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Zoptarelin Doxorubicin (AEZS 108) as Second Line Therapy for Endometrial Cancer

Randomized Controlled Study Comparing AEZS-108 With Doxorubicin as Second Line Therapy for Locally Advanced, Recurrent or Metastatic Endometrial Cancer.

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01767155
Acronym
ZoptEC
Enrollment
511
Registered
2013-01-14
Start date
2013-04-30
Completion date
2017-01-30
Last updated
2018-07-31

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

Conditions

Endometrial Cancer

Brief summary

Open-label, randomized, active-controlled, two-arm Phase III study to compare the efficacy and safety of AEZS-108 and doxorubicin.

Detailed description

The study will include about 500 patients with endometrial cancer resistant to platinum/taxane-based chemotherapy.

Interventions

DRUGAEZS-108 / zoptarelin doxorubicin

267 mg/m\^2 by 2-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles for a maximum of 9 cycles

DRUGdoxorubicin

60 mg/m\^2 by intravenous bolus injection or 1-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles

Sponsors

AEterna Zentaris
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

1. Women ≥ 18 years of age 2. Histologically confirmed endometrial cancer 3. Advanced (FIGO stage III or IV), recurrent or metastatic disease. 4. Measurable or non-measurable disease that has progressed since last treatment. 5. 5\. Patients with advanced, recurrent or metastatic endometrial cancer who have received one chemotherapeutic regimen with platinum and taxane (either as adjuvant or as first line treatment) and who have progressed. 6. Availability of fresh or archival FFPE (formalin-fixed and paraffin-embedded) tumor specimens for analysis of LHRH (luteinizing hormone releasing hormone) receptor expression.

Exclusion criteria

1. ECOG (Eastern Cooperative Oncology Group) performance status \> 2. 2. Inadequate hematologic, hepatic or renal function 3. Red blood cell transfusion within 2 weeks prior to anticipated start of study treatment. 4. History of myocardial infarction, acute inflammatory heart disease, unstable angina, or uncontrolled arrhythmia within the past 6 months. 5. Impaired cardiac function defined as left ventricular ejection fraction (LVEF) \< 50 % (or below the study site's lower limit of normal) as measured by MUGA (multigated radionuclide angiography) or ECHO (echocardiography). 6. Concomitant use of prohibited therapy (specified in protocol) 7. Chemo-, immune-, or hormone-therapy within 5 elimination half life times or 4 weeks prior to randomization, whichever is the shorter. Radiotherapy (including pre- or post-operative brachytherapy) within 4 weeks prior to randomization. 8. Previous anthracycline-based chemotherapy (daunorubicin, doxorubicin, epirubicin, idarubicin, mitoxantrone and valrubicin), in any formulation. 9. Anticipated ongoing concomitant anticancer therapy during the study. 10. History of serious co-morbidity or uncontrolled illness that would preclude study therapy, such as active tuberculosis or any other active infection. 11. Brain metastasis, leptomeningeal disease. 12. Pregnant or lactating female or female of child-bearing potential not employing adequate contraception. 13. Subjects with known hypersensitivity to peptide drugs, including LHRH agonists. 14. Receipt of 2 or more prior cytotoxic chemotherapy regimens for advanced, recurrent, or metastatic endometrial cancer. 15. Prior treatment with AEZS-108. 16. Use of LHRH agonist or antagonist treatment within 6 months prior to randomization. 17. Malignancy within last 5 years except non-melanoma skin cancer. 18. Any concomitant disease or condition which would interfere with the subjects' proper completion of the protocol assignment. 19. Concomitant or recent treatment with other investigational drug (within 4 weeks or 5 elimination half life times prior to anticipated start of study treatment). 20. Lack of ability or willingness to give informed consent. 21. Anticipated non-availability for study visits/procedures.

