Anemia, Cancer, Neoplasms
Conditions
Keywords
Anemia, Cancer, Chemotherapy-Induced Anemia, Epoetin alfa, Darbepoetin alfa
Brief summary
The purpose of this study is to compare hemoglobin response rates between two PROCRIT (epoetin alfa) doses and ARANESP (darbepoetin alfa) in anemic cancer patients receiving chemotherapy
Detailed description
This is an open-label (both the physician and the patient know which treatment is being provided), multi-center study of up to 16 weeks duration in which 450 patients will be randomly assigned (patients are assigned to a specific study group by chance) to one of three treatment groups in a 1:1:1 ratio. Patients will receive PROCRIT (epoetin alfa) 80,000 Units injected subcutaneously (under the skin) once every three weeks or 120,000 Units injected under the skin once every three weeks or ARANESP (darbepoetin alfa) 500 mcg injected under the skin once every three weeks for up to 13 weeks. PROCRIT (epoetin alfa) 80,000 Units and 120,000 Units given once every three weeks are doses and schedules that are not approved for use in the United States and are under investigation, while the ARANESP dose and schedule are approved for use in the United States. Adult patients with specific types of cancer (confirmed non-myeloid malignancy) who are scheduled to receive cyclic chemotherapy for a minimum of 12 weeks during the study and who meet all other eligibility criteria will be enrolled. This study will be conducted in approximately 80 study sites located in the United States. The study hypothesis is that a dosing regimen of PROCRIT (Epoetin alfa) 80,000 Units or 120,000 Units given once every three weeks is non-inferior to ARANESP 500 mcg given once every three weeks with respect to the mean hemoglobin (Hb) change from baseline to Study Week 7 in anemic cancer patients receiving chemotherapy. Hemoglobin levels will be monitored throughout the study on a weekly basis and before each drug dose is administered. Drug dosing will be adjusted (ie, held, reduced, resumed at a lower dose) as needed to maintain hemoglobin values within desired ranges. The maximum dose of PROCRIT (Epoetin alfa) allowed in this study is 120,000 Units every three weeks (Q3W) and the maximum dose of ARANESP (darbepoetin) is 500 mcg Q3W. Safety evaluations will be conducted throughout the study and will consist of assessment of laboratory tests, vital signs, physical examinations. The occurrence and severity of adverse events, including thrombovascular events will be evaluated throughout the study.Periodic data monitoring of the study by an external Independent Data Monitoring Committee (IDMC) will be performed. The main responsibility of the IDMC is to conduct ongoing monitoring of safety and to report any irregularities back to the Sponsor along with recommendations regarding continuation of the study. Each patient will be assigned to one of three dosing schedules. All schedules will be administered by way of subcutaneous (under the skin) injection once every three weeks over a period of 13 weeks. The three dosing schedules are as follows: PROCRIT (epoetin alfa) 80,000 Units, PROCRIT (epoetin alfa) 120,000 Units or ARANESP (darbepoetin alfa) 500 mcg
Interventions
80,000 Units and 120,000 Units of epoetin alfa (PROCRIT) injected subcutaneously once every 3 weeks for up to 13 weeks
500 mcg of darbepoetin alfa (ARANESP) injected subcutaneously the skin once every 3 weeks for up to 13 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically confirmed diagnosis of a non-myeloid malignancy * Baseline hemoglobin (Hb) value of \<= 11.0 g/dL unrelated to transfusion * No Packed Red Blood Cell (PRBC) or platelet transfusions in the 28 days prior to randomization * Scheduled to receive chemotherapy for a minimum of 12 weeks during the study * Eastern Cooperative Oncology Group (ECOG) Performance Status 0 - 2
Exclusion criteria
* No planned non-palliative radiation during the study * No current anemia due to factors other than cancer/chemotherapy (eg, iron deficiency or gastrointestinal bleeding) * No uncontrolled hypertension (defined as systolic pressure \> 180 and/or a diastolic pressure \> 100 mmHg while receiving antihypertension therapy) * No history of Deep Venous Thrombosis (DVT) or Pulmonary Embolus (PE) within 12 months before study enrollment. Prior superficial thrombophlebitis is not an exclusion criterion * No history of Cerebrovascular Accident (CVA), Transient Ischemic Attack (TIA), Acute Coronary Syndrome (ACS) including unstable angina and myocardial infarction with or without ST elevation, or other arterial thrombosis within 6 months before study enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemoglobin (Hb) Change From Baseline to Study Week 7 | Baseline (Week 1) and Week 7 | Baseline Hb was the Hb value that was consistent with the inclusion criteria and which was obtained within 72 hours of the first dose of study medication |
Secondary
| Measure | Time frame |
|---|---|
| Number of Patients Receiving at Least 1 Packed Red Blood Cell (PRBC) Transfusion During Study | up to 16 weeks |
| Time to Achieve Hb >= 11 g/dL During Study | up to 16 weeks |
| Number of Patients (Hb >= 11 g/dL) During Study. | up to 16 weeks |
Countries
United States
Participant flow
Pre-assignment details
Number of participants randomized:- epoetin alfa (80,000 Units): 77, epoetin alfa (120,000 Units): 80, darbepoetin alfa (500 mcg): 78; Number of participants treated:- epoetin alfa (80,000 Units): 75, epoetin alfa (120,000 Units): 77, darbepoetin alfa (500 mcg): 75.
