Ovarian Neoplasms, Peritoneal Neoplasms
Conditions
Brief summary
The trial will be performed to evaluate if BIBF 1120 in combination with paclitaxel and carboplatin is more effective than placebo in combination with paclitaxel and carboplatin in first-line treatment of patients with advanced ovarian cancer. Safety information about BIBF1120/paclitaxel/carboplatin will be obtained.
Interventions
comparator to BIBF 1120
Paclitaxel (standard chemo-therapy)
comparison of BIBF 1120 in combination with chemotherapy and placebo in combination with chemotherapy (paclitaxel/carboplatin)
Carboplatin (standard chemo-therapy)
Sponsors
Study design
Eligibility
Inclusion criteria
* first diagnosis of histologically confirmed epithelial ovarian cancer, fallopian tube or primary peritoneal cancer * International Federation of Gynecology and Obstetrics (FIGO) Stages IIB - IV * females, age 18 years or older * life expectancy of at least 6 months * Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2 * prior surgery, defined as either (a) debulking surgery with maximum surgical effort at cytoreduction with the goal of no residual disease or (b) biopsy or limited surgery in patients with stage IV disease for whom surgical debulking was not considered appropriate, if diagnosis is confirmed by histology and no surgery is planned prior to disease progression (including interval debulking surgery) * patient has given written informed consent which must be consistent with the International Conference on Harmonization - Good Clinical Practice (ICH-GCP) and local legislation * planned application of first dose of chemotherapy after wound healing, but no later than 10 weeks after surgery
Exclusion criteria
* histologic diagnosis of a benign or borderline tumour or of a malignant tumour of non-epithelial origin of the ovary, the fallopian tube or the peritoneum * planned surgery within 124 weeks after randomisation in this trial, including interval debulking surgery * clinically relevant non-healing wound, ulcer or bone fracture * clinical symptoms or signs of gastrointestinal obstruction that require parenteral nutrition or hydration * brain metastases * pre-existing sensory or motor neuropathy Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or higher, except due to trauma * history of major thromboembolic event * known inherited or acquired bleeding disorder * significant cardiovascular diseases * clinically relevant pericardial effusion * history of a cerebral vascular accident, transient ischemic attack or subarachnoid haemorrhage within the past 6 months * inadequate safety laboratory values * serious infections in particular if requiring systemic antibiotic (antimicrobial, antifungal) or antiviral therapy, including Hepatitis B, Hepatitis C, Human Immunodeficiency Virus (HIV) * poorly controlled diabetes mellitus or other contraindication to high dose corticosteroid therapy * gastrointestinal disorders or abnormalities that would interfere with absorption of the study drug * other malignancy diagnosed within the past 5 years. In exception to this rule, the following malignancies may be included if adequately treated: non-melanomatous skin cancer, cervical carcinoma in situ, carcinoma in situ of the breast, low risk endometrial cancer * prior systemic therapy for ovarian cancer (e.g. chemotherapy, monoclonal antibody therapy, oral targeted therapy, hormonal therapy) * prior systemic cytotoxic chemotherapy * prior treatment with BIBF 1120 or any other angiogenesis inhibitor * prior radiotherapy * serious illness or concomitant non-oncological disease such as neurologic, psychiatric or infectious disease or a laboratory abnormality that may increase the risk associated with study participation or study drug administration * Women of childbearing potential who are sexually active and not using a highly effective method of birth control during the trial and for at least twelve months after the end of active therapy. * pregnancy or breast feeding * psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up schedule * active alcohol or drug abuse * patients unable to comply with the protocol * any contraindications for therapy with paclitaxel or carboplatin * treatment with other investigational drugs or participation in another clinical trial testing a drug within the past four weeks before start of therapy or concomitantly with this trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria. | First drug administration to date of disease progression or death whichever occurs first , upto 29 months | Progression free survival (PFS) is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first according to the Investigator assessment. The primary PFS analysis of this trial was performed when approximately 753 patients had experienced a PFS event Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm. |
| PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria (Follow up Analysis). | First drug administration to date of disease progression or death whichever occurs first until final Data Base Lock (DBL) 26September16, upto 62 months | Follow-up analysis was conducted at the time of overall survival analysis. Progression free survival (PFS) is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first according to the Investigator assessment. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | First drug administration to date of death until final DBL 26September16, upto 62 months | Overall survival is defined as time from randomization to date of death (irrespective of reason). Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm. |
| Time to CA-125 Tumour Marker Progression | First drug administration until final DBL 26September16, upto 62 months | Time to tumour-marker progression was defined as the time from randomisation until the date when Carbohydrate (cancer) antigen (CA-125) values increased to higher than twice the nadir value. CA-125 \>=2 x nadir in case nadir value \> Upper limit of normal (ULN) or CA-125 \>=2 x ULN in case nadir value \<= ULN. |
| PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint). | First drug administration to date of disease progression or death whichever occurs first , upto 29 months | Progression free survival is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first based on the Investigator assessment according to Modified Response Evaluation Criteria (mRECIST), version 1.1. The primary PFS analysis of this trial was performed when approximately 753 patients had experienced a PFS event. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm. |
| Change in Abdominal/Gastro-intestinal Symptoms Over Time | First drug administration until final DBL 26September16, upto 62 months | Change in abdominal/gastro-intestinal over time was calculated on symptoms (scale composite of items 31 to 37 of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Module for Ovarian Cancer 28 (EORTC QLQ OV-28). As specified in the EORTC scoring manual, for each scale or item, a linear transformation was applied to standardize the raw score to a range from 0 to 100 (high scores represent a high/severe level of symptomatology). Mean presented is Adjusted mean. Adjusted for the stratification factors macroscopic residual postoperative tumour at baseline (yes vs. no), FIGO stage (IIB-III vs IV), and Carboplatin level (AUC5 vs. AUC6). |
| Change in Global Health Status/ Quality of Life (QoL) Scale Over Time. | First drug administration until final DBL 26September16, upto 62 months | Change in Global Health Status/ Quality of life (QoL) over time was calculated on Global Health Status/QoL scale (composite of items 29 and 30 of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30) as a general measure. As specified in the EORTC scoring manual, for each scale or item, a linear transformation was applied to standardize the raw score to a range from 0 to 100 (high scores represent a high/healthy level of functioning). Mean presented is Adjusted mean. Adjusted for the stratification factors macroscopic residual postoperative tumour at baseline (yes vs. no), FIGO stage (IIB-III vs IV), and Carboplatin level (AUC5 vs. AUC6). |
| Objective Response Based on Investigator Assessment | First drug administration until final DBL 26September16, upto 62 months | Objective tumour response defined as either complete response \[CR\] or partial response \[PR\] in patients with at least 1 target lesion reported at baseline |
| PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint - Follow up Analysis). | First drug administration to date of disease progression or death whichever occurs first until final Data Base Lock (DBL) 26September16, upto 62 months | Follow-up analysis was conducted at the time of overall survival analysis. Progression free survival is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first based on the Investigator assessment according to Modified Response Evaluation Criteria (mRECIST), version 1.1. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm. |
Countries
Australia, Austria, Belgium, Canada, Czechia, Denmark, Finland, France, Germany, Greece, Italy, Netherlands, Norway, Poland, Portugal, Russia, Slovakia, Spain, Sweden, Ukraine, United Kingdom, United States
Participant flow
Pre-assignment details
1366 patients were randomised for this study.
Participants by arm
| Arm | Count |
|---|---|
| Nintedanib Patients to receive Nintedanib 200 milligram (mg) soft gelatine capsule, taken orally twice daily, except the day of chemotherapy (carboplatin and paclitaxel) infusion, every 21 days for six courses. | 911 |
| Placebo Patients to receive matching placebo soft gelatine capsule identical to those containing Nintedanib, taken orally twice daily, except the day of chemotherapy (carboplatin and paclitaxel) infusion, every 21 days for six courses. | 455 |
| Total | 1,366 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Not treated | 9 | 5 |
| Overall Study | Other Adverse Event (AE) | 141 | 33 |
| Overall Study | Other than stated above | 42 | 23 |
| Overall Study | Progressive disease | 364 | 229 |
| Overall Study | Protocol Violation | 5 | 6 |
| Overall Study | Withdrawal by Subject | 103 | 27 |
| Overall Study | Worsening or AE of underlying disease | 5 | 4 |
Baseline characteristics
| Characteristic | Nintedanib | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 57.5 Years STANDARD_DEVIATION 11 | 56.9 Years STANDARD_DEVIATION 11.1 | 57.3 Years STANDARD_DEVIATION 11.1 |
| Sex: Female, Male Female | 911 Participants | 455 Participants | 1366 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 442 / 450 | 891 / 902 |
| serious Total, serious adverse events | 157 / 450 | 379 / 902 |
Outcome results
PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria.
Progression free survival (PFS) is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first according to the Investigator assessment. The primary PFS analysis of this trial was performed when approximately 753 patients had experienced a PFS event Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm.
Time frame: First drug administration to date of disease progression or death whichever occurs first , upto 29 months
Population: Randomised Set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria. | 17.2 Months |
| Placebo | PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria. | 16.6 Months |
PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria (Follow up Analysis).
Follow-up analysis was conducted at the time of overall survival analysis. Progression free survival (PFS) is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first according to the Investigator assessment. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm.
