Carcinoma
Conditions
Keywords
Hepatocellular carcinoma, randomized trial, medical treatment, RAD001, placebo, Advanced Hepatocellular Carcinoma (HCC)
Brief summary
The purpose of this study is to compare treatment with RAD001 plus best supportive care (BSC) to placebo plus BSC in patients with advanced HCC whose disease progressed while on or after sorafenib treatment or who are intolerant to sorafenib.
Interventions
Everolimus (labeled as RAD001) was formulated as tablets of 2.5 mg strength and blisterpacked in units of 10 tablets.
Everolimus Placebo matched to the everolimus 2.5 mg tablet strength was blister-packed in units of 10 tablets. Matching placebo tablets were formulated to be indistinguishable from the everolimus tablets. Everolimus placebo was taken as a daily oral dose of 7.5 mg and was defined as the control drug.
BSC was defined as drug or non-drug therapies, nutritional support, physical therapy or anything that the Investigator believed to be in the patient's best interest, but excluding other antineoplastic treatments. BSC administered to the patient throughout the study was to be reported on the Concomitant Medication/Significant Non-Drug Therapy electronic case report from (eCRF). Permitted BSC treatments during the study included, but were not limited to, the following: Pain medication to allow the patient to be as comfortable as possible, Bisphosphonates for bone metastases, Localized radiotherapy, for the treatment of pre-existing, painful bone metastases, Nutritional support or appetite stimulants (i.e. megestrol) as recommended by the Investigator, Oxygen therapy and blood products or transfusions
Sponsors
Study design
Eligibility
Inclusion criteria
* Advanced liver cancer * Prior systemic treatment with sorafenib for advanced HCC and for whom their disease progressed during or after sorafenib treatment, or were intolerant to sorafenib treatment. Specifically, this can be defined as: * Documented radiological confirmation (radiology scans or report) of disease progression during or after sorafenib treatment * Intolerance to sorafenib (at any dose and/or duration) is defined as documented sorafenib-related grade 3 or 4 adverse events that led to sorafenib discontinuation. NOTE: * Sorafenib must be the last antineoplastic treatment before randomization * Prior local and/or hormonal therapy (e.g., tamoxifen) before sorafenib is allowed * One systemic chemotherapy regimen for advanced HCC is allowed before sorafenib treatment * ECOG performance status of ≤ 2 * Child-Pugh A
Exclusion criteria
* Active bleeding during the last 28 days * Prior therapy with mTOR inhibitors * Prior liver or other organ transplantation which mandates systemic immunosuppression Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | When 454 OS events were observed | OS was defined as the time from the date of randomization to the date of death from any cause. The comparison of OS between the 2 arms was done using a stratified log-rank test at one-sided 2.5% level of significance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Disease Control Rate (DCR) | Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient | DCR is defined as the proportion of participants with a best objective response (BOR) of complete response (CR) or partial response (PR) or stable disease (SD) according to RECIST. The BOR was the best response recorded from the start of the treatment until disease progression. CR is disappearance of all target lesions; PR is at least a 30% decrease in the sum of the longest diameter of all target lesions, taking as reference the baseline sum of the longest diameters; SD is neither sufficient shrinkage to qualify for PR or CR nor an increase in lesions which would qualify for PD. PD is at least a 20% increase in the sum of the longest diameter of all measured target lesions, taking as reference the smallest sum of longest diameter of all target lesions recorded at or after baseline. |
