Ovarian Neoplasms
Conditions
Keywords
Ovarian cancer, malignant ascites, angiogenesis, angiogenesis inhibition, VEGF-Trap fusion recombinant protein
Brief summary
The primary objective of this study was to compare the time between paracenteses before and after administration of Aflibercept (ziv-aflibercept, AVE0005, VEGF trap, ZALTRAP®) in ovarian cancer participants with symptomatic malignant ascites. The secondary objectives were to further assess efficacy and safety of Aflibercept treatment, and the exploratory objectives were to assess pharmacokinetics, immunogenicity and health-related quality of life.
Detailed description
The study consisted of: * A 30-day screening phase prior to Day 1 * Day 1 registration and pre-treatment paracentesis * Aflibercept administration within 1-day of registration * Two-week study treatment cycles (for efficacy data, the cut-off date was 6 months post-registration * A 60-day post-treatment follow-up phase During the study, participants were treated with Aflibercept study treatment through the duration of the study unless they met one the following criteria for discontinuation: * Participant (or legal representative) chose to withdraw from treatment * The investigator or sponsor thought that continuation of the study would be detrimental to the participants well-being * Participant had intercurrent illness that prevented further administration of investigational product (IP) * Participant had more than 2 IP dose reductions * Participant had unacceptable adverse events (AEs) * Participant had arterial thromboembolic events, including cerebrovascular accidents, myocardial infarctions, transient ischemic attacks, new onset angina, or worsening of preexisting angina * Participant required surgical intervention for intestinal obstruction or gastrointestinal perforation
Interventions
4.0 mg/kg administered intravenously (IV) once every 2 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
Participants that met the following criteria were eligible. Inclusion Criteria: * Symptomatic malignant ascites resulting from advanced ovarian epithelial cancer (including fallopian tube and primary peritoneal adenocarcinoma) that required at least 3 previous therapeutic paracenteses at a frequency of 1 to 4 paracenteses per month for management. * Platinum resistant disease defined by relapse or progression of disease during or after treatment, or drug intolerance. * Topotecan- and/or liposomal doxorubicin-resistant disease defined by relapse or progression of disease during or after treatment, or drug intolerance.
Exclusion criteria
* Peritoneovenous or other type of shunt that was placed for the management of ascites * Prior treatment with a VEGF or VEGF receptor inhibitor * Uncontrolled hypertension The above information is not intended to contain all considerations relevant to participation in a clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With a Repeat Paracentesis Response (RPR) | up to 2 years post-registration | RPR was defined as at least a two-fold increase in the time to repeat paracentesis (TRP) as compared to the average duration of the 2 intervals between the 3 most recent paracenteses prior to study registration (ie, the baseline interval of paracentesis). Percentage of participants with a repeat paracentesis response were the number of participants with RPR / number of total participants \* 100. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 60-day Frequency of Paracentesis (FOP) | up to 60 days post-registration | FOP was the total number of paracenteses performed within the first 60 days postregistration. For participants who had withdrawn after registration but prior to the 60-day cutoff date, the withdrawal would have been regarded as a paracentesis event and the 60-day FOP normalized and calculated as the nearest integer of the value corresponding to 60 × number of paracenteses / x, where x represents the number of days on study. |
| Progression-free Survival (PFS) Time | up to 6 months post-registration | According to the Response Evaluation Criteria in Solid Tumors \[RECIST\], progression was at least a 20% increase in the sum of the longest diameter (LD) of tumors, compared to smallest sum LD recorded since treatment started, or the appearance of one or more new tumors. PFS time was interval from the date of registration to the date of tumor progression or death from any cause, whichever was earlier. Median PFS time was estimated from Kaplan-Meier Plots. If participants were alive and progression-free at 6 months postregistration, they were censored for PFS. |
| Time to Repeat Paracentesis (TRP) | up to 6 months from registration | TRP is the number of days between the date of registration and the date of the first postregistration paracentesis. Median TRP was estimated from Kaplan-Meier curves. For participants who did not undergo a postregistration paracentesis while on study, TRP was censored at the end of the treatment period (last dose + 1 cycle), at the last visit known without repeat paracentesis, at 6 months postregistration, or at death, whichever was earlier. |
