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A Study of Avastin (Bevacizumab) in Combination With Standard Chemotherapy in Children and Adolescents With Sarcoma.

An Open-label, Multi-center, Randomized Study of the Safety and Effect on Event-free Survival of Bevacizumab in Combination With Standard Chemotherapy in Childhood and Adolescent Patients With Metastatic Rhabdomyosarcoma and Non-rhabdomyosarcoma Soft Tissue Sarcoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00643565
Enrollment
154
Registered
2008-03-26
Start date
2008-07-29
Completion date
2019-04-30
Last updated
2019-10-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Sarcoma

Brief summary

This open-label two-arm study will assess the safety and efficacy of a combination of bevacizumab + standard chemotherapy with standard chemotherapy alone as active comparator in childhood and adolescent patients with metastatic rhabdomyosarcoma or non-rhabdomyosarcoma soft tissue sarcoma. Patients will be randomized to receive bevacizumab + standard chemotherapy or standard chemotherapy alone. Treatment will consist of 9 x 3-week cycles of induction treatment (standard chemotherapy with or without bevacizumab 7.5 mg/kg iv on day 1 of each cycle) followed by 12 x 4-week cycles of maintenance treatment (standard chemotherapy with or without bevacizumab 5 mg/kg iv on days 1 and 15 of each cycle). The anticipated time on study treatment is 1-2 years.

Interventions

DRUGStandard chemotherapy

As prescribed

DRUGbevacizumab [Avastin]

7.5 mg/kg iv on day 1 of 9 x 3-week cycles, followed by 5 mg/kg iv on days 1 and 15 of each 4-week cycle

Sponsors

Hoffmann-La Roche
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
6 Months to 18 Years
Healthy volunteers
No

Inclusion criteria

* childhood and adolescent patients aged \>/=6 months to 18 years of age * metastatic rhabdomyosarcoma or non-rhabdomyosarcoma soft tissue sarcoma * adequate bone marrow function * adequate renal and liver function * adequate blood clotting

Exclusion criteria

* previous malignant tumors * tumor invading major blood vessels * prior systemic anti-tumor treatment

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) AssessmentScreening up to approximately 6.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)EFS events included tumor progression (IRC assessed), no evidence of response after 3 cycles of induction (derived from IRC assessment), second primary cancer, or death due to any cause. Data for participants who had not experienced an event by the time of clinical cut-off were censored at the date of the last disease assessment prior to the clinical cut-off date. Data for participants who did not have any post-baseline disease assessments were censored at the time of randomization. Tumor progression was defined using Response Evaluation Criteria in Solid Tumors version 1.0 (RECIST v1.0) as at least a 20% increase in the disease measurement, taking as reference the smallest disease measurement recorded since the start of treatment, or the appearance of one or more new lesions, or evidence of clinical progression and unequivocal progression of existing non-target lesions.
EFS Duration as Per IRC AssessmentScreening up to approximately 6.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)EFS was defined as the time between randomization and occurrence of EFS event. EFS events are described in Outcome Measure 1. Median EFS was estimated using Kaplan-Meier estimates and 95% confidence intervals (CI) for median was computed using the method of Brookmeyer and Crowley.

Secondary

MeasureTime frameDescription
Duration of ResponseScreening up to approximately 6.75 yearsDuration of Response was defined as time between first objective response and the occurrence of an EFS event (described in Outcome Measure 1). Objective response was defined in Outcome Measure 3. Median duration of response was estimated using Kaplan-Meier estimates and 95% CI for median was computed using the method of Brookmeyer and Crowley.
Percentage of Participants Who DiedScreening up to approximately 10.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years.
Overall Survival DurationScreening up to approximately 10.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)Overall survival was defined as the time between randomization and death due to any cause. Participants without an event were censored at the last time they were known to be alive. Median overall survival was estimated using Kaplan-Meier estimates and 95% CI for median was computed using the method of Brookmeyer and Crowley.
Percentage of Participants Who Experienced EFS Events Among Participants Who Had Objective ResponseScreening up to approximately 6.75 yearsEFS events was described in Outcome Measure 1 and Outcome Measure 3.
Volume of Distribution of BevacizumabPre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)Volume of distribution is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired blood concentration of a drug. Steady state volume of distribution (Vss) is the apparent volume of distribution at steady-state.
Half-Life of BevacizumabPre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)Half-life is the time measured for the plasma concentration to decrease by one half.
Clearance of BevacizumabPre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)CL is a quantitative measure of the rate at which a drug substance is removed from the body. CL is expressed in milliliters per day (mL/day).
Area Under the Curve at Steady State (AUCss) of BevacizumabPre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phaseAUC is a measure of the serum concentration of the drug over time. It is used to characterize drug absorption. AUCss is expressed in milligrams times days per milliliter (mg\*day/mL).
Percentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 CriteriaScreening up to approximately 6.75 yearsObjective response prior to first local therapy (surgery and/or radiotherapy) was defined as complete response (CR) or partial response (PR) determined on two consecutive occasions \>/=4 weeks apart. Tumor response was assessed as per IRC using RECIST v1.0. CR was defined as disappearance of all target and non-target lesions. If immunocytology was available, no disease was to be detected by that methodology. PR was defined as at least a 30% decrease in the disease measurement, taking as reference the disease measurement done to confirm measurable disease at study entry.

