Progressive Sarcoma
Conditions
Keywords
progressive GIST, progressive sarcoma
Brief summary
The purpose of this multicenter, three-arm, exact binomial single-stage, phase II trial is to determine the preliminary efficacy and safety of RAD001 in patients with histological evidence of progressive or metastatic bone or soft tissue sarcoma.
Interventions
2.5 and 5 mg tablets taken orally and starting dose was 10 mg daily for all patients
Sponsors
Study design
Eligibility
Inclusion criteria
Histological evidence of progressive or metastatic bone or soft tissue sarcoma. The following tumor types are included: * malignant fibrous histiocytoma * liposarcoma * synovial sarcoma * malignant paraganglioma * fibrosarcoma * leiomyosarcoma * angiosarcoma including haemangiopericytoma * malignant peripheral nerve sheath tumor * STS, not otherwise specified * miscellaneous sarcoma including mixed mesodermal tumors of the uterus * osteosarcoma * Ewing's sarcoma * rhabdomyosarcoma * gastrointestinal stromal tumor (only after failure or intolerance of imatinib or sunitinib in 1st and 2nd line) * alveolar soft part sarcoma (ASPS) * Objective progression of disease may be documented by RECIST criteria. Any of the following would be sufficient according to RECIST: * a 20% increase in the sum of unidimensionally measured target lesions * a new lesion * unequivocal increase in non-measurable disease. * Patients must have disease not amenable to surgery, radiation, or combined modality therapy with curative intent. * ECOG performance status 0 - 2.
Exclusion criteria
Anticancer therapy within 3 weeks of enrollment including chemotherapy, hormonal therapy, immunotherapy, or radiotherapy. * The following tumor types will not be included: * gastrointestinal stromal tumor (except for patients after treatment with imatinib or sunitinib in 1st and 2nd line) * chondrosarcoma * malignant mesothelioma * neuroblastoma. * Prior therapy with RAD001 (everolimus) or other rapamycins (sirolimus, temsirolimus). * Neurotoxicity \> grade 2 CTC. * Radiation of the lung. Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best Overall Response Rates by Week 16 (ITT) | Baseline up to 16 weeks | The best overall response is the best response recorded from treatment start until disease progression/recurrence (both measurement and confirmation criteria). Best lesion response was defined by (Resist Criteria V1 for target and non-target lesions): Complete Response (CR)=at least two determinations of CR 4 weeks apart before progression, Partial Response (PR)=at least two determinations of CR 4 weeks apart before progression (and not qualifying for a CR), Stable Disease (SD)=at least one SD assessment \>6 weeks after start of treatment and Progressive Disease (PD)=Progression or death due to underlying cancer ≤16 weeks after start of treatment. PD without radiologic evidence were classified as progression only, when clear evidence of clinical deterioration was available and patient discontinued due to disease progression. Unknown (UNK) = all other cases. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Baseline up to approximately 16 weeks | The best overall response is the best response recorded from the start of the treatment until disease progression/recurrence (taking as reference for PD the smallest measurements recorded since the treatment started). In general, the patient's best response assignment will depend on the achievement of both measurement and confirmation criteria. Best lesion response was defined by (Resist Criteria V1 for target and non-target lesions). |
| Percentage of Participants With Duration of Response (CR, PR, SD) at 16 Weeks. | Baseline up to 16 weeks | Duration of response (CR, PR or SD) applied only to those patients whose best overall response was CR, PR or SD based on local radiologic assessments and was defined as the time from start of treatment to progression or death from underlying disease. Patients not experiencing progression or death at 16 weeks were censored with the date of their last tumor assessment. Duration of response was explored using the Kaplan-Meier method. |
| Percentage of Participants With Progression-free Survival (PFS) at 16 Weeks | 16 weeks | Progression-free Survival (PFS) was defined as the time from the date of start of treatment to the date of event defined as the first documented progression or death from any cause. If a patient had not had an event, PFS was censored at the date of the last adequate tumor assessment at week 16 |
| Time to Progression (TTP) (ITT) | Baseline up to 16 weeks | Time to progression (TTP) was defined as the time from the date of start of treatment to the date of event defined as the first documented progression or death from underlying disease. If a patient had not had an event, TTP was censored at the date of the last adequate tumor assessment, which was the date of Visit 6 (Week 16) for the core phase and the last available tumor assessment for the follow-up phase. TTP was explored by using the Kaplan-Meier method. |
| Percentage of Participants With Overall Survival (OS) at Week 16 (ITT) | Baseline up to 16 weeks | Overall survival (OS) was defined as the time from the date of start of treatment to death from any cause. If a patient was not known to have died (was alive), OS was censored at the date of the last contact, which was the date of Visit 6 (Week 16) for the core phase and the last available visit for the follow-up phase. OS was explored by using the Kaplan-Meier method. One death occurred in Arm 3 after Week 16. |
Countries
Germany, Italy
Participant flow
Pre-assignment details
Seventy-four patients were screened and seventy-one enrolled.
