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NKTR-102 Versus Irinotecan in Patients With Second-Line, Irinotecan-Naïve, KRAS Mutant, Colorectal Cancer

A Multicenter, Open-Label, Randomized, Phase 2 Study to Evaluate the Efficacy and Safety of NKTR-102 Versus Irinotecan in Patients With Second-Line, Irinotecan-Naive, KRAS-Mutant, Metastatic Colorectal Cancer (mCRC)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00856375
Enrollment
83
Registered
2009-03-05
Start date
2008-12-31
Completion date
2014-12-31
Last updated
2021-07-12

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

Conditions

Colorectal Cancer

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

DRUGirinotecan

IV every 3 weeks

Sponsors

Nektar Therapeutics
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

* metastatic colorectal cancer * tumor with k-ras mutation

Exclusion criteria

* More than 1 prior regimen for treatment of metastatic disease

Design outcomes

Primary

MeasureTime frameDescription
Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT PopulationEvery 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

MeasureTime frameDescription
Kaplan-Meier Estimate of OS: ITT PopulationFrom 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 PopulationFrom randomization of the first subject until documented disease progression, start of new therapy for cancer, death, or end of study approximately 42 monthsORR 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 PopulationFrom 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 monthsProgressive 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 HigherFrom 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 monthsAn 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 MetabolitesDays 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

ArmCount
NKTR-102
NKTR-102 NKTR-102: IV every 3 weeks
42
Irinotecan
IV every 3 weeks irinotecan: IV every 3 weeks
41
Total83

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath3230
Overall StudyLost to Follow-up12
Overall StudyOther01
Overall StudySponsor Terminated Study77
Overall StudyWithdrawal by Subject21

Baseline characteristics

CharacteristicNKTR-102IrinotecanTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
12 Participants11 Participants23 Participants
Age, Categorical
Between 18 and 65 years
30 Participants30 Participants60 Participants
Age, Continuous58.5 years
STANDARD_DEVIATION 10.65
57.8 years
STANDARD_DEVIATION 11.4
58.2 years
STANDARD_DEVIATION 10.97
Sex: Female, Male
Female
18 Participants16 Participants34 Participants
Sex: Female, Male
Male
24 Participants25 Participants49 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
32 / 4230 / 41
other
Total, other adverse events
42 / 4238 / 41
serious
Total, serious adverse events
19 / 4224 / 41

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
NKTR-102Kaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population4.0 months
IrinotecanKaplan-Meier Estimate of PFS by Central Radiological Review: ITT Population2.8 months
p-value: =0.0795% CI: [0.4, 1.041]Log Rank
Secondary

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

ArmMeasureValue (MEDIAN)
NKTR-102DoR by Central Radiological Review: ITT Population7.9 months
IrinotecanDoR by Central Radiological Review: ITT Population1.4 months
p-value: =0.018Log Rank
Secondary

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.

ArmMeasureValue (MEDIAN)
NKTR-102Kaplan-Meier Estimate of OS: ITT Population9.6 months
IrinotecanKaplan-Meier Estimate of OS: ITT Population8.4 months
p-value: =0.70695% CI: [0.557, 1.486]Log Rank
Secondary

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

ArmMeasureValue (MEDIAN)
NKTR-102ORR by Central Radiological Review: ITT Population9.8 percentage of patients
IrinotecanORR by Central Radiological Review: ITT Population5.0 percentage of patients
p-value: =0.67695% CI: [0.355, 11.9]Fisher Exact
Secondary

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

ArmMeasureGroupValue (NUMBER)
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Abdominal Pain14.3 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with ≥1 TEAE61.9 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Diarrhea21.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Neutropenia7.1 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Dehydration9.5 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Vomiting11.9 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Nausea14.3 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hypokalemia7.1 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Fatigue9.5 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Intestinal Obstruction2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Leukopenia7.1 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Febrile Neutropenia2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Alopecia2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Disease Progression4.8 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hyponatremia2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Acute Prerenal Failure2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Asthenia2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hyperbilirubinemia2.4 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Performance Status Decreased4.8 % of participants
NKTR-102Percentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Sepsis0 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hyperbilirubinemia2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Leukopenia4.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with ≥1 TEAE63.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Acute Prerenal Failure2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Diarrhea19.5 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Febrile Neutropenia7.3 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Neutropenia14.6 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Abdominal Pain4.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Sepsis4.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Dehydration9.8 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Alopecia4.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Vomiting7.3 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Asthenia2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Nausea2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Disease Progression2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hypokalemia7.3 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Performance Status Decreased0 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Fatigue2.4 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Hyponatremia4.9 % of participants
IrinotecanPercentage of Participants (≥2%) With Treatment-Emergent Adverse Events NCI-CTCAE Grade 3 or HigherPercentage of participants with Intestinal Obstruction9.8 % of participants
Secondary

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.

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