Gastrointestinal Neoplasms, Gastrointestinal Stromal Tumors
Conditions
Keywords
sunitinib, Phase IV, gastrointestinal stomal tumor, imatinib resistant or intolerant, Chinese
Brief summary
To investigate safety and efficacy of single agent sunitinib malate in Chinese Patients With Imatinib Resistant Or Intolerant Malignant Gastrointestinal Stromal Tumor.
Interventions
Subjects will receive treatment with sunitinib in repeated 6-week cycles (4 weeks on, 2 weeks off), at a starting dose of 50 mg.
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically-proven diagnosis of malignant GIST (Gastrointestinal Stromal Tumors). * Evidence of unidimensionally measurable disease * Failure of prior treatment with imatinib or intolerant to imatinib * Male or female, 18 years of age or older. * ECOG (Eastern Cooperative Oncology Group) performance status 0 or 1. * Resolution of all acute toxic effects * Adequate organ function.
Exclusion criteria
* Anticancer treatment after last dose of imatinib * Major surgery within 4 weeks or radiation therapy within 2 weeks. * Grade 3 hemorrhage within 4 weeks prior to starting the study treatment. * Diagnosis of second malignancy within the last 5 years. * History of brain disease. * Cardiac disease within 12 months. * Thyroid function abnormality. * Ongoing cardiac dysrhythmias. * Uncontrolled hypertension. * Ongoing treatment with anticoagulant and CYP3A4 inhibitors and inducers. * HIV or AIDS related illness. * Pregnancy or breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) | Baseline (Day 1) up to disease progression or death whichever occurred first (up to 264 weeks) | PFS was defined as the time (in weeks) from the date of the first treatment to the date of the first documentation of objective tumor progression or death due to any cause, whichever occurred first. Participants last known to be 1) alive, 2) on study treatment or discontinued study treatment, but haven't yet started a new anticancer treatment and 3) progression-free were censored at the date of the last objective disease assessment that verified lack of disease progression. Disease progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST version 1.0), as a \>=20% increase in the sum of the longest dimensions of the target lesions taking as a reference the smallest sum of the longest dimensions recorded since the treatment started, or the appearance of one or more new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline (Day 1) to death (up to 282 weeks) | OS was defined as the time (in weeks) from the date of the first treatment to the date of death due to any cause. In the absence of confirmation of death, survival time was censored at the last date the participant was known to be alive. |
| Objective Response Rate (ORR) | Baseline (Day 1) up to end of study treatment (up to 276 weeks) | ORR was defined as the proportion of participants who achieved an objective response. A participant was considered to have an objective response if a confirmed best response of complete response (CR) or partial response (PR) was achieved according to RECIST, version 1.0. CR is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 millimeters (mm). PR is at least a 30 percent (%) decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
| Time to Tumor Progression (TTP) | Baseline (Day 1) up to objective tumor progression or death due to tumor progression (up to 264 weeks) | TTP was defined as the time (in weeks) from the date of the first treatment to the date of the first documentation of objective tumor progression or death due to tumor progression. Participants last known to be 1) alive,2) on treatment or within 28 days of discontinuation from treatment and 3) progression-free were censored at the date of last objective disease assessment that verified lack of disease progression. Participants with no post baseline assessments were censored at the start date. Participants who died without prior objective disease progression and participants who discontinued treatment without objective disease progression within 28 days of last dose were censored at the date of the last objective disease assessment that verified lack of disease progression. Disease progression is defined using RECIST version 1.0. |
| Number of Participants With Significant Changes From Baseline in Physical Examination. | Baseline up to 28 days post last administration of study drug | Physical examinations including, but not limited to, general appearance, skin, neck, eyes, ears, nose, mouth, throat, breast, lungs, heart, abdomen, rectal, lymph nodes, extremities, thyroid, musculoskeletal, and nervous system were performed. |
| Number of Participants With Significant Vital Signs Changes From Baseline | Baseline (Day 1) up to 28 days post last administration of study drug | Vital signs included blood pressure (BP), temperature, heart rate, respiration rate and body weight. The criteria for significant changes included BP: systolic BP (SBP) greater than (\>) 150 millimeters of mercury (mm Hg) and/or diastolic BP (DBP) \> 100 mm Hg, or SBP \> 200 mm Hg and/or DBP \> 110 mm Hg; temperature: \>38.3 degrees Celsius (degrees C), or increase of greater than or equal to (\>=)1.1 degrees C (baseline \>=36.8 degrees C); heart rate: \>120 beats per minute (bpm) or less than (\<) 50 bpm, or increase of \>=30 bpm or decrease of ≥30 bpm; respiration rate: \> 40 /minute or \< 8 /minute; weight: a change of 5% or more from baseline. |
| Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline (Day 1), Last-on treatment visit (up to 28 days post last administration of study drug) | ECOG was used to assess participants' performance status: 0 (Fully active, able to carry on all pre-disease activities without restriction); 1 (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work or office work); 2 (Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours); 3 (Capable of only limited self-care, confined to bed or chair more than 50% of waking hours); 4 (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair); and 5 (Dead). |