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 Progressive or metastatic bone or soft tissue sarcomas | 37 |
| Arm 2 Progressive gastrointestinal stromal tumors (GIST) after failure of prior imatinib and sunitinib 1st and 2nd line | 24 |
| Arm 3 Progressive or metastatic alveolar soft part sarcoma (ASPS) | 10 |
| Total | 71 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Abnormal lab values | 1 | 0 | 0 |
| Overall Study | Administrative problems | 0 | 1 | 0 |
| Overall Study | Adverse Event | 2 | 0 | 0 |
| Overall Study | Death | 2 | 3 | 0 |
| Overall Study | Lost to Follow-up | 1 | 0 | 0 |
| Overall Study | Unsatisfactory therapeutic effect | 18 | 14 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 1 | 0 |
Baseline characteristics
| Characteristic | Arm 1 | Arm 2 | Arm 3 | Total |
|---|---|---|---|---|
| Age, Customized < 65 years | 31 Participants | 14 Participants | 9 Participants | 54 Participants |
| Age, Customized >= 65 years | 6 Participants | 10 Participants | 1 Participants | 17 Participants |
| Race/Ethnicity, Customized Black | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Caucasian | 36 Participants | 24 Participants | 10 Participants | 70 Participants |
| Sex: Female, Male Female | 14 Participants | 11 Participants | 6 Participants | 31 Participants |
| Sex: Female, Male Male | 23 Participants | 13 Participants | 4 Participants | 40 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 8 / 37 | 4 / 24 | 1 / 10 |
| other Total, other adverse events | 35 / 37 | 21 / 24 | 10 / 10 |
| serious Total, serious adverse events | 15 / 37 | 14 / 24 | 8 / 10 |
Outcome results
Best Overall Response Rates by Week 16 (ITT)
The best overall response is the best response recorded from treatment start until disease progression/recurrence (both measurement and confirmation criteria). Best lesion response was defined by (Resist Criteria V1 for target and non-target lesions): Complete Response (CR)=at least two determinations of CR 4 weeks apart before progression, Partial Response (PR)=at least two determinations of CR 4 weeks apart before progression (and not qualifying for a CR), Stable Disease (SD)=at least one SD assessment \>6 weeks after start of treatment and Progressive Disease (PD)=Progression or death due to underlying cancer ≤16 weeks after start of treatment. PD without radiologic evidence were classified as progression only, when clear evidence of clinical deterioration was available and patient discontinued due to disease progression. Unknown (UNK) = all other cases.
Time frame: Baseline up to 16 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Best Overall Response Rates by Week 16 (ITT) | Progressive Disease | 51.4 percentage of participants |
| Arm 1 | Best Overall Response Rates by Week 16 (ITT) | Stable Disease | 40.5 percentage of participants |
| Arm 1 | Best Overall Response Rates by Week 16 (ITT) | Complete Response | 0 percentage of participants |
| Arm 1 | Best Overall Response Rates by Week 16 (ITT) | Partial Response | 0 percentage of participants |
| Arm 1 | Best Overall Response Rates by Week 16 (ITT) | Unknown | 8.1 percentage of participants |
| Arm 2 | Best Overall Response Rates by Week 16 (ITT) | Stable Disease | 33.3 percentage of participants |
| Arm 2 | Best Overall Response Rates by Week 16 (ITT) | Complete Response | 0 percentage of participants |
| Arm 2 | Best Overall Response Rates by Week 16 (ITT) | Partial Response | 0 percentage of participants |
| Arm 2 | Best Overall Response Rates by Week 16 (ITT) | Progressive Disease | 62.5 percentage of participants |
| Arm 2 | Best Overall Response Rates by Week 16 (ITT) | Unknown | 4.2 percentage of participants |
| Arm 3 | Best Overall Response Rates by Week 16 (ITT) | Unknown | 0 percentage of participants |
| Arm 3 | Best Overall Response Rates by Week 16 (ITT) | Progressive Disease | 0 percentage of participants |
| Arm 3 | Best Overall Response Rates by Week 16 (ITT) | Complete Response | 0 percentage of participants |
| Arm 3 | Best Overall Response Rates by Week 16 (ITT) | Stable Disease | 100.0 percentage of participants |
| Arm 3 | Best Overall Response Rates by Week 16 (ITT) | Partial Response | 0 percentage of participants |
Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT)
The best overall response is the best response recorded from the start of the treatment until disease progression/recurrence (taking as reference for PD the smallest measurements recorded since the treatment started). In general, the patient's best response assignment will depend on the achievement of both measurement and confirmation criteria. Best lesion response was defined by (Resist Criteria V1 for target and non-target lesions).
