Carcinoma, Hepatocellular
Conditions
Keywords
Hepatocellular carcinoma, monoclonal antibody, ALK-1, best supportive care
Brief summary
The primary purpose of the study is to explore whether treatment with PF-03446962 and best supportive care is better than placebo plus best supportive care in prolonging survival of patients affected by recurrent liver cancer. In addition, the study will explore if adding PF-03446962 to best supportive care is safe, how PF-03446962 is metabolized, if there are patients' characteristics (biomarkers) that may predict response to PF-03446962, and if PF-03446962 has any effect on the patients' quality of life.
Detailed description
This study was terminated on June 24th, 2014 due to change in strategy of PF-03446962 clinical development. There were no safety or efficacy concerns regarding the study behind the decision to terminate the trial. The study was on temporary halt since March 10th and there are currently no patients on treatment or in the process of being randomized
Interventions
PF 03446962 7 mg/kg, IV, every 2 weeks, until disease progression, patient refusal or unacceptable toxicity, whichever occurs first
BSC may include medications and supportive measures deemed necessary to palliate disease related symptoms and improve quality of life
Placebo will consist of Saline (0.9% w/v Sodium Chloride Injection, USP or NS)
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of locally advanced or metastatic liver cancer obtained by histology/cytology or by imaging * Documented progression on or after treatment with sorafenib, confirmed by the Investigator upon review of appropriate imaging documentation * Child Pugh Class A disease * ECOG \[Eastern Cooperative Oncology Group\] Performance Status (PS) 0 or 1 * Mandatory tumor biopsy at study entry (pre-randomization, unless already collected after sorafenib progression but within 3 months of enrollment and no systemic anticancer therapies received)
Exclusion criteria
* Prior systemic treatment for advanced liver cancer other than sorafenib-including therapy * Prior local therapy within 2 weeks of starting the study treatment * Presence of main portal vein invasion by liver cancer
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | From first randomization to date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization | OS was the duration from date of randomization to date of death due to any cause. For participants who are alive, overall survival was censored at the last contact. Death was determined from adverse event (AE) data where outcome was death or from follow-up contact data where the participant current status was death. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Progression (TTP) | Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization. | TTP was defined as the time from first randomization to date of first documentation of objective tumor progression. If tumor progression data included more than (\>) 1 date, the first date was to be used. TTP (in months) was calculated as first event date or last known progression-free date minus the first randomization date plus 1 divided by 30.4. Tumor progression was determined from oncologic assessment data (where data meet the criteria for progressive disease per Response Evaluation Criteria in Solid Tumors \[RECIST\] version 1.1). |
| Progression-Free Survival (PFS) | Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization. | PFS was defined as the time from randomization to first documentation of objective tumor progression or to death due to any cause, whichever occured first. If tumor progression data included \>1 date, the first date was to be used. PFS (in months) was calculated as first event date minus first randomization date plus 1 divided by 30.4. |
| Objective Response Rate (ORR) - Percentage of Participants With Objective Response | Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization. | ORR was defined as the proportion of participants with confirmed complete response (CR) or confirmed partial response (PR) according to RECIST version 1.1, relative to all randomized participants. CR were those that persisted on repeat imaging study more than or equal to (\>=) 4 weeks after initial documentation of response. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions. Participants who did not have on study radiographic tumor re-evaluation or who died, progressed or dropped out for any reason prior to reaching a CR or PR were to be counted as non-responders in the assessment of ORR. A participant who initially met the criteria for a PR and then subsequently became a confirmed CR, was to be assigned a best response of CR. |
| Duration of Response (DR) | From first randomization to date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization | DR was defined as the time from the first documentation of objective tumor response to the first documentation of objective tumor progression or to death due to any cause, whichever occurred first. If tumor progression data included \>1 date, the first date was to be used. DR (in months) was calculated as the end date for DR minus date of first CR or PR that was subsequently confirmed plus 1 divided by 30.4. CR was defined as disappearance of all target lesions and non-target, if any. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions. |
| Percentage of Participants With Disease Control Rate (DCR) at 16 Weeks | From first randomization to date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization | DCR was defined as the proportion of participants with confirmed CR or confirmed PR or a best response of stable disease (SD) \>=16 weeks according to RECIST, relative to all randomized participants. CR was defined as disappearance of all target lesions. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), taking as reference the smallest sum diameters while on study. |
| Observed Serum Concentration of Circulating Protein | Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal. | — |
| Maximum Serum Concentration (Cmax) | 1 hour (after start of infusion) on Day1 of Cycles 1, 2, 4, 6, and 8 | — |