Countries

Belgium, Brazil, Canada, Chile, Czechia, France, Germany, Israel, Italy, Netherlands, Poland, Russia, Spain, United Kingdom

Participant flow

Participants by arm

ArmCount
Chemotherapy
Participants received 9 cycles of induction chemotherapy (4 cycles of IVADo-containing chemotherapy followed by 5 cycles of IVA-containing chemotherapy administered every 3 weeks as per institutional practice. As per the investigator evaluation, participants had option to undergo local therapy (radiotherapy and /or surgery) during last 3 cycles of IVA (i.e. from Cycle 6 to Cycle 9). During maintenance treatment phase, participants received vinorelbine- and cyclophosphamide-containing chemotherapy (as per institutional practice) on Day 1 and 15 of 4-week cycles for a total of 12 cycles.
80
Bevacizumab + Chemotherapy
Participants received continuous IV infusion of bevacizumab (7.5 mg/kg every 3 weeks) on Day 1 of 3-week cycles followed by induction chemotherapy (4 cycles of IVADo-containing chemotherapy followed by 5 cycles of IVA-containing chemotherapy) as per institutional practice for a total of 9 cycles during induction treatment phase. As per the investigator decision, local therapy (radiotherapy and /or surgery) was expected to start after 4 weeks of the last bevacizumab administration in the induction phase and resumed to bevacizumab in the maintenance phase at least 4 weeks after the last dose of local therapy. During maintenance treatment phase, participants received IV infusion of bevacizumab (5 mg/kg every 2 weeks) followed by vinorelbine- and cyclophosphamide-containing chemotherapy (as per institutional practice) on Days 1 and 15 of 4-week cycles for a total of 12 cycles.
74
Total154

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdministrative2216
Overall StudyAdverse Event58
Overall StudyDeath1211
Overall StudyDid Not Cooperate01
Overall StudyLost to Follow-up06
Overall StudyOther78
Overall StudyProgression of Disease1814
Overall StudyProtocol Violation30
Overall StudyRecurrence of Disease21
Overall StudyRefused Treatment / Did Not Cooperate01
Overall StudyWithdrawal by Subject41

Baseline characteristics

CharacteristicChemotherapyBevacizumab + ChemotherapyTotal
Age, Continuous10.5 years
STANDARD_DEVIATION 4.8
10.3 years
STANDARD_DEVIATION 4.9
10.4 years
STANDARD_DEVIATION 4.9
Sex: Female, Male
Female
40 Participants29 Participants69 Participants
Sex: Female, Male
Male
40 Participants45 Participants85 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
40 / 7937 / 71
other
Total, other adverse events
78 / 7971 / 71
serious
Total, serious adverse events
68 / 7966 / 71

Outcome results

Primary

EFS Duration as Per IRC Assessment

EFS was defined as the time between randomization and occurrence of EFS event. EFS events are described in Outcome Measure 1. Median EFS was estimated using Kaplan-Meier estimates and 95% confidence intervals (CI) for median was computed using the method of Brookmeyer and Crowley.

Time frame: Screening up to approximately 6.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)

Population: ITT population.

ArmMeasureValue (MEDIAN)
ChemotherapyEFS Duration as Per IRC Assessment14.85 months
Bevacizumab + ChemotherapyEFS Duration as Per IRC Assessment20.63 months
Comparison: The HR was calculated based on a stratified Cox proportional hazards model, with stratification factors of age and histology/disease risk.p-value: 0.718995% CI: [0.61, 1.41]Log Rank
Primary

Percentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment

EFS events included tumor progression (IRC assessed), no evidence of response after 3 cycles of induction (derived from IRC assessment), second primary cancer, or death due to any cause. Data for participants who had not experienced an event by the time of clinical cut-off were censored at the date of the last disease assessment prior to the clinical cut-off date. Data for participants who did not have any post-baseline disease assessments were censored at the time of randomization. Tumor progression was defined using Response Evaluation Criteria in Solid Tumors version 1.0 (RECIST v1.0) as at least a 20% increase in the disease measurement, taking as reference the smallest disease measurement recorded since the start of treatment, or the appearance of one or more new lesions, or evidence of clinical progression and unequivocal progression of existing non-target lesions.

Time frame: Screening up to approximately 6.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)

Population: ITT population.

ArmMeasureValue (NUMBER)
ChemotherapyPercentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment52.5 percentage of participants
Bevacizumab + ChemotherapyPercentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment68.9 percentage of participants
Secondary

Area Under the Curve at Steady State (AUCss) of Bevacizumab

AUC is a measure of the serum concentration of the drug over time. It is used to characterize drug absorption. AUCss is expressed in milligrams times days per milliliter (mg\*day/mL).

Time frame: Pre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase

Population: Pharmacokinetic (PK)-evaluable population included all randomized participants for whom at least one blood sample was taken for PK assessment following bevacizumab administration. Here, number of participants analyzed = participants who were evaluable for this outcome measure.

