Colorectal Cancer
Conditions
Keywords
anti-IGF-1R
Brief summary
The purpose of this study was to determine the activity of two doses of robatumumab (SCH 717454, MK-7454) in participants with relapsed or recurrent colorectal cancer. The primary study hypothesis was that decreases in Positron Emission Tomography (PET)-assessed tumor glucose metabolism (i.e., fluorodeoxyglucose \[FDG\] standardized uptake value \[SUV\]) following administration of 10 mg/kg robatumumab will exceed those following administration of 0.3 mg/kg robatumumab in participants with relapsed or recurrent colorectal cancer who had progressed after first-line chemotherapy. Investigator choices of standard chemotherapy: irinotecan as a single agent +/- cetuximab OR capecitabine as a single agent, OR FOLFOX (leucovorin calcium \[folinic acid\]\[FOL\] + fluorouracil \[F\] + oxaliplatin \[OX\]) OR CAPEO(capecitabine \[CAPE\] or Xeloda® \[XEL\] + oxaliplatin \[OX\]) OR FOLFIRI (leucovorin calcium \[folinic acid\]\[FOL\] + fluorouracil \[F\] + irinotecan \[IRI\]) +/- cetuximab OR cetuximab as a single agent.
Detailed description
Standard chemotherapy was used as a positive validation arm. Randomization was performed so that there could be no bias in the selection of participants for enrollment into the fixed-sequence arms. Once three chemotherapy-treated participants demonstrated decreases in FDG-PET SUV in the target lesion (i.e., \>20% decrease in SUVmax in the defined target lesion) in the PET/computed tomography (CT) scan performed following Cycle 1 Period 1 treatment, it was concluded that this positive validation arm had accomplished its purpose, and all subsequent participants enrolled in the study were assigned treatment with robatumumab for Period 1. There was no intention to compare the data in either period across participants who received chemotherapy with those who received robatumumab.
Interventions
DRUGIrinotecan
BIOLOGICALCetuximab
DRUGCapecitabine
BIOLOGICALRobatumumab
DRUGFOLFOX
Leucovorin calcium (folinic acid)(FOL) + 5-fluorouracil (F)+ oxaliplatin (OX)
DRUGCAPEOX/XELOX
Capecitabine (CAPE) or Xeloda® (XEL) + oxaliplatin (OX)
DRUGFOLFIRI
Leucovorin calcium (folinic acid)(FOL) + 5-fluorouracil (F)+ irinotecan (IRI)
Sponsors
Merck Sharp & Dohme LLC
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Older than 18 years of age, of any race, and gender; * Diagnosis of histologically confirmed relapsed or recurrent colorectal carcinoma that has progressed on at least first-line therapy; * Must have a computed tomography (CT) or magnetic resonance imaging (MRI) scan performed at some point during their immediate prior treatment or observation in order to determine tumor growth rate; * Must have measurable disease on a CT or MRI study, performed during Screening; * Must have an Eastern Cooperative Oncology Group (ECOG) performance status of \<=2 and a minimum life expectancy of ≥4 months; * Must have adequate organ function within 3 weeks prior to treatment assignment
Exclusion criteria
* History of another malignancy; * Known treated or untreated leptomeningeal metastasis, or a metastatic central nervous system lesion; * Surgery within 3 weeks; * Radiation therapy within 6 weeks; * A history of uncontrolled diabetes mellitus, defined as a hemoglobin A1C of \>7.5% in a participant with known diabetes mellitus; * A recent myocardial infarction (within the past year); or a participant who at the time of Screening presents with unstable or uncontrolled angina, New York Heart Association Class III or IV congestive heart failure, uncontrolled hypertension, clinically significant cardiac dysrhythmia or clinically significant electrocardiogram abnormality; * An active infection; * Has clinically significant hepatitis at Screening, or is hepatitis C antibody positive, hepatitis B surface antigen positive, or human immunodeficiency virus (HIV) seropositive.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With a >20% Decrease in Positron Emission Tomography (PET)-Assessed Tumor Glucose Metabolism: Fluorodeoxyglucose (FDG) Standardized Uptake Value (SUV) in the Target Lesion | After the first robatumumab dose in Period 2 (Up to approximately 4 weeks after first robatumumab dose in Period 1) | FDG-PET was used in this study to detect the biological activity of modulation of the target within the tumor. Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 was used to select the target lesion. All measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total, representative of all involved organs were identified as target lesions and recorded and measured at Baseline. The changes in SUVmax were calculated using the formula: (endpoint SUVmax - baseline SUVmax)/baseline SUVmax as a percentage. If multiple lesions had been measured at a visit, percentages calculated for all target lesions were averaged to find the decrease during the treatment period per participant. FDG SUVmax responder was defined as participants with \>20% decrease in SUVmax after the first cycle of robatumumab in Period 2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Experienced One or More Adverse Events (AEs) | Up to 30 days after last dose of study drug (Up to approximately 22 weeks) | An AE is any untoward medical occurrence in a participant administered study drug which does not necessarily have a causal relationship with the study drug. AEs may include the onset of new illness and the exacerbation of pre-existing conditions. |
| Best Overall Tumor Response Per Investigator Review | Up to 30 days after last dose of study drug (Up to approximately 22 weeks) | Tumor response was assessed by computed tomography (CT) or magnetic resonance imaging (MRI) scans using RECIST v 1.0 criteria at Screening, at every 8 weeks of robatumumab treatment during Period 2 and at post study. A sum of the longest diameter (LD) for all target lesions was calculated and reported as the baseline sum LD. Overall tumor responses were defined as: Complete Response (CR) - Disappearance of all target lesions; Partial Response (PR) - At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD; Progressive Disease (PD) - At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or Stable Disease (SD) - Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started. |
| Number of Participants Who Discontinued Study Drug Due to an AE | Up to last dose of study drug (Up to approximately 18 weeks) | An AE is any untoward medical occurrence in a participant administered study drug which does not necessarily have a causal relationship with the study drug. AEs may include the onset of new illness and the exacerbation of pre-existing conditions. |
| Best Overall Tumor Response Per Central Review | Up to 30 days after last dose of study drug (Up to approximately 22 weeks) | Tumor response was assessed by CT or MRI scan using RECIST v1.0 criteria at Screening, at every 8 weeks of robatumumab treatment during Period 2 and at post study. A sum of the LD for all target lesions was calculated and reported as the baseline sum LD. Overall tumor responses were defined as: Complete Response (CR) - Disappearance of all target lesions; Partial Response (PR) - At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD; Progressive Disease (PD) - At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or Stable Disease (SD) - Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started. |
| Change From Baseline in Tumor Growth Rate | Baseline and up to approximately 22 weeks | Tumor growth rate was assessed by CT or MRI scans using RECIST criteria at Screening, at every 8 weeks of robatumumab treatment and at post study. For Pre Baseline 1, tumor growth rate=(sum of longest diameter of target lesions at Baseline - the most recent prior to Baseline)/duration between Baseline and Pre Baseline. For all other cycles, tumor growth rate=(sum of longest diameter of target lesions at a cycle - Baseline)/ duration between Baseline and the cycle. The cycles presented below are relative to the first dose of robatumumab in Period 1. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Robatumumab→Robatumumab Participants receive 1 dose of robatumumab 0.3 mg/kg IV followed by 1 dose of robatumumab 10 mg/kg IV Q2W until disease progression. A cycle of robatumumab is defined as 2 weeks of treatment (i.e., 1 dose of robatumumab) with no recovery period between cycles. | 50 |
| Chemotherapy→Robatumumab Participants receive 1 cycle of standard colorectal cancer chemotherapy currently approved and available on the market for use in colorectal cancer (to be selected by the Investigator based on participant's prior treatment) followed by 1 dose of robatumumab 10 mg/kg IV Q2W until disease progression. A cycle of robatumumab is defined as 2 weeks of treatment (i.e., 1 dose of robatumumab) with no recovery period between cycles. | 17 |
