Soft Tissue Sarcoma
Conditions
Brief summary
This is a randomized, open-label, multicenter, Phase 3 study comparing the efficacy and safety of eribulin with dacarbazine in subjects with advanced soft tissue sarcoma who have disease progression within 6 months prior to study enrolment following standard therapies which must have included an anthracycline, unless contraindicated and then at least one additional regimen after failure of the anthracycline.
Interventions
DRUGEribulin mesylate 1.4 mg/m^2 intravenous
Administration of eribulin mesylate at a dose of 1.4 mg/m\^2 as an intravenous (IV) bolus infusion over 2-5 minutes on Days 1 and 8 of every cycle, where the duration of each cycle is 21 days.
DRUGDacarbazine of 850 mg/m^2, or 1,000 mg/m^2, or 1,200 mg/m^2 IV
Administration of dacarbazine at a dose of 850 mg/m\^2, or 1,000 mg/m\^2, or 1,200 mg/m\^2 selected by the Principal Investigator \[PI\] or designee according to the subject's clinical status as an IV infusion over 15-30 minutes on Day 1 of every cycle, where the duration of each cycle is 21 days.
Sponsors
Eisai Inc.
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
1. Histologically confirmed diagnosis of soft tissue sarcoma of high or intermediate grade with one of the following histological subtypes: * Adipocytic sarcoma, including: * Dedifferentiated * Myxoid * Round Cell * Pleomorphic - Leiomyosarcoma 2. Documented evidence of advanced (locally recurrent, locally advanced and/or metastatic) adipocytic (restricted to subtypes listed in Inclusion 1) or leiomyosarcoma, incurable by surgery and/or radiotherapy. 3. Subjects should have received at least two standard systematic regimens for advanced soft tissue sarcoma one of which must have included an anthracycline (unless contraindicated). 4. Radiographic evidence of disease progression by RECIST criteria on or after the last anti-cancer therapy within the 6 months prior to randomization. 5. Presence of measurable disease meeting the following criteria: * At least one lesion of greater than or equal to 1.0 cm in long-axis diameter for non lymph nodes or greater than or equal to 1.5 cm in short-axis diameter for lymph nodes which is serially measurable according to RECIST 1.1 using either computerized tomography or magnetic resonance imaging or panoramic and close-up color photography. * Lesions that have had radiotherapy must show evidence of progressive disease based on RECIST 1.1 to be deemed a target lesion. 6. Eastern Cooperative Oncology Group, performance status of 0, 1 or 2. 7. Adequate renal function defined as calculated creatinine clearance greater than 50 mL/min per the Cockroft and Gault formula. 8. Adequate bone marrow function, defined as: * Absolute neutrophil count (ANC) greater than or equal to 1,500/mm3 or greater than or equal to 1.5 x 10\^9/L. * Platelet count greater than or equal to 100,000/mm3 or greater than or equal to 100 x 10\^9/L. * Hemoglobin (Hb) greater than or equal to 10g/dL at baseline (blood transfusions,hematopoietic growth factors and hematinics are allowed during the Prerandomization Phase to correct Hb values less than 10g/dL). 9. Adequate liver function, defined as: * Bilirubin less than or equal to 1.5 times the upper limit of normal (ULN) except for unconjugated hyperbilirubinemia of Gilbert's syndrome. * Alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) less than or equal to 3 times ULN. For total ALP greater than 3 times ULN, the ALP liver isoenzyme must be less than or equal to 3 times ULN. 10. All female subjects will be considered to be of child-bearing potential unless they are postmenopausal (at least 12 months consecutive amenorrhea, in the appropriate age group and without other known or suspected cause), or have been sterilized surgically (i.e., bilateral tubal ligation greater than or equal to 1 menstrual cycle prior to randomization, or have undergone a hysterectomy and/or bilateral oophorectomy). Female subjects of child-bearing potential must agree to use two forms of highly effective contraception from the last menstrual period prior to randomization (or use a double barrier method as described below until they are on two forms of highly effective contraception for at least one menstrual cycle), during the study treatment, and for 3 months after the final dose of study treatment. Female subjects exempt from this requirement are subjects who practice total abstinence. If currently abstinent, the subject must agree to use a double barrier method of contraception, i.e., condom and occlusive cap (diaphragm or cervical/vault caps) with spermicide or until they are on two forms of highly effective contraception for at least one menstrual cycle if they become sexually active during the study treatment and for 3 months after the final dose of study treatment. Highly effective contraception includes: * Placement of intrauterine device or system, * Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault cap) with spermicide, * Established hormonal contraceptive methods: oral, injectable or implant. Female subjects who are using hormonal contraceptives must have been on a stable dose of the same hormonal contraceptive product from the last menstrual period prior to randomization, and must continue to use the same hormonal contraceptive product during study treatment, and for 3 months after the first dose of study treatment. * Vasectomized partner with confirmed azoospermia. 