| Time to Definitive Deterioration of ECOG Performance Score (PS) Score | Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient. | Change in Eastern Cooperative Oncology Group (ECOG) were assessed by time to definitive performance status deterioration by at least one category on the ECOG scale. Deterioration was considered definitive if no improvement in the ECOG PS was observed at a subsequent measurement. ECOG PS: 0=Fully active, able to carry on all pre-disease performance 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, office work; 2=Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours; 3=Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours; 4=Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair; 5=Dead |
| Time to Tumor Progression (TTP) | Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient | TTP was defined as the time from the date of randomization to the date of the first documented radiologic confirmation of disease progression. Since the study did not meet the primary objective, TTP was not formally tested. |
| Pharmacokinetics Assessments - Cmin | Until all patients have disease progression or leave study due to intolerable adverse events - Estimate of 1 year for each patient. | Cmin is the pre-dose blood concentration at steady-state (ng/mL). Pre-dose (Cmin) blood samples were collected from all patients in both arms at Visit 3. Steady-state for the Cmin sample was defined as continuous administration of the same dose in the last 4 days prior to the collection of the Cmin sample. Steady-state for the 5 mg every other day regimen was defined as the state when the 5 mg dose was taken 2 days and 4 days before sampling. PK samples were only drawn at visit 3, and only analyzed for patients receiving everolimus at steady state (if patients had received the dose the previous 4 days). In addition summary statistics were only done for each everolimus dose when 3 samples were available. Only valid pre-dose (Cmin) everolimus samples were included in the analysis. |
| Pharmacokinetics Assessments - Cmax | Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient. | Cmax is the maximum (peak) blood drug concentration after dose administration (ng/mL) calculated as the maximum of C1h and C2h. C1h was 1 hour post-dose blood concentration (ng/mL) and C2h was 2 hour post-dose blood concentration (ng/mL). C1h and C2h post-dose samples were collected from all patients in both arms at Visit 3. Steady-state for the C1h and C2h samples was defined as continuous administration of the same dose in the previous 4 days and the day on which the C1h and C2h samples were collected. Steady-state for the 5 mg every other day regimen was defined as the state when the 5 mg dose was taken 2 days and 4 days before sampling. PK samples were only drawn at visit 3, and only analyzed for patients receiving everolimus at steady state (if patients had received the dose the previous 4 days). In addition summary statistics were only done for each everolimus dose when 3 samples were available. Only valid C1h and C2h everolimus samples were included in the analysis. |
| Time to Definitive Deterioration of EORTC QLQ-C30 Scores | Until all patients have disease progression or leave study due to intolerable adverse events - Estimate of 1 year for each patient. | The primary quality of life endpoint was the time to definitive 5% deterioration from baseline in the global health status/quality of life scale of the EORTC QLQ-C30 questionnaire. Definitive deterioration by at least 5% is defined as a decrease in score by at least 5% compared to baseline, with no later observed increase above this threshold. The EORTC quality of life questionnaire (QLQ) is an integrated system for assessing the healthrelated quality of life (QoL) of cancer patients participating in international clinical trials. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems. |
Countries
Australia, Austria, Belgium, Canada, China, France, Germany, Greece, Hong Kong, Hungary, Israel, Italy, Japan, South Korea, Spain, Taiwan, Thailand, United States
Participant flow
Recruitment details
763 patients screened, 546 randomized. At 14Jun2013 data cut-off (final analysis), 3 pts in everolimus arm, 6 in placebo arm were still on treatment. Of 9 pts, 3 receiving placebo discontinued due to disease progression. Remaining 6 completed study due to sponsor's decision to end study after final results. The LPLV was 15Oct2013.
