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Andecaliximab With mFOLFOX6 as First Line Treatment for Advanced Gastric or Gastroesophageal Junction Adenocarcinoma

A Phase 3 Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of GS-5745 Combined With mFOLFOX6 as First Line Treatment in Patients With Advanced Gastric or Gastroesophageal Junction Adenocarcinoma

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02545504
Acronym
GAMMA-1
Enrollment
432
Registered
2015-09-10
Start date
2015-10-13
Completion date
2019-05-15
Last updated
2020-05-26

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

Conditions

Gastric Adenocarcinoma

Keywords

Gastroesophageal junction (GEJ), Stomach cancer

Brief summary

The primary objective of this study is to compare the efficacy of andecaliximab (GS-5745) versus placebo in combination with modified fluorouracil (5-FU), leucovorin (LV), and oxaliplatin (OXA) (mFOLFOX6) as measured by overall survival.

Interventions

800 mg administered intravenously on Days 1 and 15 of each 28-day treatment cycle

DRUGPlacebo

Administered intravenously on Days 1 and 15 of each treatment cycle

DRUGLeucovorin

Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle

DRUG5-fluorouracil

Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle

DRUGOxaliplatin

Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle

Sponsors

Gilead Sciences
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

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

Inclusion criteria

Key Inclusion Criteria: * Adults with histologically confirmed adenocarcinoma of the stomach or gastroesophageal junction that is inoperable, locally advanced or metastatic and not amenable to curative therapy * Adequate hematologic, liver, coagulation and kidney function * Eastern Cooperative Oncology Group (ECOG) ≤ 1 * Evaluable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1 Key

Exclusion criteria

* Previous chemotherapy for locally advanced or metastatic gastric cancer. * Human Epidermal Growth Factor Receptor 2 (HER2)-positive gastric cancer * HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV) infection * Pregnant or breast feeding women * Individuals with known or suspected central nervous system metastases or individuals requiring chronic daily treatment with oral corticosteroids * Grade ≥ 2 peripheral neuropathy Note: Other protocol defined Inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS)Andecaliximab + mFOLFOX6 median follow-up at the time of final analysis: 19.43 months; Placebo + mFOLFOX6 median follow-up at the time of the final analysis: 19.45 monthsOS was defined as the time interval from the date of randomization to death from any cause.

Secondary

MeasureTime frameDescription
Progression-free Survival (PFS)Andecaliximab + mFOLFOX6 median follow-up at the time of the final analysis: 18.64 months; Placebo + mFOLFOX6 median follow-up at the time of the final analysis: 18.74 monthsPFS was defined as the interval of time from the date of randomization to the earlier of the first documentation of definitive disease progression or death from any cause.
Objective Response Rate (ORR)Up to 135.4 weeks at the time of final analysisORR was defined as the percentage of participants who achieve a complete response (CR) or partial response (PR) as assessed by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. CR was defined as the disappearance of all target lesions and disappearance of all non-target lesions and normalization of tumor marker level. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs)First dose date up to the last dose date (maximum:161.7 weeks) plus 30 to 55 daysAn adverse event (AE) is any untoward medical occurrence in a clinical study participant administered a medicinal product, which does not necessarily have a causal relationship with the treatment. TEAEs are events in a given study period that meet any of the following criteria: Any AE with onset date of on or after andecalizimab/placebo start date and no later than 30 days after permanent discontinuation of all study treatment (andecaliximab/placebo and chemotherapy) or Any AEs with onset date of on or after the andecaliximab/placebo start date and no later than 55 days after permanent discontinuation of andecaliximab/placebo or AEs leading to discontinuation of andecaliximab/placebo.
Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesFirst dose date up to the last dose date (maximum: 161.7 weeks) plus 30 to 55 daysTreatment-emergent laboratory abnormalities were graded per Common Terminology Criteria for Adverse Events (CTCAE), Version 4.03 where 0=None, 1=Mild, 2=Moderate, 3=Severe, 4=Potentially Life Threatening. Treatment-emergent laboratory abnormalities are defined as values that increase at least 1 toxicity grade from baseline at any post-baseline time point, up to 30 days after the last dose of all study treatment, or 55 days after the last dose of andecaliximab/placebo for participants who permanently discontinued all study treatments. If the relevant baseline laboratory value is missing, then any abnormality of at least Grade 1 was considered treatment-emergent.

Countries

Australia, Belgium, Chile, Colombia, Czechia, France, Germany, Hungary, Italy, Peru, Poland, Romania, Spain, Turkey (Türkiye), United Kingdom, United States

Participant flow

Recruitment details

Participants were enrolled at study sites in Australia, Europe, Chile, Colombia, Peru, Turkey, and the United States. The first participant was screened on 13 October 2015. The last study visit occurred on 15 May 2019.