| Total | 67 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 6 | 3 |
| Overall Study | Not Treated | 1 | 2 |
| Overall Study | Progressive Disease | 41 | 12 |
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Robatumumab→Robatumumab | Chemotherapy→Robatumumab | Total |
|---|---|---|---|
| Age, Continuous | 64.7 Years STANDARD_DEVIATION 10.8 | 61.9 Years STANDARD_DEVIATION 10.6 | 64.0 Years STANDARD_DEVIATION 10.7 |
| Sex: Female, Male Female | 30 Participants | 9 Participants | 39 Participants |
| Sex: Female, Male Male | 20 Participants | 8 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 15 / 15 | 48 / 49 |
| serious Total, serious adverse events | 6 / 15 | 14 / 49 |
Outcome results
Primary
Number of Participants With a >20% Decrease in Positron Emission Tomography (PET)-Assessed Tumor Glucose Metabolism: Fluorodeoxyglucose (FDG) Standardized Uptake Value (SUV) in the Target Lesion
FDG-PET was used in this study to detect the biological activity of modulation of the target within the tumor. Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 was used to select the target lesion. All measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total, representative of all involved organs were identified as target lesions and recorded and measured at Baseline. The changes in SUVmax were calculated using the formula: (endpoint SUVmax - baseline SUVmax)/baseline SUVmax as a percentage. If multiple lesions had been measured at a visit, percentages calculated for all target lesions were averaged to find the decrease during the treatment period per participant. FDG SUVmax responder was defined as participants with \>20% decrease in SUVmax after the first cycle of robatumumab in Period 2.
Time frame: After the first robatumumab dose in Period 2 (Up to approximately 4 weeks after first robatumumab dose in Period 1)
Population: All participants who received ≥1 dose of robatumumab in Periods 1 and 2 and had SUV data before and after the first dose of robatumumab in Period 2 were included in the analysis. No participants in the Chemotherapy→Robatumumab group received robatumumab in Period 1.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Robatumumab→Robatumumab | Number of Participants With a >20% Decrease in Positron Emission Tomography (PET)-Assessed Tumor Glucose Metabolism: Fluorodeoxyglucose (FDG) Standardized Uptake Value (SUV) in the Target Lesion | 7 Participants |
Secondary
Best Overall Tumor Response Per Central Review
Tumor response was assessed by CT or MRI scan using RECIST v1.0 criteria at Screening, at every 8 weeks of robatumumab treatment during Period 2 and at post study. A sum of the LD for all target lesions was calculated and reported as the baseline sum LD. Overall tumor responses were defined as: Complete Response (CR) - Disappearance of all target lesions; Partial Response (PR) - At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD; Progressive Disease (PD) - At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or Stable Disease (SD) - Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Time frame: Up to 30 days after last dose of study drug (Up to approximately 22 weeks)
Population: All participants who received ≥1 dose of robatumumab were included in the analysis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Central Review | Partial Response | 0 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Central Review | Stable Disease | 10 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Central Review | Progressive Disease | 31 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Central Review | No post-Baseline assessment | 8 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Central Review | No post-Baseline assessment | 1 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Central Review | Partial Response | 0 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Central Review | Progressive Disease | 9 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Central Review | Stable Disease | 5 Participants |
Secondary
Best Overall Tumor Response Per Investigator Review
Tumor response was assessed by computed tomography (CT) or magnetic resonance imaging (MRI) scans using RECIST v 1.0 criteria at Screening, at every 8 weeks of robatumumab treatment during Period 2 and at post study. A sum of the longest diameter (LD) for all target lesions was calculated and reported as the baseline sum LD. Overall tumor responses were defined as: Complete Response (CR) - Disappearance of all target lesions; Partial Response (PR) - At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD; Progressive Disease (PD) - At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or Stable Disease (SD) - Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Time frame: Up to 30 days after last dose of study drug (Up to approximately 22 weeks)
