Skip to content

A Dose-Escalation to Rash Study of Tarceva (Erlotinib) Plus Gemcitabine in Patients With Metastatic Pancreatic Cancer

A Randomized, Open-label, Dose-escalation to Rash Study to Assess the Effect of Tarceva in Combination With Gemcitabine on Overall Survival in Patients With Metastatic Pancreatic Cancer.

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00652366
Enrollment
467
Registered
2008-04-03
Start date
2008-05-31
Completion date
2012-02-29
Last updated
2015-02-11

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

Conditions

Pancreatic Cancer

Brief summary

This study will compare the efficacy and safety of escalating versus standard doses to rash of Tarceva, in combination with gemcitabine, in patients with metastatic pancreatic cancer. During a 4 week run-in period, all patients will receive Tarceva 100mg/day po plus gemcitabine 1000mg/m2 iv on days 1, 8,15 and 22. After 4 weeks, patients who have not developed rash, or only develop grade 1 rash, will be randomized to one of 2 groups. Group 1 will receive a starting dose of Tarceva 150mg po daily, increased in steps of 50mg every 2 weeks up to a maximum of 250mg/day po, until development of grade 2 rash or other dose-limiting toxicity. Group 2 will continue to receive Tarceva 100mg/day po. All patients will continue to receive gemcitabine 1000mg/m2 iv on days 1, 8 and 15 of each 4 week cycle. The anticipated time on study treatment is until disease progression, and the target sample size is 100-500 individuals.

Interventions

DRUGErlotinib, escalating dose

100mg, PO, once daily, escalating to a maximum of 250mg, PO, once daily

DRUGErlotinib, standard dose

100mg, PO, once daily

DRUGGemcitabine

1000 mg/m2, IV, on days 1,8 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
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* adult patients, \>=18 years of age; * histologically or cytologically confirmed pancreatic cancer with measurable or non-measurable metastatic disease; * ECOG performance status of 0-1.

Exclusion criteria

* local, or locally advanced, pancreatic cancer; * prior systemic treatment for metastatic pancreatic cancer; * \<=6 months since last adjuvant chemotherapy; * other malignancies within last 5 years, except for adequately treated cancer in situ of the cervix, or basal or squamous cell skin cancer.

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants Who Died Assessed From Point of RandomizationRandomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.Overall survival (OS) assessed from the point of randomization was defined as the time from randomization to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive.
OS Assessed From Point of RandomizationRandomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.OS assessed from the point of randomization was defined as the median time, in months, from randomization to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive. The 95 percent (%) confidence interval (CI) was determined using Kaplan-Meier methodology.

Secondary

MeasureTime frameDescription
Percentage of Participants With a Best Overall Response (BOR) of Confirmed Complete Response (CR) or Partial Response (PR) According to RECISTBL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.BOR was defined as a confirmed CR or PR for at least 4 weeks. CR was defined as the disappearance of all TLs. PR was defined as at least a 30% decrease in the SLD of the TLs, taking as a reference the baseline (BL) SLD. The 95% CI for one sample binomial was determined using Pearson-Clopper method.
Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTBL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.CR was defined as the disappearance of all TLs. PR was defined as at least a 30% decrease in the SLD of the TLs, taking as a reference the BL SLD SD was defined as neither sufficient decrease in SLD to qualify for PR nor sufficient increase in SLD to qualify for PD. PD was defined as at least a 20% increase in the SLD of TLs, taking as reference the smallest SLD recorded since the treatment started. The 95% CI for one sample binomial was determined using the Pearson-Clopper method.
Percentage of Participants With SD (Maintained for at Least 8 Weeks) or CR or PR (Maintained for at Least 4 Weeks) According to RECISTBL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.Disease control was defined as a participant with a response of CR or PR for at least 4 weeks at any time during treatment, or SD that was maintained for at least 8 weeks after the start of treatment. The 95% CI for one sample binomial was determined using the Pearson-Clopper method.
Percentage of Participants With Disease Progression or Death as Assessed From Point of RandomizationRandomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.Progression-free survival (PFS) as assessed from the point of randomization was defined as the time from randomization to the first occurrence of progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors (RECIST) or death due to any cause. For target lesions (TLs), PD was defined as at least a 20% increase in the sum of longest diameter (SLD) of TLs, taking as reference the smallest SLD recorded since the treatment started. For non-target lesions (NTLs), PD was defined as unequivocal progression of existing NTLs. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment.
OS Assessed From Start of 4-Week Run-InBL and weekly thereafter for up to 46 months.OS assessed from the start of the 4-week run in period was defined as the median time, in months, from BL to the date of death, due to any cause. Participants who were still alive at the time of analysis were censored at the date they were last known to be alive. The 95% CI was determined using Kaplan-Meier methodology.
Percentage of Participants With Disease Progression or Death as Assessed From the Start of 4-Week Run-InBL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression or death for up to 46 months.PFS as assessed from the start of 4-week run-in was defined as the time from BL to the first occurrence of PD according to RECIST or death due to any cause. For TLs, PD was defined as at least a 20% increase in the SLD of TLs, taking as reference the smallest SLD recorded since the treatment started. For NTLs, PD was defined as unequivocal progression of existing NTLs. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment.
PFS Assessed From the Start of 4-Week Run-InBL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression or death for up to 46 months.PFS assessed from the start of 4-week run-in was defined as the median time, in weeks, from BL to disease progression or death due to any cause. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment. The 95% CI was determined using Kaplan-Meier methodology.
Percentage of Participants Who Died as Assessed From Start of 4-Week Run-InBL and weekly thereafter for up to 46 months.OS assessed from the start of the 4-week run in period was defined as the time from BL to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive.
PFS Assessed From Point of RandomizationRandomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.PFS assessed from the point of randomization was defined as the median time, in weeks, from randomization to disease progression or death due to any cause. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment. The 95% CI was determined using Kaplan-Meier methodology.