Pre-assignment details

635 participants were screened.

Participants by arm

ArmCount
Andecaliximab + mFOLFOX6
Participants were randomized to receive andecaliximab 800 mg IV plus mFOLFOX6 (LV+5-FU+OXA) IV as per standard of care on Days 1 and 15 of each 28-day treatment cycle during Cycles 1-6, followed by andecaliximab 800 mg IV plus LV+5-FU on Days 1 and 15 during subsequent cycles until disease progression, unacceptable toxicity, consent withdrawal, or the participant's refusal of treatment for up to 161.7 weeks.
218
Placebo + mFOLFOX6
Participants were randomized to receive placebo IV plus mFOLFOX6 (LV+5-FU+OXA) as per standard of care on Days 1 and 15 of each 28-day treatment cycle during Cycles 1-6, followed by placebo IV plus LV+5-FU on Days 1 and 15 during subsequent cycles until disease progression, unacceptable toxicity, consent withdrawal, or the participant's refusal of treatment for up to 112.3 weeks.
214
Total432

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath174168
Overall StudyInvestigator's discretion31
Overall StudyLost to Follow-up22
Overall StudyUnknown reason3032
Overall StudyWithdrew consent911

Baseline characteristics

CharacteristicTotalPlacebo + mFOLFOX6Andecaliximab + mFOLFOX6
Age, Continuous60 years
STANDARD_DEVIATION 11.7
61 years
STANDARD_DEVIATION 11.4
60 years
STANDARD_DEVIATION 11.9
Race/Ethnicity, Customized
Ethnicity
Hispanic or Latino
70 Participants32 Participants38 Participants
Race/Ethnicity, Customized
Ethnicity
Not Hispanic or Latino
343 Participants173 Participants170 Participants
Race/Ethnicity, Customized
Ethnicity
Not Permitted
19 Participants9 Participants10 Participants
Race/Ethnicity, Customized
Race
American Indian or Alaska Native
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Race
Asian
10 Participants5 Participants5 Participants
Race/Ethnicity, Customized
Race
Black or African American
8 Participants4 Participants4 Participants
Race/Ethnicity, Customized
Race
Not Permitted
14 Participants6 Participants8 Participants
Race/Ethnicity, Customized
Race
Other
29 Participants14 Participants15 Participants
Race/Ethnicity, Customized
Race
White
370 Participants184 Participants186 Participants
Region of Enrollment
Australia
31 Participants18 Participants13 Participants
Region of Enrollment
Belgium
5 Participants3 Participants2 Participants
Region of Enrollment
Chile
26 Participants11 Participants15 Participants
Region of Enrollment
Colombia
11 Participants6 Participants5 Participants
Region of Enrollment
Czechia
15 Participants5 Participants10 Participants
Region of Enrollment
France
13 Participants3 Participants10 Participants
Region of Enrollment
Germany
24 Participants8 Participants16 Participants
Region of Enrollment
Hungary
26 Participants15 Participants11 Participants
Region of Enrollment
Italy
14 Participants6 Participants8 Participants
Region of Enrollment
Peru
8 Participants4 Participants4 Participants
Region of Enrollment
Poland
24 Participants11 Participants13 Participants
Region of Enrollment
Romania
28 Participants13 Participants15 Participants
Region of Enrollment
Spain
55 Participants28 Participants27 Participants
Region of Enrollment
Turkey
35 Participants18 Participants17 Participants
Region of Enrollment
United Kingdom
11 Participants6 Participants5 Participants
Region of Enrollment
United States
106 Participants59 Participants47 Participants
Sex: Female, Male
Female
111 Participants61 Participants50 Participants
Sex: Female, Male
Male
321 Participants153 Participants168 Participants
Type of Cancer
Gastric
285 Participants143 Participants142 Participants
Type of Cancer
Gastroesophageal junction
147 Participants71 Participants76 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
174 / 218168 / 214
other
Total, other adverse events
209 / 216203 / 210
serious
Total, serious adverse events
103 / 216108 / 210

Outcome results

Primary

Overall Survival (OS)

OS was defined as the time interval from the date of randomization to death from any cause.

Time frame: Andecaliximab + mFOLFOX6 median follow-up at the time of final analysis: 19.43 months; Placebo + mFOLFOX6 median follow-up at the time of the final analysis: 19.45 months

Population: The Intent-to-Treat (ITT) Analysis Set included all randomized participants.

