Sarcoma
Conditions
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
As prescribed
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment | 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) | 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 Assessment | 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) | 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
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response | Screening up to approximately 6.75 years | 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. |
| Percentage of Participants Who Died | 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. | — |
| Overall Survival Duration | 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) | 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 Response | Screening up to approximately 6.75 years | EFS events was described in Outcome Measure 1 and Outcome Measure 3. |
| Volume of Distribution of Bevacizumab | 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) | 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 Bevacizumab | 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) | Half-life is the time measured for the plasma concentration to decrease by one half. |
| Clearance of Bevacizumab | 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) | 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 Bevacizumab | 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 | 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). |
| Percentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria | Screening up to approximately 6.75 years | 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. |
Countries
Belgium, Brazil, Canada, Chile, Czechia, France, Germany, Israel, Italy, Netherlands, Poland, Russia, Spain, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 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 |
| Total | 154 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative | 22 | 16 |
| Overall Study | Adverse Event | 5 | 8 |
| Overall Study | Death | 12 | 11 |
| Overall Study | Did Not Cooperate | 0 | 1 |
| Overall Study | Lost to Follow-up | 0 | 6 |
| Overall Study | Other | 7 | 8 |
| Overall Study | Progression of Disease | 18 | 14 |
| Overall Study | Protocol Violation | 3 | 0 |
| Overall Study | Recurrence of Disease | 2 | 1 |
| Overall Study | Refused Treatment / Did Not Cooperate | 0 | 1 |
| Overall Study | Withdrawal by Subject | 4 | 1 |
Baseline characteristics
| Characteristic | Chemotherapy | Bevacizumab + Chemotherapy | Total |
|---|---|---|---|
| Age, Continuous | 10.5 years STANDARD_DEVIATION 4.8 | 10.3 years STANDARD_DEVIATION 4.9 | 10.4 years STANDARD_DEVIATION 4.9 |
| Sex: Female, Male Female | 40 Participants | 29 Participants | 69 Participants |
| Sex: Female, Male Male | 40 Participants | 45 Participants | 85 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 40 / 79 | 37 / 71 |
| other Total, other adverse events | 78 / 79 | 71 / 71 |
| serious Total, serious adverse events | 68 / 79 | 66 / 71 |
Outcome results
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Chemotherapy | EFS Duration as Per IRC Assessment | 14.85 months |
| Bevacizumab + Chemotherapy | EFS Duration as Per IRC Assessment | 20.63 months |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chemotherapy | Percentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment | 52.5 percentage of participants |
| Bevacizumab + Chemotherapy | Percentage of Participants Who Experienced Event-Free Survival (EFS) Events as Per Independent Review Committee (IRC) Assessment | 68.9 percentage of participants |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Chemotherapy | Area Under the Curve at Steady State (AUCss) of Bevacizumab | 1010 mg*day/mL | Standard Deviation 256 |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Chemotherapy | Clearance of Bevacizumab | 167 mL/day | Standard Deviation 76.4 |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Chemotherapy | Duration of Response | NA months |
| Bevacizumab + Chemotherapy | Duration of Response | 17.48 months |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Chemotherapy | Half-Life of Bevacizumab | 20.8 days | Standard Deviation 8.58 |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Chemotherapy | Overall Survival Duration | 24.02 months |
| Bevacizumab + Chemotherapy | Overall Survival Duration | 32.79 months |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chemotherapy | Percentage of Participants Who Died | 50 percentage of participants |
| Bevacizumab + Chemotherapy | Percentage of Participants Who Died | 51.4 percentage of participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chemotherapy | Percentage of Participants Who Experienced EFS Events Among Participants Who Had Objective Response | 40.7 percentage of participants |
| Bevacizumab + Chemotherapy | Percentage of Participants Who Experienced EFS Events Among Participants Who Had Objective Response | 76.5 percentage of participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chemotherapy | Percentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria | 36.0 percentage of participants |
| Bevacizumab + Chemotherapy | Percentage of Participants With Objective Response Prior to First Local Therapy Assessed by RECIST v1.0 Criteria | 54.0 percentage of participants |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Chemotherapy | Volume of Distribution of Bevacizumab | 2070 mL | Standard Deviation 891 |