Pancreatic Cancer
Conditions
Brief summary
This study will evaluate efficacy, safety and tolerability of Avastin versus placebo added to a chemotherapeutic regimen in patients with metastatic pancreatic cancer. The anticipated time of study treatment is until confirmed evidence of disease progression, and the target sample size is 500+ individuals.
Interventions
Intervenous repeating dose
Sponsors
Study design
Eligibility
Inclusion criteria
* adult patients, \>=18 years of age; * metastatic pancreatic cancer (adenocarcinoma); * good liver, kidney, and bone marrow function.
Exclusion criteria
* previous systemic treatment for metastatic pancreatic cancer; * pregnant or lactating females; * fertile men, or women of childbearing potential, not using adequate contraception; * major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study treatment start; * current or recent treatment (within 30 days prior to starting study treatment) with another investigational drug, or participation in another investigational study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Overall Survival - Percentage of Participants With an Event | Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized | Duration of overall survival (OS) was defined as the time between date of randomization and date of death due to any cause. Participants without an event were censored at the date last known to be alive. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. |
| Duration of Overall Survival - Time to Event | Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized | Duration of OS was defined as the time between date of randomization and date of death due to any cause. Participants without an event were censored at the date last known to be alive. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. Median duration of survival was estimated using the Kaplan-Meier method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) - Time to Event | Screening, Weeks 8, 16, 24, 32, 40, and every 12 weeks thereafter or until confirmed evidence of disease progression | PFS was defined as the time between the date of randomization and the date of documented PD (per RECIST), or date of death due to any cause. Data for participants without an event were censored at the date of last follow up for progression, or date of last available tumor assessment if no further follow up assessment for progression was performed. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. Median PFS was estimated using the Kaplan-Meier method. |
| Clinical Benefit Response (CBR) | Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized | — |
| Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Weeks 1, 3, 5, 7, and 9 | Blood samples were collected from a subgroup of participants, in selected centers for the determination of bevacizumab serum concentration before the first bevacizumab/placebo exposure (Week 1) and at Weeks 3, 5, 7, and 9. Each time blood samples were collected just (preferably within 1 hour) before the start of the study treatment. |
| Percentage of Participants With Complete Response (CR), Partial Response (PR), or Stable Disease (SD) at First Postbaseline Tumor Assessment | Baseline and Week 8 | Percentage of participants with CR, PR, or SD according to modified RECIST evaluation at the first postbaseline tumor assessment. CR equaled (=) complete disappearance of all target lesions and non-target disease, with normalization of tumor marker level. PR is greater than or equal to (≥) a 30% decrease of the sum of the LD of all target lesions as referenced to the baseline sum LD of all target lesions. Persistence of one or more non-target lesions(s) and/or maintenance of tumor marker level above normal limits. SD=neither sufficient shrinkage of target lesions to qualify for PR nor sufficient increase to qualify for PD with persistence of one or more non-target lesions(s) and/or maintenance of tumor marker level above normal limits. |
| Progression-Free Survival (PFS) - Percentage of Participants With an Event | Screening, Weeks 8, 16, 24, 32, 40, and every 12 weeks thereafter or until confirmed evidence of disease progression | PFS was defined as the time between the date of randomization and the date of documented progressive disease (PD) defined according to modified Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, or date of death due to any cause. PD was defined as at least a 20 percent (%) increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum (LD) recorded since the treatment started. Participants without an event were censored at the date of last follow up for progression, or date of last available tumor assessment if no further follow up assessment for progression was performed. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. |
Countries
Australia, Austria, Belgium, Canada, China, Czechia, Finland, France, Germany, Israel, Italy, Netherlands, New Zealand, Peru, Poland, Singapore, South Africa, Spain, Sweden, Taiwan, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Bevacizumab + Gemcitabine + Erlotinib Cycle 1 (8-week cycle): Participants received bevacizumab 5 mg/kg IV on Days 1, 15, 29, and 43 (followed by 1 week off); gemcitabine 1000 mg/m\^2 IV on Days 1, 8, 15, 22, 29, 36, and 43 (followed by 1 week off); and erlotinib 100 mg tablets/capsules, PO, QD for 8 weeks.