Countries

Argentina, Australia, Austria, Belgium, Brazil, Canada, Croatia, Denmark, France, Germany, Greece, Hong Kong, Israel, Italy, Lithuania, Mexico, Poland, Romania, Serbia, Singapore, Spain, Taiwan, United Kingdom

Participant flow

Participants by arm

ArmCount
G+E: Rash ≥ Grade 2
Participants began a 4 week run-in period where they received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, 15, 22 until development of a rash Grade ≥ 2. Participants also received erlotinib, 100 mg, PO as a film-coated tablet, once daily until development of a rash Grade ≥ 2. Participants were not randomized to a treatment arm, but continued to receive the standard treatment of gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, and 15 of consecutive 4 week cycles, and erlotinib, 100 mg, PO as a film-coated tablet, once daily until disease progression, unacceptable toxicity, or withdrawal for up to 46 months.
106
G+E Standard Dose: Rash Grade < 2
Participants completed a 4 week run-in period where they received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, 15, 22. Participants also received erlotinib, 100 mg, PO as a film-coated tablet, once daily for 4 weeks. Participants without evidence of clinical progression and who had not developed rash Grade ≥ 2 or any other toxicity leading to dose adjustments or discontinuation were randomized to receive gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, and 15 of consecutive 4 week cycles and erlotinib, 100 mg, PO as a film-coated tablet, once daily until disease progression or unacceptable toxicity, or withdrawal for up to 46 months.
75
G+E Escalating Dose: Rash Grade < 2
Participants completed a 4 week run-in period where they received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, 15, 22. Participants also received erlotinib, 100 mg, PO as a film-coated tablet, once daily for 4 weeks. Participants without evidence of clinical progression and who had not developed rash Grade ≥ 2 or any other toxicity leading to dose adjustments or discontinuation were randomized to receive erlotinib, beginning at 150 mg/day, PO as a film-coated tablet, once daily and increasing in increments of 50 mg every 2 weeks up to a maximum of 250 mg/day, until development of a Grade 2 rash, or occurrence of other, non-rash, dose-limiting toxicity; treatment was continued until disease progression, unacceptable toxicity, death or withdrawal for up to 46 months. Those participants also received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, and 15 of consecutive 4 week cycles until disease progression, unacceptable toxicity, or withdrawal for up to 46 months.
70
G+E: No Rash Non-Eligible
Participants began a 4 week run-in period where they received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, 15, 22 until the appearance of evidence of clinical progression or other toxicity leading to dose adjustments or discontinuation. Participants also received erlotinib, 100 mg, PO as a film-coated tablet, once daily until the appearance of evidence of clinical progression or other toxicity leading to dose adjustments or discontinuation. Participants were not randomized to a treatment arm, but continued to receive the standard treatment of gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, and 15 of consecutive 4 week cycles, and erlotinib, 100 mg, PO as a film-coated tablet, once daily until disease progression, unacceptable toxicity, or withdrawal for up to 46 months.
179
G+E: Early Drop Out
Participants began a 4 week run-in period where they received gemcitabine, 1000 mg/m\^2, IV, on Days 1, 8, 15, 22 for up to 4 weeks. Participants also received erlotinib, 100 mg, PO as a film-coated tablet, once daily for up to 4 weeks.
36
Total466

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004
Overall StudyAdverse Event8471713
Overall StudyDeath54185
Overall StudyLack of Efficacy84585313313
Overall StudyOther52340
Overall StudyProtocol Violation10000
Overall StudyRefused treatment376175
Overall StudyViolation of Selection Criteria00100