Time frame: First drug administration to date of disease progression or death whichever occurs first until final Data Base Lock (DBL) 26September16, upto 62 months
Population: Randomised Set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria (Follow up Analysis). | 17.6 Months |
| Placebo | PFS Based on Investigator Assessment According to Modified Response Evaluation Criteria in Solid Tumors, Version 1.1 (mRECIST), and Additional Clinical Criteria (Follow up Analysis). | 16.6 Months |
Change in Abdominal/Gastro-intestinal Symptoms Over Time
Change in abdominal/gastro-intestinal over time was calculated on symptoms (scale composite of items 31 to 37 of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Module for Ovarian Cancer 28 (EORTC QLQ OV-28). As specified in the EORTC scoring manual, for each scale or item, a linear transformation was applied to standardize the raw score to a range from 0 to 100 (high scores represent a high/severe level of symptomatology). Mean presented is Adjusted mean. Adjusted for the stratification factors macroscopic residual postoperative tumour at baseline (yes vs. no), FIGO stage (IIB-III vs IV), and Carboplatin level (AUC5 vs. AUC6).
Time frame: First drug administration until final DBL 26September16, upto 62 months
Population: Randomised Set (RS) for patients with abdominal/gastro-intestinal symptoms
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nintedanib | Change in Abdominal/Gastro-intestinal Symptoms Over Time | 24.63 units on a scale | Standard Error 0.49 |
| Placebo | Change in Abdominal/Gastro-intestinal Symptoms Over Time | 19.34 units on a scale | Standard Error 0.64 |
Change in Global Health Status/ Quality of Life (QoL) Scale Over Time.
Change in Global Health Status/ Quality of life (QoL) over time was calculated on Global Health Status/QoL scale (composite of items 29 and 30 of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30) as a general measure. As specified in the EORTC scoring manual, for each scale or item, a linear transformation was applied to standardize the raw score to a range from 0 to 100 (high scores represent a high/healthy level of functioning). Mean presented is Adjusted mean. Adjusted for the stratification factors macroscopic residual postoperative tumour at baseline (yes vs. no), FIGO stage (IIB-III vs IV), and Carboplatin level (AUC5 vs. AUC6).
Time frame: First drug administration until final DBL 26September16, upto 62 months
Population: Randomised Set (RS) for patients with global health status/QoL
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nintedanib | Change in Global Health Status/ Quality of Life (QoL) Scale Over Time. | 68.79 units on a scale | Standard Error 0.48 |
| Placebo | Change in Global Health Status/ Quality of Life (QoL) Scale Over Time. | 70.67 units on a scale | Standard Error 0.65 |
Objective Response Based on Investigator Assessment
Objective tumour response defined as either complete response \[CR\] or partial response \[PR\] in patients with at least 1 target lesion reported at baseline
Time frame: First drug administration until final DBL 26September16, upto 62 months
Population: Randomised Set (RS) for patients with at least 1 target lesion reported at baseline
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nintedanib | Objective Response Based on Investigator Assessment | 74.3 percentage of participants |
| Placebo | Objective Response Based on Investigator Assessment | 70.2 percentage of participants |
Overall Survival
Overall survival is defined as time from randomization to date of death (irrespective of reason). Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm.
Time frame: First drug administration to date of death until final DBL 26September16, upto 62 months
Population: Randomised Set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | Overall Survival | 62.0 Months |
| Placebo | Overall Survival | 62.8 Months |
PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint).
Progression free survival is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first based on the Investigator assessment according to Modified Response Evaluation Criteria (mRECIST), version 1.1. The primary PFS analysis of this trial was performed when approximately 753 patients had experienced a PFS event. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm.
Time frame: First drug administration to date of disease progression or death whichever occurs first , upto 29 months
Population: Randomised Set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint). | 18.3 Months |
| Placebo | PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint). | 16.6 Months |
PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint - Follow up Analysis).
Follow-up analysis was conducted at the time of overall survival analysis. Progression free survival is calculated as the time from randomisation to the date of disease progression, or to the date of death, whichever occurs first based on the Investigator assessment according to Modified Response Evaluation Criteria (mRECIST), version 1.1. Median, 25th and 75th percentiles are calculated from an unadjusted Kaplan-Meier curve for each treatment arm.
Time frame: First drug administration to date of disease progression or death whichever occurs first until final Data Base Lock (DBL) 26September16, upto 62 months
Population: Randomised Set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint - Follow up Analysis). | 18.4 Months |
| Placebo | PFS Based on Investigator Assessment According to mRECIST Version 1.1 (Key Secondary Endpoint - Follow up Analysis). | 16.6 Months |
Time to CA-125 Tumour Marker Progression
Time to tumour-marker progression was defined as the time from randomisation until the date when Carbohydrate (cancer) antigen (CA-125) values increased to higher than twice the nadir value. CA-125 \>=2 x nadir in case nadir value \> Upper limit of normal (ULN) or CA-125 \>=2 x ULN in case nadir value \<= ULN.
Time frame: First drug administration until final DBL 26September16, upto 62 months
Population: Randomised set (RS)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nintedanib | Time to CA-125 Tumour Marker Progression | 16.6 Months |
| Placebo | Time to CA-125 Tumour Marker Progression | 14.1 Months |