11. Male subjects and their female partner who are of child-bearing potential (as defined in Inclusion 10), and are not practicing total abstinence, must agree to use two forms of highly effective contraception from the last menstrual period of their female partner prior to randomization (or use a double barrier method as described above until they are on two forms of highly effective contraception for at least one menstrual cycle), during study treatment, and for 3 months (or 6 months if they received dacarbazine) after the final dose of study treatment. If currently abstinent, must agree to use a double barrier method of contraception if they become sexually active, or until they are on two forms of highly effective contraception as described above. 12. Voluntary agreement to provide written informed consent and the willingness and ability to comply with all aspects of the protocol. 13. Males or females aged greater than or equal to 18 years at the time of informed consent.
Exclusion criteria
1. Subjects who have received any anti-cancer therapy, including radiotherapy, cytotoxic, hormonal, biological (including humanized antibodies) and targeted agents within 21 days, or five half-lives of the drug (whichever is longer) prior to randomization. 2. Subjects who have not recovered from acute toxicities as a result of prior anti-cancer therapy to less than or equal to Grade 1, according to Common Terminology Criteria for Adverse Events (CTCAE), except for peripheral neuropathy (see Exclusion 6) and alopecia. 3. Subjects that have previously been treated with dacarbazine or its analogue temozolomide or eribulin. 4. Major surgery within 21 days prior to randomization. 5. Pre-existing peripheral neuropathy greater than CTCAE Grade 2. 6. Significant cardiovascular impairment, defined as: * Cardiac failure, New York Heart Association (NYHA) Class II according to the NYHA Functional Classification, * Unstable angina or myocardial infarction within 6 months of enrolment, * Serious and potentially life-threatening arrhythmia. 7. Subjects with a high probability of Long QT Syndrome or QTc interval prolongation of more than or equal to 501 msec on at least two separate ECGs, following correction of any electrolyte imbalance. 8. Subjects with known central nervous system metastases. 9. Any serious concomitant illness or infectious disease requiring treatment, or infectious disease not requiring treatment, but with significant risks for myelosuppressive complications associated with chemotherapy. 10. Any malignancy that required treatment, or has shown evidence of recurrence (except for soft tissue sarcoma, non-melanoma skin cancer, or histologically confirmed complete excision of carcinoma in situ) during the 5 years prior to randomization. 11. Female subjects must not be pregnant as documented by a negative beta-human chorionic gonadotropin (beta-hCG) test with a minimum sensitivity 25 IU/L or equivalent unit of beta-hCG at Screening and Baseline, or breastfeeding. 12. Hypersensitivity to the active substance, or any of the excipients of the eribulin drug product, or dacarbazine, (please refer to the dacarbazine prescribing information). 13. Any medical or other condition which, in the opinion of the PI or designee, will preclude participation in a clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | From date of treatment start until date of death from any cause, up to 5 years 5 months | OS was defined as the time in months from the date of treatment start until death, regardless of cause. In the absence of confirmation of death, participants were censored either at the date that participant was last known to be alive or the date of study cut-off, whichever was earlier. Participants who died on the date of randomization had a survival time of 0.5 day. Allocation of randomization numbers were performed based upon the following stratification factors: (a) Histology (adipocytic \[ADI\] or leiomyosarcoma \[LMS\]), (b) Region (Region 1: USA and Canada; or Region 2: Western Europe, Australia, Israel; or Region 3: Eastern Europe, Latin America, and Asia), and (c) Number of prior regimens for advanced soft tissue sarcoma (STS) (2 or greater than \[\>\] 2 prior regimens). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Randomization (day 1) to the date of first documentation of disease progression, or date of death (whichever occurred first), up to 5 years 5 months | PFS was defined as the time from the date of randomization to the date of first documentation of disease progression, or date of death (whichever occurred first). The date of disease progression was defined as the date of radiologic disease progression as assessed by the investigator or designee based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Participants who did not have an event (i.e., participants who were lost to follow-up or who did not progress or die at the date of data cut-off), were censored. Participants who discontinued study treatment without disease progression were censored on the date of their last radiological assessment (scan date). |
| Progression-Free Rate at 12 Weeks (PFR12wks) | From date of randomization start until Week 12 | The PFR12wks was defined as the percentage of participants who were still alive without disease progression at 12 weeks from the date of randomization. Tumor assessment by the investigator or designee was based on RECIST criteria 1.1. |
| Clinical Benefit Rate (CBR) | From date of treatment start (Day 1) until disease progression, development of unacceptable toxicity, withdrawal of consent, participant's choice to stop study treatment, up to 5 years 5 months | CBR was defined as the percentage of participants who have best overall response (BOR) of complete response (CR), or partial response (PR), or duration of stable disease (dSD) greater than or equal to 11 weeks, between Arm A and Arm B. CBR was estimated by treatment arm based on the tumor response evaluation performed by the PI or designee according to RECIST 1.1. CR was defined as disappearance of all target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum of the longest diameter. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechia, Denmark, France, Germany, Israel, Italy, Netherlands, New Zealand, Poland, Romania, Russia, Singapore, South Korea, Spain, Thailand, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm A: Eribulin Mesylate Eribulin mesylate at a dose of 1.4 mg/m\^2 was administered IV as a bolus infusion over 2-5 minutes on Days 1 and 8 of every 21-day treatment cycle. | 228 |
| Arm B: Dacarbazine Dacarbazine at a dose of 850 mg/m\^2, 1000 mg/m\^2, or 1200 mg/m\^2 (as selected by the Principal Investigator \[PI\] or designee prior to randomization according to the participant's clinical status) was administered as an IV infusion over 15-30 minutes (or up to 60 minutes as per institutional guidelines) on Day 1 of every 21-day treatment cycle. | 224 |
| Total | 452 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative decision | 0 | 1 |
| Overall Study | Adverse Event | 14 | 10 |
| Overall Study | Clinical progression | 24 | 27 |
| Overall Study | Disease progression-according to RECIST | 173 | 165 |
| Overall Study | Not treated | 1 | 1 |
| Overall Study | Other | 8 | 6 |
| Overall Study | Subject choice | 5 | 10 |
| Overall Study | Withdrawal of consent from study | 3 | 4 |
Baseline characteristics
| Characteristic | Arm A: Eribulin Mesylate | Arm B: Dacarbazine | Total |
|---|---|---|---|
| Age, Continuous | 55.6 Years STANDARD_DEVIATION 11.01 | 55.7 Years STANDARD_DEVIATION 10.35 | 55.7 Years STANDARD_DEVIATION 10.68 |
| Sex: Female, Male Female | 161 Participants | 142 Participants | 303 Participants |
| Sex: Female, Male Male | 67 Participants | 82 Participants | 149 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 198 / 228 | 206 / 224 |
| other Total, other adverse events | 224 / 228 | 218 / 224 |
| serious Total, serious adverse events | 76 / 228 | 71 / 224 |
Outcome results
Primary
Overall Survival (OS)
OS was defined as the time in months from the date of treatment start until death, regardless of cause. In the absence of confirmation of death, participants were censored either at the date that participant was last known to be alive or the date of study cut-off, whichever was earlier. Participants who died on the date of randomization had a survival time of 0.5 day. Allocation of randomization numbers were performed based upon the following stratification factors: (a) Histology (adipocytic \[ADI\] or leiomyosarcoma \[LMS\]), (b) Region (Region 1: USA and Canada; or Region 2: Western Europe, Australia, Israel; or Region 3: Eastern Europe, Latin America, and Asia), and (c) Number of prior regimens for advanced soft tissue sarcoma (STS) (2 or greater than \[\>\] 2 prior regimens).