Time frame: Baseline up to approximately 16 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Complete response | 0 percentage of participants |
| Arm 1 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Partial response | 0 percentage of participants |
| Arm 2 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Complete response | 0 percentage of participants |
| Arm 2 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Partial response | 0 percentage of participants |
| Arm 3 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Complete response | 0 percentage of participants |
| Arm 3 | Objective Tumor Response Rates (Complete Response and Partial Response) at Week 16 (ITT) | Partial response | 0 percentage of participants |
Percentage of Participants With Duration of Response (CR, PR, SD) at 16 Weeks.
Duration of response (CR, PR or SD) applied only to those patients whose best overall response was CR, PR or SD based on local radiologic assessments and was defined as the time from start of treatment to progression or death from underlying disease. Patients not experiencing progression or death at 16 weeks were censored with the date of their last tumor assessment. Duration of response was explored using the Kaplan-Meier method.
Time frame: Baseline up to 16 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 | Percentage of Participants With Duration of Response (CR, PR, SD) at 16 Weeks. | 60 percentage of participants |
| Arm 2 | Percentage of Participants With Duration of Response (CR, PR, SD) at 16 Weeks. | 62.5 percentage of participants |
| Arm 3 | Percentage of Participants With Duration of Response (CR, PR, SD) at 16 Weeks. | 100 percentage of participants |
Percentage of Participants With Overall Survival (OS) at Week 16 (ITT)
Overall survival (OS) was defined as the time from the date of start of treatment to death from any cause. If a patient was not known to have died (was alive), OS was censored at the date of the last contact, which was the date of Visit 6 (Week 16) for the core phase and the last available visit for the follow-up phase. OS was explored by using the Kaplan-Meier method. One death occurred in Arm 3 after Week 16.
Time frame: Baseline up to 16 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 | Percentage of Participants With Overall Survival (OS) at Week 16 (ITT) | 68.8 percentage of participants |
| Arm 2 | Percentage of Participants With Overall Survival (OS) at Week 16 (ITT) | 56.9 percentage of participants |
| Arm 3 | Percentage of Participants With Overall Survival (OS) at Week 16 (ITT) | 100.0 percentage of participants |
Percentage of Participants With Progression-free Survival (PFS) at 16 Weeks
Progression-free Survival (PFS) was defined as the time from the date of start of treatment to the date of event defined as the first documented progression or death from any cause. If a patient had not had an event, PFS was censored at the date of the last adequate tumor assessment at week 16
Time frame: 16 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 | Percentage of Participants With Progression-free Survival (PFS) at 16 Weeks | 35.1 percentage of participants |
| Arm 2 | Percentage of Participants With Progression-free Survival (PFS) at 16 Weeks | 30.5 percentage of participants |
| Arm 3 | Percentage of Participants With Progression-free Survival (PFS) at 16 Weeks | 100.0 percentage of participants |
Time to Progression (TTP) (ITT)
Time to progression (TTP) was defined as the time from the date of start of treatment to the date of event defined as the first documented progression or death from underlying disease. If a patient had not had an event, TTP was censored at the date of the last adequate tumor assessment, which was the date of Visit 6 (Week 16) for the core phase and the last available tumor assessment for the follow-up phase. TTP was explored by using the Kaplan-Meier method.
Time frame: Baseline up to 16 weeks
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 1 | Time to Progression (TTP) (ITT) | 57 days |
| Arm 2 | Time to Progression (TTP) (ITT) | 57 days |
| Arm 3 | Time to Progression (TTP) (ITT) | 499 days |