Design outcomes

Primary

MeasureTime frameDescription
Compare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.From randomization to death from any cause. During ongoing treatment: response evaluation every 3 cycles. For patients gone of treatment: re-assessment every 12 weeks.Overall survival was defined as the elapsed time from randomization to death from any cause. For surviving patients, follow-up was to be censored at the date of last contact. The final analysis, which was event-based, was conducted after approximately 384 randomized patients had died. A log-rank test with an overall two sided Type I Error rate of 0.05 after taking the interim analyses into account was used to compare OS between the two treatment arms via a SAS (Statistical Analysis System) LIFETEST procedure. Kaplan Meier estimates were used to calculate median OS and the 95% confidence interval (CI) of the median OS. The proportion of patients alive at 6 and 12 months (from randomization date) and the 95% CIs for these estimated proportions were calculated.

Secondary

MeasureTime frameDescription
Compare Efficacy Based on Objective Response Rate (ORR).3 yearsThe ORR was defined as the sum of the Complete Response (CR) and Partial Response (PR). CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) was to have a reduction in the short axis to \<10 mm. PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. All responses were confirmed at least 4 weeks after the initial response was observed. Tumor assessments occurred every 3 cycles (± 7 days) during ongoing treatment then every 3 months (± 7 days) thereafter while the patient was on study. The last assessment occurred either when progression was confirmed or when approximately 384 randomized patients had died.
Compare Efficacy Based on Progression-free Survival (PFS).During ongoing treatment: response evaluation every 3 cycles. For patients gone of treatment: re-assessment every 12 weeks.Progression-free survival (PFS): days between randomization and the date of documented progression or death for any cause that occurred up to the end of the study. For patients whose progression status could not be determined, their PFS data was censored for the last adequate progression assessment date that the patient was confirmed to have no progression. Response and progression were to be evaluated using the international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (uni-dimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes were to be used. During ongoing treatment, patients were to be re-evaluated for response every 3 cycles (i.e. every 9 weeks). A subsequent scan was obtained no earlier than 4 weeks following the initial documentation of an objective status of either complete response (CR) or partial response (PR).
Compare Efficacy Based on Clinical Benefit Rate (CBR).3 yearsClinical benefit was defined as having stable disease (SD) or better lasting for at least 9 weeks. The CBR was analyzed using the same methods for the ORR analyses. The analysis of CBR (CR+PR+SD) was performed in the ITT (intention-to-treat) population. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) was to have a reduction in the short axis to \<10 mm. PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. All responses were confirmed at least 4 weeks after the initial response was observed. Tumor assessments occurred every 3 cycles (± 7 days) during ongoing treatment then every 3 months (± 7 days) thereafter while the patient was on study. The last assessment occurred either when progression was confirmed or when approximately 384 randomized patients had died.

Countries

Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Czechia, Denmark, Finland, Germany, Ireland, Israel, Italy, Netherlands, Norway, Poland, Romania, Russia, Spain, Ukraine, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
AEZS-108 / Zoptarelin Doxorubicin
267 mg/m2 by 2-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles up to 9 cycles AEZS-108 / zoptarelin doxorubicin: 267 mg/m2 by 2-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles for a maximum of 9 cycles
256
Doxorubicin/ Standard Chemotherapy
60 mg/m2 by intravenous bolus injection or 1-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles doxorubicin: 60 mg/m2 by intravenous bolus injection or 1-hour intravenous infusion, on Day 1 of 21-day (3-week) cycles
255
Total511