Participants by arm
| Arm | Count |
|---|---|
| Epoetin Alfa (80,000 Units) epoetin alfa (PROCRIT) 80,000 Units subcutaneous (SC) once every 3 weeks (Q3W) for up to 13 weeks | 77 |
| Epoetin Alfa (120,000 Units) epoetin alfa (PROCRIT) 120,000 Units SC Q3W for up to 13 weeks | 80 |
| Darbepoetin Alfa (500 Mcg) darbepoetin alfa (ARANESP) 500 mcg SC Q3W for up to 13 weeks | 78 |
| Total | 235 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 6 | 5 | 4 |
| Overall Study | Chang from original chemo stratification | 4 | 5 | 6 |
| Overall Study | Completed chemotherapy | 4 | 5 | 1 |
| Overall Study | Death | 3 | 0 | 1 |
| Overall Study | Disease progression | 7 | 4 | 5 |
| Overall Study | Lost to Follow-up | 1 | 0 | 0 |
| Overall Study | Physician Decision | 13 | 10 | 4 |
| Overall Study | Protocol Violation | 3 | 5 | 2 |
| Overall Study | Withdrawal by Subject | 3 | 6 | 10 |
Baseline characteristics
| Characteristic | Epoetin Alfa (80,000 Units) | Epoetin Alfa (120,000 Units) | Darbepoetin Alfa (500 Mcg) | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 41 Participants | 46 Participants | 37 Participants | 124 Participants |
| Age, Categorical Between 18 and 65 years | 36 Participants | 34 Participants | 41 Participants | 111 Participants |
| Age Continuous | 65.05 years STANDARD_DEVIATION 12.54 | 64.84 years STANDARD_DEVIATION 11.66 | 63.00 years STANDARD_DEVIATION 12.05 | 64.30 years STANDARD_DEVIATION 12.07 |
| Chemotherapy Type Non-Platinum | 48 participants | 48 participants | 48 participants | 144 participants |
| Chemotherapy Type Platinum | 29 participants | 32 participants | 30 participants | 91 participants |
| Sex: Female, Male Female | 41 Participants | 57 Participants | 52 Participants | 150 Participants |
| Sex: Female, Male Male | 36 Participants | 23 Participants | 26 Participants | 85 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 | 58 / 75 | 68 / 77 | 67 / 75 |
| serious Total, serious adverse events | 28 / 75 | 23 / 77 | 25 / 75 |
Outcome results
Hemoglobin (Hb) Change From Baseline to Study Week 7
Baseline Hb was the Hb value that was consistent with the inclusion criteria and which was obtained within 72 hours of the first dose of study medication
Time frame: Baseline (Week 1) and Week 7
Population: per-protocol (PP) population that includes a subset of the modified intent-to-treat (mITT) population with subjects who were randomized and received at least one dose of study medication, had transfusion-unrelated Hb values obtained at both baseline and Week 7, met inclusion and exclusion criteria, and had no major protocol violations up to Week 7
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Epoetin Alfa (80,000 Units) | Hemoglobin (Hb) Change From Baseline to Study Week 7 | 0.64 g/dL | Standard Deviation 1.3 |
| Epoetin Alfa (120,000 Units) | Hemoglobin (Hb) Change From Baseline to Study Week 7 | 0.40 g/dL | Standard Deviation 1.37 |
| Darbepoetin Alfa (500 Mcg) | Hemoglobin (Hb) Change From Baseline to Study Week 7 | 0.84 g/dL | Standard Deviation 1.28 |
Number of Patients (Hb >= 11 g/dL) During Study.
Time frame: up to 16 weeks
Population: modified intention-to-treat (mITT) population that includes the subjects who were randomized, received at least one dose of study medication, and had transfusion-unrelated Hb values obtained at baseline and at least one post baseline visit
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Epoetin Alfa (80,000 Units) | Number of Patients (Hb >= 11 g/dL) During Study. | 51 participants |
| Epoetin Alfa (120,000 Units) | Number of Patients (Hb >= 11 g/dL) During Study. | 48 participants |
| Darbepoetin Alfa (500 Mcg) | Number of Patients (Hb >= 11 g/dL) During Study. | 56 participants |
Number of Patients Receiving at Least 1 Packed Red Blood Cell (PRBC) Transfusion During Study
Time frame: up to 16 weeks
Population: modified intention-to-treat (mITT) population that includes the subjects who were randomized, received at least one dose of study medication, and had transfusion-unrelated Hb values obtained at baseline and at least one post baseline visit
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Epoetin Alfa (80,000 Units) | Number of Patients Receiving at Least 1 Packed Red Blood Cell (PRBC) Transfusion During Study | 12 participants |
| Epoetin Alfa (120,000 Units) | Number of Patients Receiving at Least 1 Packed Red Blood Cell (PRBC) Transfusion During Study | 22 participants |
| Darbepoetin Alfa (500 Mcg) | Number of Patients Receiving at Least 1 Packed Red Blood Cell (PRBC) Transfusion During Study | 17 participants |
Time to Achieve Hb >= 11 g/dL During Study
Time frame: up to 16 weeks
Population: modified intention-to-treat (mITT) population that includes the subjects who were randomized, received at least one dose of study medication, and had transfusion-unrelated Hb values obtained at baseline and at least one post baseline visit
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Epoetin Alfa (80,000 Units) | Time to Achieve Hb >= 11 g/dL During Study | 37 days |
| Epoetin Alfa (120,000 Units) | Time to Achieve Hb >= 11 g/dL During Study | 44 days |
| Darbepoetin Alfa (500 Mcg) | Time to Achieve Hb >= 11 g/dL During Study | 36 days |