ArmMeasureValue (MEDIAN)
Andecaliximab + mFOLFOX6Overall Survival (OS)12.52 months
Placebo + mFOLFOX6Overall Survival (OS)11.76 months
Comparison: The primary and secondary endpoints were tested sequentially in the following gate-keeping order: the primary OS endpoint, then the secondary PFS endpoint, and finally the secondary ORR endpoint.p-value: 0.562595% CI: [0.74, 1.18]Log Rank
Secondary

Objective Response Rate (ORR)

ORR was defined as the percentage of participants who achieve a complete response (CR) or partial response (PR) as assessed by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. CR was defined as the disappearance of all target lesions and disappearance of all non-target lesions and normalization of tumor marker level. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Time frame: Up to 135.4 weeks at the time of final analysis

Population: Participants in the ITT Analysis Set were analyzed.

ArmMeasureValue (NUMBER)
Andecaliximab + mFOLFOX6Objective Response Rate (ORR)50.5 percentage of participants
Placebo + mFOLFOX6Objective Response Rate (ORR)41.1 percentage of participants
Comparison: The primary and secondary endpoints were tested sequentially in the following gate-keeping order: the primary OS endpoint, then the secondary PFS endpoint, and finally the secondary ORR endpoint. ORR was tested only if OS and PFS were significant.The P-value is for display only.p-value: 0.049395% CI: [1, 2.15]Cochran-Mantel-Haenszel
Comparison: The primary and secondary endpoints were tested sequentially in the following gate-keeping order: the primary OS endpoint, then the secondary PFS endpoint, and finally the secondary ORR endpoint. ORR was tested only if OS and PFS were significant.95% CI: [0.1, 18.8]
Secondary

Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs)

An adverse event (AE) is any untoward medical occurrence in a clinical study participant administered a medicinal product, which does not necessarily have a causal relationship with the treatment. TEAEs are events in a given study period that meet any of the following criteria: Any AE with onset date of on or after andecalizimab/placebo start date and no later than 30 days after permanent discontinuation of all study treatment (andecaliximab/placebo and chemotherapy) or Any AEs with onset date of on or after the andecaliximab/placebo start date and no later than 55 days after permanent discontinuation of andecaliximab/placebo or AEs leading to discontinuation of andecaliximab/placebo.

Time frame: First dose date up to the last dose date (maximum:161.7 weeks) plus 30 to 55 days

Population: The Safety Analysis Set included all participants who received at least one dose of andecaliximab/placebo.

ArmMeasureValue (NUMBER)
Andecaliximab + mFOLFOX6Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs)99.1 percentage of participants
Placebo + mFOLFOX6Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs)99.5 percentage of participants
Secondary

Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities

Treatment-emergent laboratory abnormalities were graded per Common Terminology Criteria for Adverse Events (CTCAE), Version 4.03 where 0=None, 1=Mild, 2=Moderate, 3=Severe, 4=Potentially Life Threatening. Treatment-emergent laboratory abnormalities are defined as values that increase at least 1 toxicity grade from baseline at any post-baseline time point, up to 30 days after the last dose of all study treatment, or 55 days after the last dose of andecaliximab/placebo for participants who permanently discontinued all study treatments. If the relevant baseline laboratory value is missing, then any abnormality of at least Grade 1 was considered treatment-emergent.

Time frame: First dose date up to the last dose date (maximum: 161.7 weeks) plus 30 to 55 days

Population: Participants in the Safety Analysis Set were analyzed.

ArmMeasureGroupValue (NUMBER)
Andecaliximab + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesHematology94.4 percentage of participants
Andecaliximab + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesSerum Chemistry91.7 percentage of participants
Andecaliximab + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesCoagulation7.4 percentage of participants
Placebo + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesHematology89.5 percentage of participants
Placebo + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesSerum Chemistry92.9 percentage of participants
Placebo + mFOLFOX6Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory AbnormalitiesCoagulation3.3 percentage of participants
Secondary

Progression-free Survival (PFS)

PFS was defined as the interval of time from the date of randomization to the earlier of the first documentation of definitive disease progression or death from any cause.

Time frame: Andecaliximab + mFOLFOX6 median follow-up at the time of the final analysis: 18.64 months; Placebo + mFOLFOX6 median follow-up at the time of the final analysis: 18.74 months

Population: Participants in the ITT Analysis Set were analyzed.

ArmMeasureValue (MEDIAN)
Andecaliximab + mFOLFOX6Progression-free Survival (PFS)7.46 months
Placebo + mFOLFOX6Progression-free Survival (PFS)7.06 months
Comparison: The primary and secondary endpoints were tested sequentially in the following gate-keeping order: the primary OS endpoint, then the secondary PFS endpoint, and finally the secondary ORR endpoint. PFS was tested only if OS was significant. The P-value is for display only.p-value: 0.103195% CI: [0.67, 1.04]Log Rank

Source: ClinicalTrials.gov · Data processed: Mar 1, 2026