Baseline characteristics

CharacteristicTotalAEZS-108 / Zoptarelin DoxorubicinDoxorubicin/ Standard Chemotherapy
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
245 Participants126 Participants119 Participants
Age, Categorical
Between 18 and 65 years
266 Participants130 Participants136 Participants
Age, Continuous63.7 years
STANDARD_DEVIATION 8.71
63.7 years
STANDARD_DEVIATION 8.63
63.8 years
STANDARD_DEVIATION 8.81
ECOG (Eastern Cooperative Oncology Group) PS (Performance Status)
0
245 Participants120 Participants125 Participants
ECOG (Eastern Cooperative Oncology Group) PS (Performance Status)
1
239 Participants121 Participants118 Participants
ECOG (Eastern Cooperative Oncology Group) PS (Performance Status)
2
26 Participants15 Participants11 Participants
ECOG (Eastern Cooperative Oncology Group) PS (Performance Status)
unknown
1 Participants0 Participants1 Participants
Race/Ethnicity, Customized
Race/Ethnicity
Asian
11 Participants6 Participants5 Participants
Race/Ethnicity, Customized
Race/Ethnicity
Black or African American
17 Participants10 Participants7 Participants
Race/Ethnicity, Customized
Race/Ethnicity
Native Hawaiian or Other Pacific Islander
2 Participants1 Participants1 Participants
Race/Ethnicity, Customized
Race/Ethnicity
Other
3 Participants1 Participants2 Participants
Race/Ethnicity, Customized
Race/Ethnicity
Unknown
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Race/Ethnicity
White
477 Participants237 Participants240 Participants
Sex: Female, Male
Female
511 Participants256 Participants255 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants
Stage of endometrial cancer at study entry
Advanced (FIGO III or IV)
193 Participants99 Participants94 Participants
Stage of endometrial cancer at study entry
Metastatic
176 Participants86 Participants90 Participants
Stage of endometrial cancer at study entry
Recurrent
142 Participants71 Participants71 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
196 / 252188 / 249
other
Total, other adverse events
239 / 252240 / 249
serious
Total, serious adverse events
92 / 25275 / 249

Outcome results

Primary

Compare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.

Overall survival was defined as the elapsed time from randomization to death from any cause. For surviving patients, follow-up was to be censored at the date of last contact. The final analysis, which was event-based, was conducted after approximately 384 randomized patients had died. A log-rank test with an overall two sided Type I Error rate of 0.05 after taking the interim analyses into account was used to compare OS between the two treatment arms via a SAS (Statistical Analysis System) LIFETEST procedure. Kaplan Meier estimates were used to calculate median OS and the 95% confidence interval (CI) of the median OS. The proportion of patients alive at 6 and 12 months (from randomization date) and the 95% CIs for these estimated proportions were calculated.

Time frame: From randomization to death from any cause. During ongoing treatment: response evaluation every 3 cycles. For patients gone of treatment: re-assessment every 12 weeks.

ArmMeasureGroupValue (NUMBER)
AEZS-108 / Zoptarelin DoxorubicinCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Death Events196 participants
AEZS-108 / Zoptarelin DoxorubicinCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Censored60 participants
AEZS-108 / Zoptarelin DoxorubicinCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Survivors at 6 months171 participants
AEZS-108 / Zoptarelin DoxorubicinCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Survivors at 12 months111 participants
Doxorubicin/ Standard ChemotherapyCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Survivors at 12 months106 participants
Doxorubicin/ Standard ChemotherapyCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Death Events188 participants
Doxorubicin/ Standard ChemotherapyCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Survivors at 6 months174 participants
Doxorubicin/ Standard ChemotherapyCompare the Overall Survival (OS) of Patients Treated With AEZS-108 to the OS of Patients Treated With Doxorubicin.Censored67 participants
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 6 months95% CI: [63.6, 75.1]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 12 months95% CI: [39.5, 52]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 6 months95% CI: [66, 77.3]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 12 months95% CI: [38.2, 50.7]
Comparison: A Cox model with treatment effects was used to estimate the hazard ratio and perform hypothesis testing. The estimated hazard ratio and the 95% CI of the hazard ratio were presented.p-value: 0.544195% CI: [0.87, 1.3]Log Rank
Secondary

Compare Efficacy Based on Clinical Benefit Rate (CBR).

Clinical benefit was defined as having stable disease (SD) or better lasting for at least 9 weeks. The CBR was analyzed using the same methods for the ORR analyses. The analysis of CBR (CR+PR+SD) was performed in the ITT (intention-to-treat) population. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) was to have a reduction in the short axis to \<10 mm. PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. All responses were confirmed at least 4 weeks after the initial response was observed. Tumor assessments occurred every 3 cycles (± 7 days) during ongoing treatment then every 3 months (± 7 days) thereafter while the patient was on study. The last assessment occurred either when progression was confirmed or when approximately 384 randomized patients had died.