| Trough Serum Concentration of PF-03446962 (Ctrough) | 0 hour (predose) on Day 1 of Cycles 1, 2, 4, 6, and 8 | — |
| Number of Participants With Human Anti-Human Antibodies (HAHA) | Cycle 1, 2, 4, 6, 8 Day 1 at 0 hour (pre-dose) | — |
| Presence of Sensitivity Signature | Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal. | Tumor molecular characteristics including but not limited to transcriptomic (RNA) signatures of sensitivity |
| Ratio to Baseline of Serum Circulating Protein Concentration | Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal. | Protein involved TGFB1, VEGF-A, VEGF-C, PIGF, Endoglin, BMP-9, VEGFR1, VEGFR2, VEGFr3, Ang-2, VEGF-D, CD54, CD106, and CCL2. Tumor molecular characteristics including but not limited to transcriptomic (ribonucleic acid) signatures of efficacy. |
| Change From Baseline in Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire (FACT-Hep) | Screening, Cycle 1 Day1,8; Cycle >=2 Day1; End of treatment, survival follow-up up to 24 months after last participant randomization. | Patient reported outcomes (PROs) were assessed using the FACT-Hep. The FACT-Hep included the FACT-general (FACT-G) and a hepatobiliary module, it consisted of the 27-item FACT-G, which assessed generic health-related quality of life (HRQoL) concerns, and the 18-item hepatobiliary subscale (HS), which assessed disease-specific issues. The questionnaire used a 5 point Likert scale from '0' not at all to '4' very much regarding how much each item was present in the last 7 days; lower score indicated severer symptom. Eight of the items (lack of energy, pain, weight loss, back pain, fatigue, stomach pain/discomfort, nausea, and jaundice) made up the Fact Hepatobiliary Symptom Index (FHSI 8) were considered to be symptoms specific to hepatobiliary cancer. |
Countries
Japan, United States
Participant flow
Recruitment details
Only 3 participants were enrolled into this study as of termination date. One participant was assigned to receive PF-03446962 plus best supportive care (BSC) treatment and 2 participants were assigned to receive only BSC treatment.
Participants by arm
| Arm | Count |
|---|---|
| PF-03446962 Plus BSC PF-03446962 7 mg/kg was administered IV as 1-hour infusion q2w plus BSC | 1 |
| BSC Alone BSC might vary depending on the participant's signs and symptoms, site current practice, and country practice and might include medications and supportive measures deemed necessary to palliate disease-related symptoms and improve quality of life. | 2 |
| Total | 3 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Progression of Disease | 1 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 2 |
Baseline characteristics
| Characteristic | PF-03446962 Plus BSC | BSC Alone | Total |
|---|---|---|---|
| Age, Customized 18 to 44 Years | 1 Participants 0 | 0 Participants | 1 Participants |
| Age, Customized 45 to 64 Years | 0 Participants | 2 Participants 6.4 | 2 Participants |
| Sex: Female, Male Female | 1 Participants | 0 Participants | 1 Participants |
| Sex: Female, Male Male | 0 Participants | 2 Participants | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 1 / 1 | 0 / 2 |
| serious Total, serious adverse events | 0 / 1 | 0 / 2 |
Outcome results
Overall Survival (OS)
OS was the duration from date of randomization to date of death due to any cause. For participants who are alive, overall survival was censored at the last contact. Death was determined from adverse event (AE) data where outcome was death or from follow-up contact data where the participant current status was death.
Time frame: From first randomization to date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization
Population: Full analysis set (FAS) included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PF-03446962 Plus BSC | Overall Survival (OS) | NA Months |
| BSC Alone | Overall Survival (OS) | NA Months |
Change From Baseline in Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire (FACT-Hep)
Patient reported outcomes (PROs) were assessed using the FACT-Hep. The FACT-Hep included the FACT-general (FACT-G) and a hepatobiliary module, it consisted of the 27-item FACT-G, which assessed generic health-related quality of life (HRQoL) concerns, and the 18-item hepatobiliary subscale (HS), which assessed disease-specific issues. The questionnaire used a 5 point Likert scale from '0' not at all to '4' very much regarding how much each item was present in the last 7 days; lower score indicated severer symptom. Eight of the items (lack of energy, pain, weight loss, back pain, fatigue, stomach pain/discomfort, nausea, and jaundice) made up the Fact Hepatobiliary Symptom Index (FHSI 8) were considered to be symptoms specific to hepatobiliary cancer.
Time frame: Screening, Cycle 1 Day1,8; Cycle >=2 Day1; End of treatment, survival follow-up up to 24 months after last participant randomization.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| PF-03446962 Plus BSC | Change From Baseline in Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire (FACT-Hep) | NA Units on scale |
| BSC Alone | Change From Baseline in Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire (FACT-Hep) | NA Units on scale |
Duration of Response (DR)
DR was defined as the time from the first documentation of objective tumor response to the first documentation of objective tumor progression or to death due to any cause, whichever occurred first. If tumor progression data included \>1 date, the first date was to be used. DR (in months) was calculated as the end date for DR minus date of first CR or PR that was subsequently confirmed plus 1 divided by 30.4. CR was defined as disappearance of all target lesions and non-target, if any. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions.
Time frame: From first randomization to date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization
Population: Subgroup of participants with objective response. Since objective response was not assessed in any of the participants, ideally the number of participants analyzed field should be 0 and the reason was insufficient data available to conduct adequate analysis due to premature termination of the study.
