Breast Neoplasms
Conditions
Keywords
Breast cancer, advanced, sunitinib, bevacizumab, paclitaxel, Phase 3
Brief summary
To compare treatment with SU011248 plus paclitaxel versus bevacizumab plus paclitaxel to determine which treatment works better against breast cancer
Detailed description
On May 27, 2009, the independent Data Monitoring Committee (DMC) reviewed the progress of Study A6181094. The DMC determined Study A6181094 had met pre-specified futility criteria and was unlikely to meet its primary endpoint to demonstrate a statistically significant improvement in progression-free survival (PFS) in patients treated with sunitinib plus paclitaxel versus bevacizumab plus paclitaxel. Pfizer notified clinical trial investigators involved in the study and regulatory agencies of these findings. Enrollment in this study has been stopped.
Interventions
Sunitinib 25 mg daily by oral capsules with titration up to 37.5 mg,
Paclitaxel 90 mg/m2 IV, 3 weekly doses every 28 days until progression or unacceptable toxicity.
Bevacizumab 10 mg/kg IV every 2 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of advanced breast cancer. * Measurable disease as per RECIST (Response Evaluation Criterion) in Solid Tumors or bone-only disease. * ECOG (Eastern Cooperative Oncology Group) performance status 0 or 1.
Exclusion criteria
* No prior treatment with cytotoxics in the advanced disease setting. * HER2/neu positive disease unless trastuzumab was previously received or is contraindicated. * Treatment with a taxane in the adjuvant setting unless disease free interval \>12 months after end of treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months or death | Time from date of randomization to the date of the first documentation of objective tumor progression or death due to any cause, whichever occurred first. PFS = (first event date minus randomization date +1) divided by 30.4 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response (DR) | From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months or death due to any cause | DR=time from the first documentation of objective tumor response (CR or PR) that was subsequently confirmed to first documentation of objective disease progression or death due to any cause, whichever was first. DR was calculated as \[the date response ended (ie, date of progressive disease or death) minus first CR or PR date that was subsequently confirmed +1)\] divided by 30.4. |
| Overall Survival (OS) | From date of randomization up to 5 years. Survival follow-up changed to 28-days after treatment discontinuation when study was discontinued. | OS was defined as the time from date of randomization to death due to any cause. OS (in months) was calculated as (date of death minus randomization date +1) divided by 30.4. |
| Percentage of Participants Surviving at 1 and 2 Years | Year 1, Year 2 | Percentage of those surviving at the end of one year or end of 2 years from the first dose of study treatment. |
| European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30) | Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months | EORTC QLQ-C30: global health/QoL, functional domains (physical, role, cognitive, emotional, social), and symptom scales/items (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea). Recall period: past week; response range: not at all to very much, global/QOL range: very poor to excellent. Scale score range: 0 to 100. Higher functional/global QoL score = better functioning and higher symptom score = greater degree of symptoms. |
| Number of Participants With Objective Response | From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months | Objective response = participants with confirmed complete response (CR) or partial response (PR) according to the Response Evaluation Criteria in Solid Tumors (RECIST). A CR was defined as the disappearance of all target lesions. A PR was defined as a \> = 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions. |
| Euro Quality of Life-5 Dimension (EQ-5D) | Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months | EQ-5D: health status in 5 dimensions (mobility, self-care, pain/discomfort, anxiety/depression, usual activities). Three-level scale (1=no problem, 2=some problem, and 3=extreme problem). A single score between 1 and 3 is generated for each domain. For each subject, the outcome rating on the 5 domains could be mapped to a single index through an algorithm. The index ranges between 0 and 1, with the higher score indicating a better health state perceived by the subject. |