Cycles 2 and beyond (4-week cycle): Participants received bevacizumab 5 mg/kg IV on Days 1 and 15 (followed by 2 weeks off); gemcitabine 1000 mg/m\^2 IV on Days 1, 8, and 15 (followed by 1 week off); and erlotinib 100 mg tablets/capsules PO QD. Participants continued on treatment until disease progression, unacceptable toxicity, or participant withdrawal. | 306 |
| Placebo + Gemcitabine + Erlotinib Cycle 1 (8-week cycle): Participants received placebo IV on Days 1, 15, 29, and 43 (followed by 1 week off); gemcitabine 1000 mg/m\^2 IV on Days 1, 8, 15, 22, 29, 36, and 43 (followed by 1 week off); and erlotinib 100 mg tablets/capsules, PO, QD for 8 weeks.
Cycles 2 and beyond (4-week cycle): Participants received placebo IV on Days 1 and 15 (followed by 2 weeks off); gemcitabine 1000 mg/m\^2 IV on Days 1, 8, and 15 (followed by 1 week off); and erlotinib 100 mg tablets/capsules PO QD. Participants continued on treatment until disease progression, unacceptable toxicity, or participant withdrawal. | 301 |
| Total | 607 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Alive and in follow-up | 45 | 48 |
| Overall Study | Alive and still on treatment | 34 | 18 |
| Overall Study | Lost to Follow-up | 6 | 2 |
Baseline characteristics
| Characteristic | Bevacizumab + Gemcitabine + Erlotinib | Placebo + Gemcitabine + Erlotinib | Total |
|---|---|---|---|
| Age, Continuous | 61.5 years STANDARD_DEVIATION 10.36 | 61.0 years STANDARD_DEVIATION 10.03 | 61.2 years STANDARD_DEVIATION 10.19 |
| Sex: Female, Male Female | 132 Participants | 113 Participants | 245 Participants |
| Sex: Female, Male Male | 174 Participants | 188 Participants | 362 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 290 / 297 | 276 / 286 |
| serious Total, serious adverse events | 139 / 297 | 119 / 286 |
Outcome results
Duration of Overall Survival - Percentage of Participants With an Event
Duration of overall survival (OS) was defined as the time between date of randomization and date of death due to any cause. Participants without an event were censored at the date last known to be alive. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization.
Time frame: Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Duration of Overall Survival - Percentage of Participants With an Event | 72.2 percentage of participants |
| Placebo + Gemcitabine + Erlotinib | Duration of Overall Survival - Percentage of Participants With an Event | 77.4 percentage of participants |
Duration of Overall Survival - Time to Event
Duration of OS was defined as the time between date of randomization and date of death due to any cause. Participants without an event were censored at the date last known to be alive. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. Median duration of survival was estimated using the Kaplan-Meier method.
Time frame: Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized
Population: ITT Population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Duration of Overall Survival - Time to Event | 7.1 months |
| Placebo + Gemcitabine + Erlotinib | Duration of Overall Survival - Time to Event | 6.0 months |
Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib
Blood samples were collected from a subgroup of participants, in selected centers for the determination of bevacizumab serum concentration before the first bevacizumab/placebo exposure (Week 1) and at Weeks 3, 5, 7, and 9. Each time blood samples were collected just (preferably within 1 hour) before the start of the study treatment.