Baseline characteristics

CharacteristicTotalG+E: Rash ≥ Grade 2G+E Standard Dose: Rash Grade < 2G+E Escalating Dose: Rash Grade < 2G+E: No Rash Non-EligibleG+E: Early Drop Out
Age, Customized
≥ 65 Years
205 participants40 participants32 participants36 participants82 participants15 participants
Age, Customized
Less Than (<) 65 Years
261 participants66 participants43 participants34 participants97 participants21 participants
Sex: Female, Male
Female
208 Participants41 Participants41 Participants34 Participants77 Participants15 Participants
Sex: Female, Male
Male
258 Participants65 Participants34 Participants36 Participants102 Participants21 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —— / —
other
Total, other adverse events
105 / 10574 / 7771 / 71178 / 17834 / 36
serious
Total, serious adverse events
39 / 10524 / 7720 / 7164 / 17822 / 36

Outcome results

Primary

OS Assessed From Point of Randomization

OS assessed from the point of randomization was defined as the median time, in months, from randomization to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive. The 95 percent (%) confidence interval (CI) was determined using Kaplan-Meier methodology.

Time frame: Randomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.

Population: FAS

ArmMeasureValue (MEDIAN)
G+E Standard Dose: Rash Grade < 2OS Assessed From Point of Randomization8.4 months
G+E Escalating Dose: Rash Grade < 2OS Assessed From Point of Randomization7.0 months
p-value: 0.202695% CI: [0.88, 1.8]Log Rank
Primary

Percentage of Participants Who Died Assessed From Point of Randomization

Overall survival (OS) assessed from the point of randomization was defined as the time from randomization to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive.

Time frame: Randomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.

Population: Full analysis set (FAS): all randomized participants.

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants Who Died Assessed From Point of Randomization81.3 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants Who Died Assessed From Point of Randomization85.7 percentage of participants
Secondary

OS Assessed From Start of 4-Week Run-In

OS assessed from the start of the 4-week run in period was defined as the median time, in months, from BL to the date of death, due to any cause. Participants who were still alive at the time of analysis were censored at the date they were last known to be alive. The 95% CI was determined using Kaplan-Meier methodology.

Time frame: BL and weekly thereafter for up to 46 months.

Population: FAS

ArmMeasureValue (MEDIAN)
G+E Standard Dose: Rash Grade < 2OS Assessed From Start of 4-Week Run-In7.9 months
G+E Escalating Dose: Rash Grade < 2OS Assessed From Start of 4-Week Run-In9.3 months
G+E Escalating Dose: Rash Grade < 2OS Assessed From Start of 4-Week Run-In8.0 months
p-value: 0.267895% CI: [0.6, 1.15]Log Rank
p-value: 0.844995% CI: [0.74, 1.43]Log Rank
Secondary

Percentage of Participants Who Died as Assessed From Start of 4-Week Run-In

OS assessed from the start of the 4-week run in period was defined as the time from BL to the date of death due to any cause. Participants still alive at the time of analysis were censored at the date they were last known to be alive.

Time frame: BL and weekly thereafter for up to 46 months.

Population: FAS

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants Who Died as Assessed From Start of 4-Week Run-In84.9 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants Who Died as Assessed From Start of 4-Week Run-In81.3 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants Who Died as Assessed From Start of 4-Week Run-In85.7 percentage of participants
Secondary

Percentage of Participants With a Best Overall Response (BOR) of Confirmed Complete Response (CR) or Partial Response (PR) According to RECIST

BOR was defined as a confirmed CR or PR for at least 4 weeks. CR was defined as the disappearance of all TLs. PR was defined as at least a 30% decrease in the SLD of the TLs, taking as a reference the baseline (BL) SLD. The 95% CI for one sample binomial was determined using Pearson-Clopper method.

Time frame: BL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.

Population: FAS

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a Best Overall Response (BOR) of Confirmed Complete Response (CR) or Partial Response (PR) According to RECIST14.7 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a Best Overall Response (BOR) of Confirmed Complete Response (CR) or Partial Response (PR) According to RECIST8.6 percentage of participants
p-value: 0.254395% CI: [-17.2, 5]Chi-squared
95% CI: [0.19, 1.56]
Secondary

Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECIST

CR was defined as the disappearance of all TLs. PR was defined as at least a 30% decrease in the SLD of the TLs, taking as a reference the BL SLD SD was defined as neither sufficient decrease in SLD to qualify for PR nor sufficient increase in SLD to qualify for PD. PD was defined as at least a 20% increase in the SLD of TLs, taking as reference the smallest SLD recorded since the treatment started. The 95% CI for one sample binomial was determined using the Pearson-Clopper method.

Time frame: BL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.