| EQ - Visual Analog Scale (EQ-VAS) | Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months | 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. |
| Biomarkers | Day 1 of Cycles 1 through 3 and 5, Day 8 of Cycle 1, and Day 15 of Cycle 1 | Concentrations of plasma proteins (eg, soluble Vascular Endothelial Growth Factor Receptor 2 \[VEGFR2\] and VEGFR3, VEGF-A, placental growth factor \[PlGF\], soluble KIT, and possibly soluble PDGFRβ and PDGF) that may be associated with angiogenesis and tumor proliferation. |
| EORTC QLQ Breast Cancer Module (BR23) | Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months | BR23: measured disease related symptoms of dry mouth, eye pain, hair loss, hot flushes, attractiveness, future health, sexual activity, arm/shoulder pain, breast pain, swollen breast, and skin problems on the breast. Recall period: past week; response range: not at all to very much. Scale score range: 0 to 100. Higher symptom score = greater degree of symptoms. |
Countries
Germany, Italy, Spain, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Sunitinib + Paclitaxel Starting sunitinib doses of 25 mg daily. After Cycle 1, escalation to 37.5 mg daily was permitted in the absence of complicated neutropenia and if all 3 Cycle 1 paclitaxel doses were successfully administered at 90 mg/m\^2, at discretion of the investigator. Paclitaxel could have been reduced to 65 mg/m\^2 based on tolerability; re-escalation to 80 or 90 mg/m\^2 upon recovery was permitted. | 241 |
| Bevacizumab + Paclitaxel Bevacizumab 10 mg/kg; infusion duration according to standard of care. Paclitaxel starting dose of 90 mg/m\^2, as a 1 hour infusion. Paclitaxel could have been reduced to 65 mg/m\^2 based on tolerability; re-escalation to 80 or 90 mg/m\^2 upon recovery was permitted. | 247 |
| Total | 488 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event (AE) | 1 | 5 |
| Overall Study | Death | 9 | 8 |
| Overall Study | Lost to Follow-up | 2 | 1 |
| Overall Study | Objective Progression or Relapse | 111 | 104 |
| Overall Study | Other | 73 | 107 |
| Overall Study | Protocol Violation | 0 | 2 |
| Overall Study | Refused Treatment-Reason Other Than AE | 4 | 7 |
| Overall Study | Study Terminated by Sponsor | 41 | 13 |
Baseline characteristics
| Characteristic | Sunitinib + Paclitaxel | Bevacizumab + Paclitaxel | Total |
|---|---|---|---|
| Age, Customized 18 to 44 years | 38 Participants | 40 Participants | 78 Participants |
| Age, Customized 45 to 64 years | 144 Participants | 137 Participants | 281 Participants |
| Age, Customized more than 65 years | 59 Participants | 70 Participants | 129 Participants |
| Sex: Female, Male Female | 240 Participants | 247 Participants | 487 Participants |
| Sex: Female, Male Male | 1 Participants | 0 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 232 / 235 | 239 / 242 |
| serious Total, serious adverse events | 89 / 235 | 85 / 242 |
Outcome results
Progression-Free Survival (PFS)
Time from date of randomization to the date of the first documentation of objective tumor progression or death due to any cause, whichever occurred first. PFS = (first event date minus randomization date +1) divided by 30.4
Time frame: From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months or death
Population: The intent-to-treat (ITT) population included all patients who were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib + Paclitaxel | Progression-Free Survival (PFS) | 7.4 Months |
| Bevacizumab + Paclitaxel | Progression-Free Survival (PFS) | 9.2 Months |
Biomarkers
Concentrations of plasma proteins (eg, soluble Vascular Endothelial Growth Factor Receptor 2 \[VEGFR2\] and VEGFR3, VEGF-A, placental growth factor \[PlGF\], soluble KIT, and possibly soluble PDGFRβ and PDGF) that may be associated with angiogenesis and tumor proliferation.
Time frame: Day 1 of Cycles 1 through 3 and 5, Day 8 of Cycle 1, and Day 15 of Cycle 1
Population: ITT. Biomarker data were collected, but since the study was stopped early and there were too few events of OS, PFS, etc, data were not analyzed.
Duration of Response (DR)
DR=time from the first documentation of objective tumor response (CR or PR) that was subsequently confirmed to first documentation of objective disease progression or death due to any cause, whichever was first. DR was calculated as \[the date response ended (ie, date of progressive disease or death) minus first CR or PR date that was subsequently confirmed +1)\] divided by 30.4.