Time frame: From date of treatment start until date of death from any cause, up to 5 years 5 months
Population: Full analysis set (FAS) (Intent-to-Treat (ITT) analysis set) included all participants who were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: Eribulin Mesylate | Overall Survival (OS) | 13.5 Months |
| Arm B: Dacarbazine | Overall Survival (OS) | 11.5 Months |
Comparison: Statistical analysis was designed to detect superiority of Arm A (eribulin) over Arm B (dacarbazine). OS was compared between the two treatment arms using a two-sided stratified log-rank test at a nominal significance level of 0.0455 (adjusted for the interim analysis). This was the primary analysis that was performed when the target number of events (\~353 deaths) was observed.p-value: =0.016995% CI: [0.618, 0.954]Log Rank
Secondary
Clinical Benefit Rate (CBR)
CBR was defined as the percentage of participants who have best overall response (BOR) of complete response (CR), or partial response (PR), or duration of stable disease (dSD) greater than or equal to 11 weeks, between Arm A and Arm B. CBR was estimated by treatment arm based on the tumor response evaluation performed by the PI or designee according to RECIST 1.1. CR was defined as disappearance of all target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum of the longest diameter.
Time frame: From date of treatment start (Day 1) until disease progression, development of unacceptable toxicity, withdrawal of consent, participant's choice to stop study treatment, up to 5 years 5 months
Population: FAS (ITT analysis set) included all participants who were randomized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Eribulin Mesylate | Clinical Benefit Rate (CBR) | 46.1 Percentage of participants |
| Arm B: Dacarbazine | Clinical Benefit Rate (CBR) | 47.8 Percentage of participants |
Comparison: The PFR12wks was compared between the treatment arms using stratified CMH chi-square test stratified by histology, geographic region, and number of prior regimens for advanced STS.p-value: =0.74195% CI: [0.7, 1.4]Cochran-Mantel-Haenszel
Secondary
Progression-Free Rate at 12 Weeks (PFR12wks)
The PFR12wks was defined as the percentage of participants who were still alive without disease progression at 12 weeks from the date of randomization. Tumor assessment by the investigator or designee was based on RECIST criteria 1.1.
Time frame: From date of randomization start until Week 12
Population: FAS (ITT analysis set) included all participants who were randomized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Eribulin Mesylate | Progression-Free Rate at 12 Weeks (PFR12wks) | 33.3 Percentage of participants |
| Arm B: Dacarbazine | Progression-Free Rate at 12 Weeks (PFR12wks) | 28.6 Percentage of participants |
Comparison: The PFR12wks was compared between the treatment arms using stratified Cochran-Mantel-Haenszel (CMH) chi-square test stratified by histology, geographic region, and number of prior regimens for advanced STS.p-value: 0.25395% CI: [0.8, 1.9]Cochran-Mantel-Haenszel
Secondary
Progression-Free Survival (PFS)
PFS was defined as the time from the date of randomization to the date of first documentation of disease progression, or date of death (whichever occurred first). The date of disease progression was defined as the date of radiologic disease progression as assessed by the investigator or designee based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Participants who did not have an event (i.e., participants who were lost to follow-up or who did not progress or die at the date of data cut-off), were censored. Participants who discontinued study treatment without disease progression were censored on the date of their last radiological assessment (scan date).
Time frame: Randomization (day 1) to the date of first documentation of disease progression, or date of death (whichever occurred first), up to 5 years 5 months
Population: FAS (ITT analysis set) included all participants who were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: Eribulin Mesylate | Progression-Free Survival (PFS) | 2.6 Months |
| Arm B: Dacarbazine | Progression-Free Survival (PFS) | 2.6 Months |
Comparison: The PFS and PFS rate at 3, 6, and 12 months (95% confidence interval (CI)) was calculated using Kaplan-Meier (K-M) product-limit method and Greenwood Formula. PFS was compared between the treatment arms using two-sided stratified log-rank test, stratified by histology, geographic region, and number of prior regimens for advanced STS.p-value: =0.228795% CI: [0.71, 1.085]Log Rank