Time frame: Weeks 1, 3, 5, 7, and 9
Population: ITT Population. Number (n) = number of participants assessed at a specific visit.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Week 1 (n=4) | 0.52 micrograms/milliliter | Standard Deviation 14.98 |
| Bevacizumab + Gemcitabine + Erlotinib | Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Week 3 (n=78) | 27.09 micrograms/milliliter | Standard Deviation 18.23 |
| Bevacizumab + Gemcitabine + Erlotinib | Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Week 5 (n=73) | 35.23 micrograms/milliliter | Standard Deviation 24.88 |
| Bevacizumab + Gemcitabine + Erlotinib | Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Week 7 (n=72) | 41.19 micrograms/milliliter | Standard Deviation 19.68 |
| Bevacizumab + Gemcitabine + Erlotinib | Bevacizumab Concentration in the Presence of Gemcitabine and Erlotinib | Week 9 (n=61) | 44.60 micrograms/milliliter | Standard Deviation 22.57 |
Clinical Benefit Response (CBR)
Time frame: Randomization, Weeks 1-8 of Cycle 1, Weeks 1-3 of consecutive cycles, 28 days and 3 months after lst treatment, and every 3 months for up to 18 months from last participant randomized
Population: The analysis of the CBR was dependent on the calculation of analgesic therapy (AT); this calculation relies on established conversion factors for different morphine derivatives (MD). Many MD utilized by participants do not have well-established conversion factors, yielding uninterpretable results. Therefore, CBR was not analyzed in this study.
Percentage of Participants With Complete Response (CR), Partial Response (PR), or Stable Disease (SD) at First Postbaseline Tumor Assessment
Percentage of participants with CR, PR, or SD according to modified RECIST evaluation at the first postbaseline tumor assessment. CR equaled (=) complete disappearance of all target lesions and non-target disease, with normalization of tumor marker level. PR is greater than or equal to (≥) a 30% decrease of the sum of the LD of all target lesions as referenced to the baseline sum LD of all target lesions. Persistence of one or more non-target lesions(s) and/or maintenance of tumor marker level above normal limits. SD=neither sufficient shrinkage of target lesions to qualify for PR nor sufficient increase to qualify for PD with persistence of one or more non-target lesions(s) and/or maintenance of tumor marker level above normal limits.
Time frame: Baseline and Week 8
Population: ITT Population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Percentage of Participants With Complete Response (CR), Partial Response (PR), or Stable Disease (SD) at First Postbaseline Tumor Assessment | 62.1 percentage of participants |
| Placebo + Gemcitabine + Erlotinib | Percentage of Participants With Complete Response (CR), Partial Response (PR), or Stable Disease (SD) at First Postbaseline Tumor Assessment | 58.5 percentage of participants |
Progression-Free Survival (PFS) - Percentage of Participants With an Event
PFS was defined as the time between the date of randomization and the date of documented progressive disease (PD) defined according to modified Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, or date of death due to any cause. PD was defined as at least a 20 percent (%) increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum (LD) recorded since the treatment started. Participants without an event were censored at the date of last follow up for progression, or date of last available tumor assessment if no further follow up assessment for progression was performed. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization.
Time frame: Screening, Weeks 8, 16, 24, 32, 40, and every 12 weeks thereafter or until confirmed evidence of disease progression
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Progression-Free Survival (PFS) - Percentage of Participants With an Event | 84.0 percentage of participants |
| Placebo + Gemcitabine + Erlotinib | Progression-Free Survival (PFS) - Percentage of Participants With an Event | 92.4 percentage of participants |
Progression-Free Survival (PFS) - Time to Event
PFS was defined as the time between the date of randomization and the date of documented PD (per RECIST), or date of death due to any cause. Data for participants without an event were censored at the date of last follow up for progression, or date of last available tumor assessment if no further follow up assessment for progression was performed. Participants who were randomized but not exposed to study drug and had no further follow up were censored at the date of randomization. Median PFS was estimated using the Kaplan-Meier method.
Time frame: Screening, Weeks 8, 16, 24, 32, 40, and every 12 weeks thereafter or until confirmed evidence of disease progression
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Gemcitabine + Erlotinib | Progression-Free Survival (PFS) - Time to Event | 4.6 months |
| Placebo + Gemcitabine + Erlotinib | Progression-Free Survival (PFS) - Time to Event | 3.6 months |