Participants by arm
| Arm | Count |
|---|---|
| Everolimus + Best Supportive Care (BSC) Patients were assigned to the Everolimus + BSC arm in a ratio of 2:1 over the Placebo arm. Everolimus was taken as a daily oral dose of 7.5 mg but dose adjustments of study drug (reduction, interruption or possible dose re-escalation to starting dose) according to safety findings were allowed. In addition to taking Everolimus, all patients also received BSC as per normal local practice. | 362 |
| Placebo + Best Supportive Care Placebo-Everolimus was taken as a daily oral dose of 7.5 mg and was defined as the control drug. In addition to taking Placebo Everolimus, all patients also received BSC as per normal local practice. | 184 |
| Total | 546 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative problems | 1 | 1 |
| Overall Study | Adverse Event | 61 | 14 |
| Overall Study | Death | 13 | 5 |
| Overall Study | Disease Progression | 261 | 152 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | New cancer therapy | 2 | 0 |
| Overall Study | Protocol Violation | 0 | 2 |
| Overall Study | Sponsor's decision to end study | 3 | 3 |
| Overall Study | Withdrawal by Subject | 20 | 7 |
Baseline characteristics
| Characteristic | Everolimus + Best Supportive Care (BSC) | Placebo + Best Supportive Care | Total |
|---|---|---|---|
| Age, Continuous | 65.1 Years STANDARD_DEVIATION 11.7 | 64.2 Years STANDARD_DEVIATION 10.41 | 64.8 Years STANDARD_DEVIATION 11.28 |
| Age, Customized >=35 - <55 years | 48 Participants | 31 Participants | 79 Participants |
| Age, Customized < 35 years | 7 Participants | 1 Participants | 8 Participants |
| Age, Customized >=55 - <65 years | 100 Participants | 61 Participants | 161 Participants |
| Age, Customized >= 65 years | 207 Participants | 91 Participants | 298 Participants |
| BMI | 24.5 kg/m^2 STANDARD_DEVIATION 4.64 | 24.8 kg/m^2 STANDARD_DEVIATION 4.99 | 24.6 kg/m^2 STANDARD_DEVIATION 4.76 |
| Height | 167.9 cm STANDARD_DEVIATION 8.66 | 169.2 cm STANDARD_DEVIATION 8.84 | 168.3 cm STANDARD_DEVIATION 8.73 |
| Race/Ethnicity, Customized Asian | 137 Participants | 58 Participants | 195 Participants |
| Race/Ethnicity, Customized Black | 6 Participants | 3 Participants | 9 Participants |
| Race/Ethnicity, Customized Caucasian | 192 Participants | 110 Participants | 302 Participants |
| Race/Ethnicity, Customized Other | 27 Participants | 12 Participants | 39 Participants |
| Race/Ethnicity, Customized Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Sex: Female, Male Female | 59 Participants | 24 Participants | 83 Participants |
| Sex: Female, Male Male | 303 Participants | 160 Participants | 463 Participants |
| Weight | 69.6 kg STANDARD_DEVIATION 15.62 | 71.3 kg STANDARD_DEVIATION 17.71 | 70.2 kg STANDARD_DEVIATION 16.35 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 343 / 361 | 147 / 182 |
| serious Total, serious adverse events | 171 / 361 | 64 / 182 |
Outcome results
Overall Survival (OS)
OS was defined as the time from the date of randomization to the date of death from any cause. The comparison of OS between the 2 arms was done using a stratified log-rank test at one-sided 2.5% level of significance.
Time frame: When 454 OS events were observed
Population: The Full Analysis Set (FAS) comprised all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Overall Survival (OS) | 7.56 Months |
| Placebo + Best Supportive Care | Overall Survival (OS) | 7.33 Months |
Percentage of Participants With Disease Control Rate (DCR)
DCR is defined as the proportion of participants with a best objective response (BOR) of complete response (CR) or partial response (PR) or stable disease (SD) according to RECIST. The BOR was the best response recorded from the start of the treatment until disease progression. CR is disappearance of all target lesions; PR is at least a 30% decrease in the sum of the longest diameter of all target lesions, taking as reference the baseline sum of the longest diameters; SD is neither sufficient shrinkage to qualify for PR or CR nor an increase in lesions which would qualify for PD. PD is at least a 20% increase in the sum of the longest diameter of all measured target lesions, taking as reference the smallest sum of longest diameter of all target lesions recorded at or after baseline.
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient
Population: The Full Analysis Set (FAS) comprised all randomized patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Percentage of Participants With Disease Control Rate (DCR) | 56.1 Percentage of Participants |
| Placebo + Best Supportive Care | Percentage of Participants With Disease Control Rate (DCR) | 45.1 Percentage of Participants |
Pharmacokinetics Assessments - Cmax
Cmax is the maximum (peak) blood drug concentration after dose administration (ng/mL) calculated as the maximum of C1h and C2h. C1h was 1 hour post-dose blood concentration (ng/mL) and C2h was 2 hour post-dose blood concentration (ng/mL). C1h and C2h post-dose samples were collected from all patients in both arms at Visit 3. Steady-state for the C1h and C2h samples was defined as continuous administration of the same dose in the previous 4 days and the day on which the C1h and C2h samples were collected. Steady-state for the 5 mg every other day regimen was defined as the state when the 5 mg dose was taken 2 days and 4 days before sampling. PK samples were only drawn at visit 3, and only analyzed for patients receiving everolimus at steady state (if patients had received the dose the previous 4 days). In addition summary statistics were only done for each everolimus dose when 3 samples were available. Only valid C1h and C2h everolimus samples were included in the analysis.