| Number of Participants With Abnormal Clinical Laboratory Measurements | Baseline up to 28 days post last administration of study drug | The total number of participants with laboratory test abnormalities without regard to baseline abnormality was assessed. Laboratory parameters included hematology (hemoglobin, platelets, white blood cell count, lymphocytes, neutrophils, basophils, eosinophils and monocytes), liver function (total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein and albumin), renal function (blood urea nitrogen, creatinine and uric acid), electrolytes (sodium, potassium, chloride, calcium, magnesium and phosphate), hormones (thyroxine and thyroid stimulating hormone), clinical chemistry (glucose), and urinalysis (urine protein) tests. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Response (TTR) | Baseline (Day 1) to tumor response (up to 82 weeks) | TTR was defined as the time (in weeks) from the date of the first dose of study treatment to the date of the first documentation of objective tumor response (CR or PR based on RECIST, version 1.0) that was subsequently confirmed. |
Countries
China
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Sutent (Sunitinib Malate) The starting dose of sunitinib was 50 mg orally once daily as a single agent for 4 consecutive weeks followed by a 2-week off-treatment period to form a complete cycle of 6 weeks (schedule 4/2). Participants experiencing dose-limiting toxicity attributed to study medication had dose interrupted or reduced depending on individual tolerability. If dose reductions were required, the dose of 37.5 mg was achieved by administration of 3 × 12.5 mg capsules, and the dose of 25 mg was achieved by administration of 2 × 12.5 mg capsules. There was no limit for number of cycles for this study, study treatment was permanently discontinued upon disease progression, occurrence of unacceptable toxicity, withdrawal of participant consent, or another withdrawal criterion was met. | 59 |
| Total | 59 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 50 |
| Overall Study | Lost to Follow-up | 3 |
| Overall Study | Study terminated by the Sponsor | 7 |
Baseline characteristics
| Characteristic | Sutent (Sunitinib Malate) |
|---|---|
| Age, Continuous | 55.1 years STANDARD_DEVIATION 12.2 |
| Sex: Female, Male Female | 20 Participants |
| Sex: Female, Male Male | 39 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 57 / 59 |
| serious Total, serious adverse events | 12 / 59 |
Outcome results
Progression-free Survival (PFS)
PFS was defined as the time (in weeks) from the date of the first treatment to the date of the first documentation of objective tumor progression or death due to any cause, whichever occurred first. Participants last known to be 1) alive, 2) on study treatment or discontinued study treatment, but haven't yet started a new anticancer treatment and 3) progression-free were censored at the date of the last objective disease assessment that verified lack of disease progression. Disease progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST version 1.0), as a \>=20% increase in the sum of the longest dimensions of the target lesions taking as a reference the smallest sum of the longest dimensions recorded since the treatment started, or the appearance of one or more new lesions.
Time frame: Baseline (Day 1) up to disease progression or death whichever occurred first (up to 264 weeks)
Population: Safety analysis included all participants who started study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sutent (Sunitinib Malate) | Progression-free Survival (PFS) | 46.4 weeks |
Eastern Cooperative Oncology Group (ECOG) Performance Status
ECOG was used to assess participants' performance status: 0 (Fully active, able to carry on all pre-disease activities without restriction); 1 (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work or office work); 2 (Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours); 3 (Capable of only limited self-care, confined to bed or chair more than 50% of waking hours); 4 (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair); and 5 (Dead).
Time frame: Baseline (Day 1), Last-on treatment visit (up to 28 days post last administration of study drug)
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 0 | 11 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 1 | 48 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 2 | 0 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 3 | 0 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 4 | 0 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Baseline, ECOG = 5 | 0 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 0 | 3 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 1 | 47 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 2 | 8 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 3 | 1 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 4 | 0 participants |
| Sutent (Sunitinib Malate) | Eastern Cooperative Oncology Group (ECOG) Performance Status | Last on treatment, ECOG = 5 | 0 participants |
Number of Participants With Abnormal Clinical Laboratory Measurements
The total number of participants with laboratory test abnormalities without regard to baseline abnormality was assessed. Laboratory parameters included hematology (hemoglobin, platelets, white blood cell count, lymphocytes, neutrophils, basophils, eosinophils and monocytes), liver function (total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein and albumin), renal function (blood urea nitrogen, creatinine and uric acid), electrolytes (sodium, potassium, chloride, calcium, magnesium and phosphate), hormones (thyroxine and thyroid stimulating hormone), clinical chemistry (glucose), and urinalysis (urine protein) tests.
