Partial Response (PR) | 0 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Missing | 24 participants |
| Placebo Double-Blind Treatment | Best Overall Tumor Response During Double-blind Treatment Phase | Stable Disease | 50 participants |
Change From Baseline in EQ-5D Health State Profile Index
Change: median index score at observation minus median index score at baseline. EQ-5D is a generic instrument that describes health status in 5 dimensions (mobility, self-care, pain/discomfort, anxiety/depression, usual activities) with a weighted health Index based on general population values where where 0.0 = death and 1.0 = perfect health.
Time frame: Day 1 & 28 of each cycle : duration of double-blind treatment phase
Population: ITT Population. Number subjects with evaluable data: (n=sunitinib, placebo)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 1 Day 28 (n=185, 87) | 0.000 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 2 Day 1 (n=149, 53) | 0.000 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 2 Day 28 (n=129, 41) | -0.017 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 3 Day 1 (n=104, 17) | 0.000 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 3 Day 28 (n=91, 13) | -0.036 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 4 Day 1 (n=74, 10) | 0.000 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 3 Day 28 (n=91, 13) | 0.000 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 1 Day 28 (n=185, 87) | 0.000 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 3 Day 1 (n=104, 17) | 0.000 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 2 Day 1 (n=149, 53) | 0.000 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 4 Day 1 (n=74, 10) | 0.059 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline in EQ-5D Health State Profile Index | Cycle 2 Day 28 (n=129, 41) | 0.000 score on scale |
Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS)
Change: median score at observation minus median score at baseline. EQ-VAS score on the self-rated thermometer, indicating the patient's own assessment of their health status from 0 (worst) to 100 (best) imaginable health state.
Time frame: Day 1 & 28 of each cycle : duration of double-blind treatment phase
Population: ITT population. Number subjects with evaluable data: (n=sunitinib, placebo)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 1 Day 28 (n=187, 89) | -3.0 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 2 Day 1 (n=148, 53) | 0.0 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 2 Day 28 (n=132, 41) | -4.5 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 3 Day 1 (n=102,16) | 0.0 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 3 Day 28 (n=91,13) | -5.0 score on scale |
| Sunitinib Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 4 Day 1 (n=73,10) | 0.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 3 Day 28 (n=91,13) | -1.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 1 Day 28 (n=187, 89) | 0.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 3 Day 1 (n=102,16) | 0.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 2 Day 1 (n=148, 53) | 0.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 4 Day 1 (n=73,10) | 5.0 score on scale |
| Placebo Double-Blind Treatment | Change From Baseline Score in EuroQoL Visual Analog Scale (EQ-VAS) | Cycle 2 Day 28 (n=132, 41) | 0.0 score on scale |
Confirmed Objective Response (CR or PR) in Subjects
Overall confirmed objective response = confirmed Complete Response (CR) OR confirmed Partial Response (PR) according to RECIST. Confirmed responses were those that persisted on repeat imaging study ≥ 4 weeks after initial documentation of response.
Time frame: Day 28 of each cycle : duration of double-blind treatment phase
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Confirmed Objective Response (CR or PR) in Subjects | 16 participants |
| Placebo Double-Blind Treatment | Confirmed Objective Response (CR or PR) in Subjects | 0 participants |
Duration of Performance Status Maintenance
Time from randomization until the last time the performance status was no worse than at baseline or to death due to cancer in the absence of previous documentation of performance status worsening.
Time frame: Day 28 of each cycle : duration of double-blind treatment phase
Population: ITT Population. Number of subjects at median observed to have status worsening or died before status worsening.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Duration of Performance Status Maintenance | 18.9 weeks |
Overall Survival
Time from date of randomization to date of death due to any cause.
Time frame: clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug
Population: ITT population; Number subjects Dead = 176, 90 (sunitinib, placebo respectively). Subjects who were not known to be dead at the time the database was closed for analysis were censored on the date they were last known to be alive.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Overall Survival | 72.7 weeks |
| Placebo Double-Blind Treatment | Overall Survival | 64.9 weeks |
Overall Survival Based on the Rank Preserving Structural Failure Time Method
time from date of randomization to date of death due to any cause (rank preserving structural failure time method).
Time frame: clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug
Population: ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Overall Survival Based on the Rank Preserving Structural Failure Time Method | 72.7 weeks |
| Placebo Double-Blind Treatment | Overall Survival Based on the Rank Preserving Structural Failure Time Method | 39.0 weeks |
Overall Survival Status of Subjects
Number of subjects alive at end of study.
Time frame: clinic visit or telephone contact every 2 months for up to 3 years from the last dose of study drug
Population: ITT population.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sunitinib Double-Blind Treatment | Overall Survival Status of Subjects | Dead | 176 participants |
| Sunitinib Double-Blind Treatment | Overall Survival Status of Subjects | Alive | 67 participants |
| Placebo Double-Blind Treatment | Overall Survival Status of Subjects | Alive | 28 participants |
| Placebo Double-Blind Treatment | Overall Survival Status of Subjects | Dead | 90 participants |
Progression Free Survival (PFS)
Time from randomization to first documentation of objective tumor progression or to death due to any cause (on treatment or within 28 days of last dose).
Time frame: Day 28 of each cycle : duration of double-blind treatment phase
Population: ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Progression Free Survival (PFS) | 22.9 weeks |
| Placebo Double-Blind Treatment | Progression Free Survival (PFS) | 6.0 weeks |
Subjects With Pain Relief Response Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI)
MPQ-PPI: 0=no pain to 5= excruciating pain. Pain Relief Response= 1) Decrease by \>= 1 points in MPQ-PPI score with either Decrease or No Change in total analgesic use \>= 50% over baseline OR 2) No change in MPQ-PPI score with Decrease total analgesic use \>= 50% over baseline.
Time frame: Day 1 & 28 of each cycle : duration of double-blind treatment phase
Population: Pain-Relief-Response population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Subjects With Pain Relief Response Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI) | 46 participants |
| Placebo Double-Blind Treatment | Subjects With Pain Relief Response Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI) | 10 participants |
Time to Pain Progression Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI)
25th Quartile: Time to Progression. Progression: a) No change (NC) in MPQ-PPI score (0=no pain to 5=excruciating pain) with increase total analgesic use \>= 50% over baseline OR b) Increase score \>= 1 point with either NC in total analgesic use or increase total analgesic use \>= 50% over baseline. (50th Quartile not achieved.)
Time frame: Day 1 & 28 of each cycle : duration of double-blind treatment phase
Population: Pain-Relief-Response population. Subjects at 25th Quartile with pain progress during blinded phase.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Time to Pain Progression Using McGill Pain Questionnaire-present Pain Intensity (MPQ-PPI) | 12.1 weeks (25th Quartile) |
Time to Tumor Response (TTR)
Time from date of randomization to first documentation of objective tumor response that was subsequently confirmed. TTR was only calculated for the subgroup of subjects with a confirmed objective tumor response.
Time frame: Day 28 of each cycle : duration of double-blind treatment phase
Population: ITT population. Number of subjects analyzed = number of subjects with tumor response.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib Double-Blind Treatment | Time to Tumor Response (TTR) | 13.4 weeks |