Maximum Serum Concentration (Cmax)
Time frame: 1 hour (after start of infusion) on Day1 of Cycles 1, 2, 4, 6, and 8
Population: The pharmacokinetic (PK) concentration set consisted of all participants who were treated and had at least one concentration on at least 1 day of PK assessment.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| PF-03446962 Plus BSC | Maximum Serum Concentration (Cmax) | NA microgram per milliliter (mcg/mL) |
Number of Participants With Human Anti-Human Antibodies (HAHA)
Time frame: Cycle 1, 2, 4, 6, 8 Day 1 at 0 hour (pre-dose)
Population: The immunogenicity assessment consisted of all participants who had at least 1 sample on at least 1 day of immunogenicity assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PF-03446962 Plus BSC | Number of Participants With Human Anti-Human Antibodies (HAHA) | NA Participants |
Objective Response Rate (ORR) - Percentage of Participants With Objective Response
ORR was defined as the proportion of participants with confirmed complete response (CR) or confirmed partial response (PR) according to RECIST version 1.1, relative to all randomized participants. CR were those that persisted on repeat imaging study more than or equal to (\>=) 4 weeks after initial documentation of response. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions. Participants who did not have on study radiographic tumor re-evaluation or who died, progressed or dropped out for any reason prior to reaching a CR or PR were to be counted as non-responders in the assessment of ORR. A participant who initially met the criteria for a PR and then subsequently became a confirmed CR, was to be assigned a best response of CR.
Time frame: Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PF-03446962 Plus BSC | Objective Response Rate (ORR) - Percentage of Participants With Objective Response | NA Percentage of Participants |
| BSC Alone | Objective Response Rate (ORR) - Percentage of Participants With Objective Response | NA Percentage of Participants |
Observed Serum Concentration of Circulating Protein
Time frame: Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PF-03446962 Plus BSC | Observed Serum Concentration of Circulating Protein | NA mcg/mL |
Percentage of Participants With Disease Control Rate (DCR) at 16 Weeks
DCR was defined as the proportion of participants with confirmed CR or confirmed PR or a best response of stable disease (SD) \>=16 weeks according to RECIST, relative to all randomized participants. CR was defined as disappearance of all target lesions. PR was defined as \>=30% decrease in the sum of diameters of target lesions and non CR/non PD to non-target lesions. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), taking as reference the smallest sum diameters while on study.
Time frame: From first randomization to date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months after last participant randomization
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PF-03446962 Plus BSC | Percentage of Participants With Disease Control Rate (DCR) at 16 Weeks | NA Percentage of Participants |
| BSC Alone | Percentage of Participants With Disease Control Rate (DCR) at 16 Weeks | NA Percentage of Participants |
Presence of Sensitivity Signature
Tumor molecular characteristics including but not limited to transcriptomic (RNA) signatures of sensitivity
Time frame: Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
Progression-Free Survival (PFS)
PFS was defined as the time from randomization to first documentation of objective tumor progression or to death due to any cause, whichever occured first. If tumor progression data included \>1 date, the first date was to be used. PFS (in months) was calculated as first event date minus first randomization date plus 1 divided by 30.4.
Time frame: Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PF-03446962 Plus BSC | Progression-Free Survival (PFS) | NA Months |
| BSC Alone | Progression-Free Survival (PFS) | NA Months |
Ratio to Baseline of Serum Circulating Protein Concentration
Protein involved TGFB1, VEGF-A, VEGF-C, PIGF, Endoglin, BMP-9, VEGFR1, VEGFR2, VEGFr3, Ang-2, VEGF-D, CD54, CD106, and CCL2. Tumor molecular characteristics including but not limited to transcriptomic (ribonucleic acid) signatures of efficacy.
Time frame: Cycle 1 Day 1 (before infusion), Cycle 4 Day 1 (before infusion), at disease progression/participant withdrawal.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PF-03446962 Plus BSC | Ratio to Baseline of Serum Circulating Protein Concentration | NA Percentage |
Time to Tumor Progression (TTP)
TTP was defined as the time from first randomization to date of first documentation of objective tumor progression. If tumor progression data included more than (\>) 1 date, the first date was to be used. TTP (in months) was calculated as first event date or last known progression-free date minus the first randomization date plus 1 divided by 30.4. Tumor progression was determined from oncologic assessment data (where data meet the criteria for progressive disease per Response Evaluation Criteria in Solid Tumors \[RECIST\] version 1.1).
Time frame: Screening and every 8 weeks by calendar thereafter, up to 24 months after last participant randomization.
Population: FAS included all randomized participants regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PF-03446962 Plus BSC | Time to Tumor Progression (TTP) | NA Months |
| BSC Alone | Time to Tumor Progression (TTP) | NA Months |
Trough Serum Concentration of PF-03446962 (Ctrough)
Time frame: 0 hour (predose) on Day 1 of Cycles 1, 2, 4, 6, and 8
Population: The PK concentration set consisted of all participants who were treated and had at least one concentration on at least 1 day of PK assessment.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| PF-03446962 Plus BSC | Trough Serum Concentration of PF-03446962 (Ctrough) | NA mcg/mL |