Time frame: Baseline up to 28 days post last administration of study drug
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sutent (Sunitinib Malate) | Number of Participants With Abnormal Clinical Laboratory Measurements | 57 participants |
Number of Participants With Significant Changes From Baseline in Physical Examination.
Physical examinations including, but not limited to, general appearance, skin, neck, eyes, ears, nose, mouth, throat, breast, lungs, heart, abdomen, rectal, lymph nodes, extremities, thyroid, musculoskeletal, and nervous system were performed.
Time frame: Baseline up to 28 days post last administration of study drug
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sutent (Sunitinib Malate) | Number of Participants With Significant Changes From Baseline in Physical Examination. | 28 participants |
Number of Participants With Significant Vital Signs Changes From Baseline
Vital signs included blood pressure (BP), temperature, heart rate, respiration rate and body weight. The criteria for significant changes included BP: systolic BP (SBP) greater than (\>) 150 millimeters of mercury (mm Hg) and/or diastolic BP (DBP) \> 100 mm Hg, or SBP \> 200 mm Hg and/or DBP \> 110 mm Hg; temperature: \>38.3 degrees Celsius (degrees C), or increase of greater than or equal to (\>=)1.1 degrees C (baseline \>=36.8 degrees C); heart rate: \>120 beats per minute (bpm) or less than (\<) 50 bpm, or increase of \>=30 bpm or decrease of ≥30 bpm; respiration rate: \> 40 /minute or \< 8 /minute; weight: a change of 5% or more from baseline.
Time frame: Baseline (Day 1) up to 28 days post last administration of study drug
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | SBP >150 mm Hg or DBP >100 mm Hg | 9 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | SBP >200 mm Hg or DBP >110 mm Hg | 1 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | heart rate: <50 bpm | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | heart rate: >120 bpm | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | heart rate: >=30 bpm increase from baseline | 2 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | heart rate: >=30 bpm decrease from baseline | 2 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | temperature: >38.3°C | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | temperature: >=1.1°C increase (baseline >=36.8°C) | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | respiration rate: <8/minute | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | respiration rate: >40/minute | 0 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | weight: >=5% increase from baseline | 12 participants |
| Sutent (Sunitinib Malate) | Number of Participants With Significant Vital Signs Changes From Baseline | weight: >=5% decrease from baseline | 20 participants |
Objective Response Rate (ORR)
ORR was defined as the proportion of participants who achieved an objective response. A participant was considered to have an objective response if a confirmed best response of complete response (CR) or partial response (PR) was achieved according to RECIST, version 1.0. CR is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 millimeters (mm). PR is at least a 30 percent (%) decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: Baseline (Day 1) up to end of study treatment (up to 276 weeks)
Population: The per-protocol analysis set included all enrolled participants who had the disease under study, measurable disease and an adequate baseline disease assessment, and who started study treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sutent (Sunitinib Malate) | Objective Response Rate (ORR) | 19.0 % of participants |
Overall Survival (OS)
OS was defined as the time (in weeks) from the date of the first treatment to the date of death due to any cause. In the absence of confirmation of death, survival time was censored at the last date the participant was known to be alive.
Time frame: Baseline (Day 1) to death (up to 282 weeks)
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sutent (Sunitinib Malate) | Overall Survival (OS) | 111.3 weeks |
Time to Tumor Progression (TTP)
TTP was defined as the time (in weeks) from the date of the first treatment to the date of the first documentation of objective tumor progression or death due to tumor progression. Participants last known to be 1) alive,2) on treatment or within 28 days of discontinuation from treatment and 3) progression-free were censored at the date of last objective disease assessment that verified lack of disease progression. Participants with no post baseline assessments were censored at the start date. Participants who died without prior objective disease progression and participants who discontinued treatment without objective disease progression within 28 days of last dose were censored at the date of the last objective disease assessment that verified lack of disease progression. Disease progression is defined using RECIST version 1.0.
Time frame: Baseline (Day 1) up to objective tumor progression or death due to tumor progression (up to 264 weeks)
Population: Safety analysis set included all participants who started study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sutent (Sunitinib Malate) | Time to Tumor Progression (TTP) | 47.3 weeks |
Time to Tumor Response (TTR)
TTR was defined as the time (in weeks) from the date of the first dose of study treatment to the date of the first documentation of objective tumor response (CR or PR based on RECIST, version 1.0) that was subsequently confirmed.
Time frame: Baseline (Day 1) to tumor response (up to 82 weeks)
Population: All participants who started study treatment (safety analysis set) had a confirmed objective tumor response.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sutent (Sunitinib Malate) | Time to Tumor Response (TTR) | 22.6 weeks |