| Number of Participants With a Positive Anti-drug Antibody Response | up to 60 days after the last dose of treatment | Anti-drug antibodies in participant's serum were measured using 2 different methods * an Enzyme Linked Immunosorbent Assay (ELISA) in which the lower limit of detection (LLOD) was 238.4 ng/mL; and * an Electrochemiluminescence-based, Bridging Assay in which the validated LLOD was about 5.4 ng/mL in the absence of aflibercept and about 25.2 ng/mL in the presence of 20 μg/mL of aflibercept. Participants with detectable anti-drug antibodies by either method were considered to have a positive anti-drug antibody response. |
| Safety - Number of Participants With Adverse Events (AE) | up to 60 days after last dose of treatment (approximately 2 years), or until TEAE was resolved or stabilized | All AEs regardless of seriousness or relationship to study treatment, spanning from the first administration of study treatment until 60 days after the last administration of study treatment, were recorded, and followed until resolution or stabilization. The number of participants with all treatment emergent adverse events (TEAE), serious adverse events (SAE), TEAE leading to death, and TEAE leading to permanent treatment discontinuation are reported. |
| Overall Survival (OS) Time | up to 6 months post-registration | OS time was the time interval between the date of registration to the date of death from any cause. Median OS was estimated from Kaplan-Meier curves. Participants who died after efficacy data cutoff date (6 months postregistration) were censored at the data cutoff date. |
Countries
Italy, Sweden, United States
Participant flow
Recruitment details
17 participants were screened for this study, of which 16 participants were enrolled.
Participants by arm
| Arm | Count |
|---|---|
| Aflibercept Participants with advanced ovarian epithelial cancer treated with 4.0 mg/kg Aflibercept every 2 weeks until a criterion for treatment discontinuation was met | 16 |
| Total | 16 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 2 |
| Overall Study | Disease Progression | 13 |
| Overall Study | Participant request | 1 |
Baseline characteristics
| Characteristic | Aflibercept |
|---|---|
| Age Continuous | 59.3 years STANDARD_DEVIATION 8.9 |
| Age, Customized <65 years | 11 participants |
| Age, Customized >=65 years | 5 participants |
| Baseline interval of paracentesis | 16.5 days STANDARD_DEVIATION 7.8 |
| Eastern Cooperative Oncology Group (ECOG) performance status score ECOG Score = 0 | 3 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status score ECOG Score = 1 | 10 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status score ECOG Score = 2 | 3 participants |
| Histology Clear cell (mesonephroid) | 1 Participants |
| Histology Endometrioid | 3 Participants |
| Histology Missing data | 2 Participants |
| Histology Other | 1 Participants |
| Histology Serous | 9 Participants |
| Histology grade Moderately differentiated | 1 Participants |
| Histology grade Poorly differentiated | 10 Participants |
| Histology grade Unknown | 5 Participants |
| Primary tumor site - Ovaries | 16 Participants |
| Prior anticancer surgeries, No | 1 Participants |
| Prior anticancer surgeries, Yes | 15 Participants |
| Race/Ethnicity, Customized Caucasian | 16 Participants |
| Sex: Female, Male Female | 16 Participants |
| Sex: Female, Male Male | 0 Participants |
| Time since initial cancer diagnosis | 2.8 Years STANDARD_DEVIATION 1.7 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 16 / 16 |
| serious Total, serious adverse events | 15 / 16 |
Outcome results
Percentage of Participants With a Repeat Paracentesis Response (RPR)
RPR was defined as at least a two-fold increase in the time to repeat paracentesis (TRP) as compared to the average duration of the 2 intervals between the 3 most recent paracenteses prior to study registration (ie, the baseline interval of paracentesis). Percentage of participants with a repeat paracentesis response were the number of participants with RPR / number of total participants \* 100.
Time frame: up to 2 years post-registration
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Aflibercept | Percentage of Participants With a Repeat Paracentesis Response (RPR) | 62.5 percentage of participants |
60-day Frequency of Paracentesis (FOP)
FOP was the total number of paracenteses performed within the first 60 days postregistration. For participants who had withdrawn after registration but prior to the 60-day cutoff date, the withdrawal would have been regarded as a paracentesis event and the 60-day FOP normalized and calculated as the nearest integer of the value corresponding to 60 × number of paracenteses / x, where x represents the number of days on study.