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient.
Population: Safety Set consists of all patients who received at least one dose of study treatment with a valid postbaseline assessment. All PK analyses were based on the Safety Set.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Pharmacokinetics Assessments - Cmax | 47.881 ng/mL | Standard Deviation 21.0999 |
| Placebo + Best Supportive Care | Pharmacokinetics Assessments - Cmax | 31.592 ng/mL | Standard Deviation 21.1622 |
Pharmacokinetics Assessments - Cmin
Cmin is the pre-dose blood concentration at steady-state (ng/mL). Pre-dose (Cmin) blood samples were collected from all patients in both arms at Visit 3. Steady-state for the Cmin sample was defined as continuous administration of the same dose in the last 4 days prior to the collection of the Cmin sample. Steady-state for the 5 mg every other day regimen was defined as the state when the 5 mg dose was taken 2 days and 4 days before sampling. PK samples were only drawn at visit 3, and only analyzed for patients receiving everolimus at steady state (if patients had received the dose the previous 4 days). In addition summary statistics were only done for each everolimus dose when 3 samples were available. Only valid pre-dose (Cmin) everolimus samples were included in the analysis.
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events - Estimate of 1 year for each patient.
Population: Safety Set consisted of all patients who received at least one dose of study treatment with a valid postbaseline assessment. All PK analyses were based on the Safety Set.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Pharmacokinetics Assessments - Cmin | 16.141 ng/mL | Standard Deviation 9.2297 |
| Placebo + Best Supportive Care | Pharmacokinetics Assessments - Cmin | 9.318 ng/mL | Standard Deviation 4.9705 |
Time to Definitive Deterioration of ECOG Performance Score (PS) Score
Change in Eastern Cooperative Oncology Group (ECOG) were assessed by time to definitive performance status deterioration by at least one category on the ECOG scale. Deterioration was considered definitive if no improvement in the ECOG PS was observed at a subsequent measurement. ECOG PS: 0=Fully active, able to carry on all pre-disease performance 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, office work; 2=Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours; 3=Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours; 4=Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair; 5=Dead
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient.
Population: The Full Analysis Set (FAS) comprised all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Time to Definitive Deterioration of ECOG Performance Score (PS) Score | 4.27 Months |
| Placebo + Best Supportive Care | Time to Definitive Deterioration of ECOG Performance Score (PS) Score | 4.47 Months |
Time to Definitive Deterioration of EORTC QLQ-C30 Scores
The primary quality of life endpoint was the time to definitive 5% deterioration from baseline in the global health status/quality of life scale of the EORTC QLQ-C30 questionnaire. Definitive deterioration by at least 5% is defined as a decrease in score by at least 5% compared to baseline, with no later observed increase above this threshold. The EORTC quality of life questionnaire (QLQ) is an integrated system for assessing the healthrelated quality of life (QoL) of cancer patients participating in international clinical trials. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events - Estimate of 1 year for each patient.
Population: The Full Analysis Set (FAS) comprised all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Time to Definitive Deterioration of EORTC QLQ-C30 Scores | 2.86 Months |
| Placebo + Best Supportive Care | Time to Definitive Deterioration of EORTC QLQ-C30 Scores | 3.45 Months |
Time to Tumor Progression (TTP)
TTP was defined as the time from the date of randomization to the date of the first documented radiologic confirmation of disease progression. Since the study did not meet the primary objective, TTP was not formally tested.
Time frame: Until all patients have disease progression or leave study due to intolerable adverse events- Estimate of 1 year for each patient
Population: The Full Analysis Set (FAS) comprised all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Best Supportive Care (BSC) | Time to Tumor Progression (TTP) | 2.96 Months |
| Placebo + Best Supportive Care | Time to Tumor Progression (TTP) | 2.60 Months |