Population: FAS

ArmMeasureGroupValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTPR14.7 percentage of participants
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTPD25.3 percentage of participants
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTSD58.7 percentage of participants
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTMissing (no response assessment)1.3 percentage of participants
G+E Standard Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTCR0.0 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTMissing (no response assessment)5.7 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTCR1.4 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTPR7.1 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTSD72.9 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With a CR, PR, Stable Disease (SD), or PD According to RECISTPD12.9 percentage of participants
Secondary

Percentage of Participants With Disease Progression or Death as Assessed From Point of Randomization

Progression-free survival (PFS) as assessed from the point of randomization was defined as the time from randomization to the first occurrence of progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors (RECIST) or death due to any cause. For target lesions (TLs), PD was defined as at least a 20% increase in the sum of longest diameter (SLD) of TLs, taking as reference the smallest SLD recorded since the treatment started. For non-target lesions (NTLs), PD was defined as unequivocal progression of existing NTLs. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment.

Time frame: Randomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.

Population: FAS

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants With Disease Progression or Death as Assessed From Point of Randomization90.7 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With Disease Progression or Death as Assessed From Point of Randomization88.6 percentage of participants
Secondary

Percentage of Participants With Disease Progression or Death as Assessed From the Start of 4-Week Run-In

PFS as assessed from the start of 4-week run-in was defined as the time from BL to the first occurrence of PD according to RECIST or death due to any cause. For TLs, PD was defined as at least a 20% increase in the SLD of TLs, taking as reference the smallest SLD recorded since the treatment started. For NTLs, PD was defined as unequivocal progression of existing NTLs. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment.

Time frame: BL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression or death for up to 46 months.

Population: FAS

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants With Disease Progression or Death as Assessed From the Start of 4-Week Run-In90.6 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With Disease Progression or Death as Assessed From the Start of 4-Week Run-In90.7 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With Disease Progression or Death as Assessed From the Start of 4-Week Run-In88.6 percentage of participants
Secondary

Percentage of Participants With SD (Maintained for at Least 8 Weeks) or CR or PR (Maintained for at Least 4 Weeks) According to RECIST

Disease control was defined as a participant with a response of CR or PR for at least 4 weeks at any time during treatment, or SD that was maintained for at least 8 weeks after the start of treatment. The 95% CI for one sample binomial was determined using the Pearson-Clopper method.

Time frame: BL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression for up to 46 months.

Population: FAS

ArmMeasureValue (NUMBER)
G+E Standard Dose: Rash Grade < 2Percentage of Participants With SD (Maintained for at Least 8 Weeks) or CR or PR (Maintained for at Least 4 Weeks) According to RECIST62.7 percentage of participants
G+E Escalating Dose: Rash Grade < 2Percentage of Participants With SD (Maintained for at Least 8 Weeks) or CR or PR (Maintained for at Least 4 Weeks) According to RECIST47.1 percentage of participants
p-value: 0.060395% CI: [-32.4, 1.3]Chi-squared
Secondary

PFS Assessed From Point of Randomization

PFS assessed from the point of randomization was defined as the median time, in weeks, from randomization to disease progression or death due to any cause. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment. The 95% CI was determined using Kaplan-Meier methodology.

Time frame: Randomization [Day 1 of Cycle 2 (4-week cycles)] and weekly thereafter for up to 46 months.

Population: FAS

ArmMeasureValue (MEDIAN)
G+E Standard Dose: Rash Grade < 2PFS Assessed From Point of Randomization19.4 weeks
G+E Escalating Dose: Rash Grade < 2PFS Assessed From Point of Randomization15.3 weeks
p-value: 0.629895% CI: [0.77, 1.54]Log Rank
Secondary

PFS Assessed From the Start of 4-Week Run-In

PFS assessed from the start of 4-week run-in was defined as the median time, in weeks, from BL to disease progression or death due to any cause. Participants who had neither progressed nor died at time of analysis were censored at the date of last tumor assessment. The 95% CI was determined using Kaplan-Meier methodology.

Time frame: BL, Weeks 8, 16, 24, 32, 40, every 12 weeks thereafter until disease progression or death for up to 46 months.

Population: FAS; only participants with an event of PD or death were included in the analysis.

ArmMeasureValue (MEDIAN)
G+E Standard Dose: Rash Grade < 2PFS Assessed From the Start of 4-Week Run-In17.1 weeks
G+E Escalating Dose: Rash Grade < 2PFS Assessed From the Start of 4-Week Run-In23.4 weeks
G+E Escalating Dose: Rash Grade < 2PFS Assessed From the Start of 4-Week Run-In19.3 weeks
p-value: 0.021795% CI: [0.51, 0.95]Log Rank
p-value: 0.159695% CI: [0.57, 1.1]Log Rank

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026