Time frame: up to 60 days post-registration
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Aflibercept | 60-day Frequency of Paracentesis (FOP) | 1.5 paracenteses | Standard Deviation 1.6 |
Number of Participants With a Positive Anti-drug Antibody Response
Anti-drug antibodies in participant's serum were measured using 2 different methods * an Enzyme Linked Immunosorbent Assay (ELISA) in which the lower limit of detection (LLOD) was 238.4 ng/mL; and * an Electrochemiluminescence-based, Bridging Assay in which the validated LLOD was about 5.4 ng/mL in the absence of aflibercept and about 25.2 ng/mL in the presence of 20 μg/mL of aflibercept. Participants with detectable anti-drug antibodies by either method were considered to have a positive anti-drug antibody response.
Time frame: up to 60 days after the last dose of treatment
Population: Participants who received at least part of 1 dose of aflibercept and had evaluable blood samples
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Aflibercept | Number of Participants With a Positive Anti-drug Antibody Response | 0 participants |
Overall Survival (OS) Time
OS time was the time interval between the date of registration to the date of death from any cause. Median OS was estimated from Kaplan-Meier curves. Participants who died after efficacy data cutoff date (6 months postregistration) were censored at the data cutoff date.
Time frame: up to 6 months post-registration
Population: All participants were analyzed. 5 participants who died after efficacy data cutoff date (6 months postregistration) were censored at the data cutoff date.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Aflibercept | Overall Survival (OS) Time | 92.0 days |
Progression-free Survival (PFS) Time
According to the Response Evaluation Criteria in Solid Tumors \[RECIST\], progression was at least a 20% increase in the sum of the longest diameter (LD) of tumors, compared to smallest sum LD recorded since treatment started, or the appearance of one or more new tumors. PFS time was interval from the date of registration to the date of tumor progression or death from any cause, whichever was earlier. Median PFS time was estimated from Kaplan-Meier Plots. If participants were alive and progression-free at 6 months postregistration, they were censored for PFS.
Time frame: up to 6 months post-registration
Population: Participants with a PFS event (tumor progression or death) were analyzed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Aflibercept | Progression-free Survival (PFS) Time | 59.5 days |
Safety - Number of Participants With Adverse Events (AE)
All AEs regardless of seriousness or relationship to study treatment, spanning from the first administration of study treatment until 60 days after the last administration of study treatment, were recorded, and followed until resolution or stabilization. The number of participants with all treatment emergent adverse events (TEAE), serious adverse events (SAE), TEAE leading to death, and TEAE leading to permanent treatment discontinuation are reported.
Time frame: up to 60 days after last dose of treatment (approximately 2 years), or until TEAE was resolved or stabilized
Population: All participants who received at least part of 1 dose of the study treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Aflibercept | Safety - Number of Participants With Adverse Events (AE) | With at least one TEAE | 16 participants |
| Aflibercept | Safety - Number of Participants With Adverse Events (AE) | With at least one serious TEAE | 15 participants |
| Aflibercept | Safety - Number of Participants With Adverse Events (AE) | With a TEAE leading to death | 8 participants |
| Aflibercept | Safety - Number of Participants With Adverse Events (AE) | With a TEAE resulting in discontinuation | 2 participants |
Time to Repeat Paracentesis (TRP)
TRP is the number of days between the date of registration and the date of the first postregistration paracentesis. Median TRP was estimated from Kaplan-Meier curves. For participants who did not undergo a postregistration paracentesis while on study, TRP was censored at the end of the treatment period (last dose + 1 cycle), at the last visit known without repeat paracentesis, at 6 months postregistration, or at death, whichever was earlier.
Time frame: up to 6 months from registration
Population: All participants were analyzed. 8 had one or more paracentesis events. Participants with no paracentesis events were censored at the end of the treatment period (last dose + 1 cycle).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Aflibercept | Time to Repeat Paracentesis (TRP) | 76.0 days |