Colorectal Cancer
Conditions
Keywords
colorectal cancer, Colorectal cancer, second line
Brief summary
This study will evaluate whether NKTR-102, an investigational drug has an anti-tumor effect in patients with colorectal cancer. This study will also evaluate how the safety and anti-tumor activity of NKTR-102 compares with irinotecan, a cancer drug that is approved for use in the US for treatment of patients with certain types of colorectal cancer.
Detailed description
NKTR-102 (Topoisomerase I Inhibitor Polymer Conjugate) is a polyethylene glycol (PEG) conjugate of irinotecan. Irinotecan is a topoisomerase I inhibitor approved worldwide. In the US, irinotecan is indicated as a component of first-line therapy in combination with 5 fluorouracil (5 FU) and leucovorin for patients with metastatic carcinoma of the colon or rectum. Irinotecan is also indicated for patients with metastatic carcinoma of the colon or rectum whose disease has recurred or progressed following initial fluorouracil-based therapy. Second-line therapy for colorectal cancer typically involves cetuximab and irinotecan. However, growing evidence indicates that cetuximab (or other EGFR inhibitors) is not appropriate therapy for patients with mutant KRAS. For these patients, irinotecan may be appropriate as a single agent, and a new therapy that could improve upon efficacy and safety would provide an important option for the treatment of advanced colorectal cancer.
Interventions
IV every 3 weeks
IV every 3 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
* metastatic colorectal cancer * tumor with k-ras mutation
Exclusion criteria
* More than 1 prior regimen for treatment of metastatic disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population | Every 6 weeks (± 5 days) from Cycle 1, Day 1 until documented disease progression, start of new therapy for cancer, death, or end of study, approximately 42 months. | PFS was defined as the time from the date of randomisation to the date of disease progression (assessed by central radiological review according to Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1) or death due to any cause, whichever comes first. PFS was determined using the intention-to-treat (ITT) population which included all randomized patients who underwent baseline evaluation, with treatment assigned according to randomized arm. For patients whose disease did not progress or who did not die, the PFS time was censored at the time of the last tumor assessment that demonstrated lack of disease progression. For patients who received new anti-cancer therapy, the PFS time was censored at the time of last tumor assessment prior to the new anti-cancer therapy starts. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kaplan-Meier Estimate of OS: ITT Population | From randomization to death, loss to follow-up, withdrawal of consent for further follow-up for survival, or end of study, approximately 42 months. | Duration of OS was defined as the time from the date of randomization to the date of death due to any cause. Patients were followed until their date of death, loss to follow-up, withdrawal of consent for further follow-up for survival, or final database closure. Patients who were lost-to-follow-up or were not known to have died were censored at last date they were shown to be alive. Patients who did not have any follow-up since the date of randomization were censored at the date of randomization. |
| ORR by Central Radiological Review: ITT Population | From randomization of the first subject until documented disease progression, start of new therapy for cancer, death, or end of study approximately 42 months | ORR was defined as the proportion of patients with a complete response (CR) or a partial response (PR) per RECIST 1.1 based upon the best response as assessed by central radiological review; confirmation of response was not required. The analyses were performed for patients in the ITT population who had measurable disease as determined by the central imaging facility at baseline. |
| DoR by Central Radiological Review: ITT Population | From the time measurement criteria for CR/PR (whichever was first recorded) were first met until the first date that recurrent disease or PD or death was objectively documented, assessed until the end of study approximately 42 months | Progressive Disease (PD) is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that was the smallest on study); in addition to a relative increase of 20%, the sum must have also demonstrated an absolute increase of at least 5 mm. CR is defined as disappearance of all target lesions; any pathological lymph nodes (whether target or non-target) must have had a reduction in short axis to \< 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters |
| Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | From the first dose of study medication through the End-of-Treatment visit (30 ± 3 days from last dose of study drug), assessed until the end of study approximately 42 months | An adverse event (AE) was any untoward medical occurrence in a patient administered a pharmaceutical product which did not necessarily have a causal relationship with the treatment. An AE could have been any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Pre-existing events, which increased in frequency or severity or changed in nature during or as a consequence of use of the study medication were also considered as AEs. All AEs were assessed for severity using the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 3.0. If a particular AE was not listed in the NCI CTCAE Version 3.0, the following criteria were used: Grade 3 = severe; Grade 4 = life threatening or disabling; Grade 5 = death. |
| PK Parameters of NKTR-102 or Irinotecan and Respective Metabolites | Days 1, 2, 3, 4, 8 and 15 of Cycles 1 and 3 and Day 1 of Cycles 2, 4 and all subsequent cycles, until End of Study, approximately 42 months. | Blood samples for PK analysis were collected from 4 patients only, 3 from the irinotecan treatment arm and 1 from the NKTR-102 treatment arm. NKTR-102, irinotecan, SN38, SN38-G, 7-ethyl-10-\[4-N-(5-aminopentanoic acid)-1-piperidino\]carbonyloxycamptothecin, and 7-ethyl-10-(4-amino-1-piperidino) carbonyloxycamptothecin concentration levels were determined. However, due to the limited number of patients with PK samples, no further PK analysis was conducted. |
Countries
Belgium, Germany, India, Spain, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| NKTR-102 NKTR-102
NKTR-102: IV every 3 weeks | 42 |
| Irinotecan IV every 3 weeks
irinotecan: IV every 3 weeks | 41 |
| Total | 83 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 32 | 30 |
| Overall Study | Lost to Follow-up | 1 | 2 |
| Overall Study | Other | 0 | 1 |
| Overall Study | Sponsor Terminated Study | 7 | 7 |
| Overall Study | Withdrawal by Subject | 2 | 1 |
Baseline characteristics
| Characteristic | NKTR-102 | Irinotecan | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 12 Participants | 11 Participants | 23 Participants |
| Age, Categorical Between 18 and 65 years | 30 Participants | 30 Participants | 60 Participants |
| Age, Continuous | 58.5 years STANDARD_DEVIATION 10.65 | 57.8 years STANDARD_DEVIATION 11.4 | 58.2 years STANDARD_DEVIATION 10.97 |
| Sex: Female, Male Female | 18 Participants | 16 Participants | 34 Participants |
| Sex: Female, Male Male | 24 Participants | 25 Participants | 49 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 32 / 42 | 30 / 41 |
| other Total, other adverse events | 42 / 42 | 38 / 41 |
| serious Total, serious adverse events | 19 / 42 | 24 / 41 |
Outcome results
Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population
PFS was defined as the time from the date of randomisation to the date of disease progression (assessed by central radiological review according to Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1) or death due to any cause, whichever comes first. PFS was determined using the intention-to-treat (ITT) population which included all randomized patients who underwent baseline evaluation, with treatment assigned according to randomized arm. For patients whose disease did not progress or who did not die, the PFS time was censored at the time of the last tumor assessment that demonstrated lack of disease progression. For patients who received new anti-cancer therapy, the PFS time was censored at the time of last tumor assessment prior to the new anti-cancer therapy starts.
Time frame: Every 6 weeks (± 5 days) from Cycle 1, Day 1 until documented disease progression, start of new therapy for cancer, death, or end of study, approximately 42 months.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| NKTR-102 | Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population | 4.0 months |
| Irinotecan | Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population | 2.8 months |
DoR by Central Radiological Review: ITT Population
Progressive Disease (PD) is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that was the smallest on study); in addition to a relative increase of 20%, the sum must have also demonstrated an absolute increase of at least 5 mm. CR is defined as disappearance of all target lesions; any pathological lymph nodes (whether target or non-target) must have had a reduction in short axis to \< 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters
Time frame: From the time measurement criteria for CR/PR (whichever was first recorded) were first met until the first date that recurrent disease or PD or death was objectively documented, assessed until the end of study approximately 42 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| NKTR-102 | DoR by Central Radiological Review: ITT Population | 7.9 months |
| Irinotecan | DoR by Central Radiological Review: ITT Population | 1.4 months |
Kaplan-Meier Estimate of OS: ITT Population
Duration of OS was defined as the time from the date of randomization to the date of death due to any cause. Patients were followed until their date of death, loss to follow-up, withdrawal of consent for further follow-up for survival, or final database closure. Patients who were lost-to-follow-up or were not known to have died were censored at last date they were shown to be alive. Patients who did not have any follow-up since the date of randomization were censored at the date of randomization.