Population: All participants who received ≥1 dose of robatumumab were included in the analysis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Investigator Review | Partial Response | 1 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Investigator Review | Progressive Disease | 33 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Investigator Review | No post-Baseline assessment | 5 Participants |
| Robatumumab→Robatumumab | Best Overall Tumor Response Per Investigator Review | Stable Disease | 10 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Investigator Review | No post-Baseline assessment | 2 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Investigator Review | Partial Response | 0 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Investigator Review | Stable Disease | 7 Participants |
| Chemotherapy→Robatumumab | Best Overall Tumor Response Per Investigator Review | Progressive Disease | 6 Participants |
Secondary
Change From Baseline in Tumor Growth Rate
Tumor growth rate was assessed by CT or MRI scans using RECIST criteria at Screening, at every 8 weeks of robatumumab treatment and at post study. For Pre Baseline 1, tumor growth rate=(sum of longest diameter of target lesions at Baseline - the most recent prior to Baseline)/duration between Baseline and Pre Baseline. For all other cycles, tumor growth rate=(sum of longest diameter of target lesions at a cycle - Baseline)/ duration between Baseline and the cycle. The cycles presented below are relative to the first dose of robatumumab in Period 1.
Time frame: Baseline and up to approximately 22 weeks
Population: All participants who received ≥1 dose of robatumumab in Periods 1 and 2 were included in the analysis. No participants in the Chemotherapy→Robatumumab group received robatumumab in Period 1.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Robatumumab→Robatumumab | Change From Baseline in Tumor Growth Rate | Cycle 9 (n=7) | 0.19 mm/day | Standard Deviation 0.26 |
| Robatumumab→Robatumumab | Change From Baseline in Tumor Growth Rate | Pre Baseline 1 (n=46) | 0.49 mm/day | Standard Deviation 0.48 |
| Robatumumab→Robatumumab | Change From Baseline in Tumor Growth Rate | Cycle 1 (n=24) | 0.07 mm/day | Standard Deviation 0.67 |
| Robatumumab→Robatumumab | Change From Baseline in Tumor Growth Rate | Cycle 2 (n=25) | 0.41 mm/day | Standard Deviation 0.57 |
| Robatumumab→Robatumumab | Change From Baseline in Tumor Growth Rate | Cycle 5 (n=25) | 0.53 mm/day | Standard Deviation 0.63 |
Secondary
Number of Participants Who Discontinued Study Drug Due to an AE
An AE is any untoward medical occurrence in a participant administered study drug which does not necessarily have a causal relationship with the study drug. AEs may include the onset of new illness and the exacerbation of pre-existing conditions.
Time frame: Up to last dose of study drug (Up to approximately 18 weeks)
Population: All participants who received ≥1 dose of study drug were included in the analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Robatumumab→Robatumumab | Number of Participants Who Discontinued Study Drug Due to an AE | 6 Participants |
| Chemotherapy→Robatumumab | Number of Participants Who Discontinued Study Drug Due to an AE | 3 Participants |
Secondary
Number of Participants Who Experienced One or More Adverse Events (AEs)
An AE is any untoward medical occurrence in a participant administered study drug which does not necessarily have a causal relationship with the study drug. AEs may include the onset of new illness and the exacerbation of pre-existing conditions.
Time frame: Up to 30 days after last dose of study drug (Up to approximately 22 weeks)
Population: All participants who received ≥1 dose of study drug were included in the analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Robatumumab→Robatumumab | Number of Participants Who Experienced One or More Adverse Events (AEs) | 49 Participants |
| Chemotherapy→Robatumumab | Number of Participants Who Experienced One or More Adverse Events (AEs) | 15 Participants |