Time frame: 3 years

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Clinical Benefit Rate (CBR).CR6 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Clinical Benefit Rate (CBR).PR26 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Clinical Benefit Rate (CBR).SD106 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Clinical Benefit Rate (CBR).Progressive Disease (PD)65 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Clinical Benefit Rate (CBR).Progressive Disease (PD)67 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Clinical Benefit Rate (CBR).CR5 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Clinical Benefit Rate (CBR).SD102 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Clinical Benefit Rate (CBR).PR31 Participants
Comparison: Hypothesis testing between the two treatment arms was performed using a Mantel Haenszel test.p-value: 0.692495% CI: [0.76, 1.52]Mantel Haenszel
Secondary

Compare Efficacy Based on Objective Response Rate (ORR).

The ORR was defined as the sum of the Complete Response (CR) and Partial Response (PR). CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) was to have a reduction in the short axis to \<10 mm. PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. All responses were confirmed at least 4 weeks after the initial response was observed. Tumor assessments occurred every 3 cycles (± 7 days) during ongoing treatment then every 3 months (± 7 days) thereafter while the patient was on study. The last assessment occurred either when progression was confirmed or when approximately 384 randomized patients had died.

Time frame: 3 years

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Objective Response Rate (ORR).CR6 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Objective Response Rate (ORR).PR26 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Objective Response Rate (ORR).ORR32 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Objective Response Rate (ORR).CR5 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Objective Response Rate (ORR).PR31 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Objective Response Rate (ORR).ORR36 Participants
Comparison: Hypothesis testing between the two treatment arms was performed using a Mantel Haenszel test. The odds ratio and 95% CI of the odds ratio were presented.p-value: 0.590795% CI: [0.52, 1.45]Mantel Haenszel
Secondary

Compare Efficacy Based on Progression-free Survival (PFS).

Progression-free survival (PFS): days between randomization and the date of documented progression or death for any cause that occurred up to the end of the study. For patients whose progression status could not be determined, their PFS data was censored for the last adequate progression assessment date that the patient was confirmed to have no progression. Response and progression were to be evaluated using the international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (uni-dimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes were to be used. During ongoing treatment, patients were to be re-evaluated for response every 3 cycles (i.e. every 9 weeks). A subsequent scan was obtained no earlier than 4 weeks following the initial documentation of an objective status of either complete response (CR) or partial response (PR).

Time frame: During ongoing treatment: response evaluation every 3 cycles. For patients gone of treatment: re-assessment every 12 weeks.

Population: The population analyzed is the mITT. PFS was analyzed in the subset of patients from mITT that have CR, PR or stable disease (SD) as best overall response.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Progression-free Survival (PFS).PFS events166 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Progression-free Survival (PFS).Censored90 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Progression-free Survival (PFS).Progression Free Survivors at 6 months69 Participants
AEZS-108 / Zoptarelin DoxorubicinCompare Efficacy Based on Progression-free Survival (PFS).Progression Free Survivors at 12 months28 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Progression-free Survival (PFS).Progression Free Survivors at 12 months12 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Progression-free Survival (PFS).PFS events148 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Progression-free Survival (PFS).Progression Free Survivors at 6 months51 Participants
Doxorubicin/ Standard ChemotherapyCompare Efficacy Based on Progression-free Survival (PFS).Censored107 Participants
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 6 months.95% CI: [39.5, 53.6]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 12 months95% CI: [14.6, 27.4]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 6 months95% CI: [40, 54.7]
Comparison: Kaplan-Meier log-log transformed estimates: survivors at 12 months95% CI: [6.9, 19.3]
Comparison: Hypothesis testing between the two treatment arms was performed using a log rank test.p-value: 0.308995% CI: [0.71, 1.11]Log Rank

Source: ClinicalTrials.gov · Data processed: Mar 8, 2026