Time frame: From randomization to death, loss to follow-up, withdrawal of consent for further follow-up for survival, or end of study, approximately 42 months.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| NKTR-102 | Kaplan-Meier Estimate of OS: ITT Population | 9.6 months |
| Irinotecan | Kaplan-Meier Estimate of OS: ITT Population | 8.4 months |
ORR by Central Radiological Review: ITT Population
ORR was defined as the proportion of patients with a complete response (CR) or a partial response (PR) per RECIST 1.1 based upon the best response as assessed by central radiological review; confirmation of response was not required. The analyses were performed for patients in the ITT population who had measurable disease as determined by the central imaging facility at baseline.
Time frame: From randomization of the first subject until documented disease progression, start of new therapy for cancer, death, or end of study approximately 42 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| NKTR-102 | ORR by Central Radiological Review: ITT Population | 9.8 percentage of patients |
| Irinotecan | ORR by Central Radiological Review: ITT Population | 5.0 percentage of patients |
Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher
An adverse event (AE) was any untoward medical occurrence in a patient administered a pharmaceutical product which did not necessarily have a causal relationship with the treatment. An AE could have been any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Pre-existing events, which increased in frequency or severity or changed in nature during or as a consequence of use of the study medication were also considered as AEs. All AEs were assessed for severity using the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 3.0. If a particular AE was not listed in the NCI CTCAE Version 3.0, the following criteria were used: Grade 3 = severe; Grade 4 = life threatening or disabling; Grade 5 = death.
Time frame: From the first dose of study medication through the End-of-Treatment visit (30 ± 3 days from last dose of study drug), assessed until the end of study approximately 42 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Abdominal Pain | 14.3 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with ≥1 TEAE | 61.9 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Diarrhea | 21.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Neutropenia | 7.1 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Dehydration | 9.5 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Vomiting | 11.9 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Nausea | 14.3 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hypokalemia | 7.1 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Fatigue | 9.5 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Intestinal Obstruction | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Leukopenia | 7.1 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Febrile Neutropenia | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Alopecia | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Disease Progression | 4.8 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hyponatremia | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Acute Prerenal Failure | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Asthenia | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hyperbilirubinemia | 2.4 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Performance Status Decreased | 4.8 % of participants |
| NKTR-102 | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Sepsis | 0 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hyperbilirubinemia | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Leukopenia | 4.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with ≥1 TEAE | 63.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Acute Prerenal Failure | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Diarrhea | 19.5 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Febrile Neutropenia | 7.3 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Neutropenia | 14.6 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Abdominal Pain | 4.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Sepsis | 4.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Dehydration | 9.8 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Alopecia | 4.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Vomiting | 7.3 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Asthenia | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Nausea | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Disease Progression | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hypokalemia | 7.3 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Performance Status Decreased | 0 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Fatigue | 2.4 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Hyponatremia | 4.9 % of participants |
| Irinotecan | Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or Higher | Percentage of participants with Intestinal Obstruction | 9.8 % of participants |
PK Parameters of NKTR-102 or Irinotecan and Respective Metabolites
Blood samples for PK analysis were collected from 4 patients only, 3 from the irinotecan treatment arm and 1 from the NKTR-102 treatment arm. NKTR-102, irinotecan, SN38, SN38-G, 7-ethyl-10-\[4-N-(5-aminopentanoic acid)-1-piperidino\]carbonyloxycamptothecin, and 7-ethyl-10-(4-amino-1-piperidino) carbonyloxycamptothecin concentration levels were determined. However, due to the limited number of patients with PK samples, no further PK analysis was conducted.
Time frame: Days 1, 2, 3, 4, 8 and 15 of Cycles 1 and 3 and Day 1 of Cycles 2, 4 and all subsequent cycles, until End of Study, approximately 42 months.
Population: There are no data available for this outcome, due to the very small number of PK samples that were collected from these patients.