ArmMeasureValue (MEAN)Dispersion
ChemotherapyArea Under the Curve at Steady State (AUCss) of Bevacizumab1010 mg*day/mLStandard Deviation 256
Secondary

Clearance of Bevacizumab

CL is a quantitative measure of the rate at which a drug substance is removed from the body. CL is expressed in milliliters per day (mL/day).

Time frame: Pre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)

Population: PK-evaluable population. Only participants who received bevacizumab were to be analyzed for PK assessment.

ArmMeasureValue (MEAN)Dispersion
ChemotherapyClearance of Bevacizumab167 mL/dayStandard Deviation 76.4
Secondary

Duration of Response

Duration of Response was defined as time between first objective response and the occurrence of an EFS event (described in Outcome Measure 1). Objective response was defined in Outcome Measure 3. Median duration of response was estimated using Kaplan-Meier estimates and 95% CI for median was computed using the method of Brookmeyer and Crowley.

Time frame: Screening up to approximately 6.75 years

Population: ITT population. Here, number of participants analyzed = participants who were evaluable for this outcome measure.

ArmMeasureValue (MEDIAN)
ChemotherapyDuration of ResponseNA months
Bevacizumab + ChemotherapyDuration of Response17.48 months
Secondary

Half-Life of Bevacizumab

Half-life is the time measured for the plasma concentration to decrease by one half.

Time frame: Pre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)

Population: PK-evaluable population. Only participants who received bevacizumab were to be analyzed for PK assessment.

ArmMeasureValue (MEAN)Dispersion
ChemotherapyHalf-Life of Bevacizumab20.8 daysStandard Deviation 8.58
Secondary

Overall Survival Duration

Overall survival was defined as the time between randomization and death due to any cause. Participants without an event were censored at the last time they were known to be alive. Median overall survival was estimated using Kaplan-Meier estimates and 95% CI for median was computed using the method of Brookmeyer and Crowley.

Time frame: Screening up to approximately 10.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years)

Population: ITT population. Here number of participants analyzed = participants available for the analysis of this outcome measure.

ArmMeasureValue (MEDIAN)
ChemotherapyOverall Survival Duration24.02 months
Bevacizumab + ChemotherapyOverall Survival Duration32.79 months
Comparison: The HR was calculated based on a stratified Cox proportional hazards model, with stratification factors of age and histology/disease risk.p-value: 0.321195% CI: [0.51, 1.25]Log Rank
Secondary

Percentage of Participants Who Died

Time frame: Screening up to approximately 10.75 years (assessed at screening, Cycles 4, 7 of induction phase, Cycles 1, 4, 7, 10 of maintenance, then every 3 months for 1.5 years and thereafter every 6 months for 2.5 years.

Population: ITT population.

ArmMeasureValue (NUMBER)
ChemotherapyPercentage of Participants Who Died50 percentage of participants
Bevacizumab + ChemotherapyPercentage of Participants Who Died51.4 percentage of participants
Secondary

Percentage of Participants Who Experienced EFS Events Among Participants Who Had Objective Response

EFS events was described in Outcome Measure 1 and Outcome Measure 3.

Time frame: Screening up to approximately 6.75 years

Population: ITT population. Here number of participants analyzed = participants available for the analysis of this outcome measure.

ArmMeasureValue (NUMBER)
ChemotherapyPercentage of Participants Who Experienced EFS Events Among Participants Who Had Objective Response40.7 percentage of participants
Bevacizumab + ChemotherapyPercentage of Participants Who Experienced EFS Events Among Participants Who Had Objective Response76.5 percentage of participants
Secondary

Percentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria

Objective response prior to first local therapy (surgery and/or radiotherapy) was defined as complete response (CR) or partial response (PR) determined on two consecutive occasions \>/=4 weeks apart. Tumor response was assessed as per IRC using RECIST v1.0. CR was defined as disappearance of all target and non-target lesions. If immunocytology was available, no disease was to be detected by that methodology. PR was defined as at least a 30% decrease in the disease measurement, taking as reference the disease measurement done to confirm measurable disease at study entry.

Time frame: Screening up to approximately 6.75 years

Population: ITT population.

ArmMeasureValue (NUMBER)
ChemotherapyPercentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria36.0 percentage of participants
Bevacizumab + ChemotherapyPercentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria54.0 percentage of participants
Secondary

Volume of Distribution of Bevacizumab

Volume of distribution is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired blood concentration of a drug. Steady state volume of distribution (Vss) is the apparent volume of distribution at steady-state.

Time frame: Pre- and within 3 hours post-dose on Days 1, 8, and 15 of Cycle 1, Day 1 of Cycle 2-4 of induction phase (1 cycle = 3 weeks)

Population: PK-evaluable population. Only participants who received bevacizumab were to be analyzed for PK assessment.

ArmMeasureValue (MEAN)Dispersion
ChemotherapyVolume of Distribution of Bevacizumab2070 mLStandard Deviation 891

Source: ClinicalTrials.gov · Data processed: Mar 9, 2026