Time frame: From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months or death due to any cause
Population: ITT. DR was calculated for the subgroup of subjects with objective response. 78 subjects reported CR or PR response and were analyzed for DR in each treatment group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib + Paclitaxel | Duration of Response (DR) | 6.3 Months |
| Bevacizumab + Paclitaxel | Duration of Response (DR) | 14.8 Months |
EORTC QLQ Breast Cancer Module (BR23)
BR23: measured disease related symptoms of dry mouth, eye pain, hair loss, hot flushes, attractiveness, future health, sexual activity, arm/shoulder pain, breast pain, swollen breast, and skin problems on the breast. Recall period: past week; response range: not at all to very much. Scale score range: 0 to 100. Higher symptom score = greater degree of symptoms.
Time frame: Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months
Population: ITT. BR23 evaluations were not analyzed since enrollment in this study was terminated early for futility at the first interim analysis.
EQ - Visual Analog Scale (EQ-VAS)
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 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months
Population: ITT. EQ-VAS evaluations were not analyzed since enrollment in this study was terminated early for futility at the first interim analysis.
European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30)
EORTC QLQ-C30: global health/QoL, functional domains (physical, role, cognitive, emotional, social), and symptom scales/items (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea). Recall period: past week; response range: not at all to very much, global/QOL range: very poor to excellent. Scale score range: 0 to 100. Higher functional/global QoL score = better functioning and higher symptom score = greater degree of symptoms.
Time frame: Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months
Population: ITT. EORTC QLQ-C30 evaluations were not analyzed since enrollment in this study was terminated early for futility.
Euro Quality of Life-5 Dimension (EQ-5D)
EQ-5D: health status in 5 dimensions (mobility, self-care, pain/discomfort, anxiety/depression, usual activities). Three-level scale (1=no problem, 2=some problem, and 3=extreme problem). A single score between 1 and 3 is generated for each domain. For each subject, the outcome rating on the 5 domains could be mapped to a single index through an algorithm. The index ranges between 0 and 1, with the higher score indicating a better health state perceived by the subject.
Time frame: Day 1 of Cycles 1 through 7 and then odd-numbered cycles thereafter until 18 months
Population: ITT. EQ-5D evaluations were not analyzed since enrollment in this study was terminated early for futility at the first interim analysis.
Number of Participants With Objective Response
Objective response = participants with confirmed complete response (CR) or partial response (PR) according to the Response Evaluation Criteria in Solid Tumors (RECIST). A CR was defined as the disappearance of all target lesions. A PR was defined as a \> = 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.
Time frame: From date of randomization through Day 1 and every 8 weeks thereafter up to 18 months
Population: ITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib + Paclitaxel | Number of Participants With Objective Response | 78 participants |
| Bevacizumab + Paclitaxel | Number of Participants With Objective Response | 78 participants |
Overall Survival (OS)
OS was defined as the time from date of randomization to death due to any cause. OS (in months) was calculated as (date of death minus randomization date +1) divided by 30.4.
Time frame: From date of randomization up to 5 years. Survival follow-up changed to 28-days after treatment discontinuation when study was discontinued.
Population: ITT. The median OS for bevacizumab + paclitaxel at the time of data cut off was not reached; therefore, it could not be calculated.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib + Paclitaxel | Overall Survival (OS) | 17.6 Months |
| Bevacizumab + Paclitaxel | Overall Survival (OS) | NA Months |
Percentage of Participants Surviving at 1 and 2 Years
Percentage of those surviving at the end of one year or end of 2 years from the first dose of study treatment.
Time frame: Year 1, Year 2
Population: ITT.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sunitinib + Paclitaxel | Percentage of Participants Surviving at 1 and 2 Years | Year 1 | 76.8 percentage of participants |
| Sunitinib + Paclitaxel | Percentage of Participants Surviving at 1 and 2 Years | Year 2 | 35.5 percentage of participants |
| Bevacizumab + Paclitaxel | Percentage of Participants Surviving at 1 and 2 Years | Year 1 | 83.7 percentage of participants |
| Bevacizumab + Paclitaxel | Percentage of Participants Surviving at 1 and 2 Years | Year 2 | 61.0 percentage of participants |