Gastric Adenocarcinoma
Conditions
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
Administered intravenously on Days 1 and 15 of each treatment cycle
Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle
Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle
Administered intravenously per standard of care on Days 1 and 15 of each treatment cycle
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| 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 months | OS was defined as the time interval from the date of randomization to death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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 months | 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. |
| Objective Response Rate (ORR) | Up to 135.4 weeks at the time of final analysis | 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. |
| 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 days | 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. |
| Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | First dose date up to the last dose date (maximum: 161.7 weeks) plus 30 to 55 days | 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 432 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 174 | 168 |
| Overall Study | Investigator's discretion | 3 | 1 |
| Overall Study | Lost to Follow-up | 2 | 2 |
| Overall Study | Unknown reason | 30 | 32 |
| Overall Study | Withdrew consent | 9 | 11 |
Baseline characteristics
| Characteristic | Total | Placebo + mFOLFOX6 | Andecaliximab + mFOLFOX6 |
|---|---|---|---|
| Age, Continuous | 60 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 Participants | 32 Participants | 38 Participants |
| Race/Ethnicity, Customized Ethnicity Not Hispanic or Latino | 343 Participants | 173 Participants | 170 Participants |
| Race/Ethnicity, Customized Ethnicity Not Permitted | 19 Participants | 9 Participants | 10 Participants |
| Race/Ethnicity, Customized Race American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Race Asian | 10 Participants | 5 Participants | 5 Participants |
| Race/Ethnicity, Customized Race Black or African American | 8 Participants | 4 Participants | 4 Participants |
| Race/Ethnicity, Customized Race Not Permitted | 14 Participants | 6 Participants | 8 Participants |
| Race/Ethnicity, Customized Race Other | 29 Participants | 14 Participants | 15 Participants |
| Race/Ethnicity, Customized Race White | 370 Participants | 184 Participants | 186 Participants |
| Region of Enrollment Australia | 31 Participants | 18 Participants | 13 Participants |
| Region of Enrollment Belgium | 5 Participants | 3 Participants | 2 Participants |
| Region of Enrollment Chile | 26 Participants | 11 Participants | 15 Participants |
| Region of Enrollment Colombia | 11 Participants | 6 Participants | 5 Participants |
| Region of Enrollment Czechia | 15 Participants | 5 Participants | 10 Participants |
| Region of Enrollment France | 13 Participants | 3 Participants | 10 Participants |
| Region of Enrollment Germany | 24 Participants | 8 Participants | 16 Participants |
| Region of Enrollment Hungary | 26 Participants | 15 Participants | 11 Participants |
| Region of Enrollment Italy | 14 Participants | 6 Participants | 8 Participants |
| Region of Enrollment Peru | 8 Participants | 4 Participants | 4 Participants |
| Region of Enrollment Poland | 24 Participants | 11 Participants | 13 Participants |
| Region of Enrollment Romania | 28 Participants | 13 Participants | 15 Participants |
| Region of Enrollment Spain | 55 Participants | 28 Participants | 27 Participants |
| Region of Enrollment Turkey | 35 Participants | 18 Participants | 17 Participants |
| Region of Enrollment United Kingdom | 11 Participants | 6 Participants | 5 Participants |
| Region of Enrollment United States | 106 Participants | 59 Participants | 47 Participants |
| Sex: Female, Male Female | 111 Participants | 61 Participants | 50 Participants |
| Sex: Female, Male Male | 321 Participants | 153 Participants | 168 Participants |
| Type of Cancer Gastric | 285 Participants | 143 Participants | 142 Participants |
| Type of Cancer Gastroesophageal junction | 147 Participants | 71 Participants | 76 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 174 / 218 | 168 / 214 |
| other Total, other adverse events | 209 / 216 | 203 / 210 |
| serious Total, serious adverse events | 103 / 216 | 108 / 210 |
Outcome results
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Andecaliximab + mFOLFOX6 | Overall Survival (OS) | 12.52 months |
| Placebo + mFOLFOX6 | Overall Survival (OS) | 11.76 months |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Andecaliximab + mFOLFOX6 | Objective Response Rate (ORR) | 50.5 percentage of participants |
| Placebo + mFOLFOX6 | Objective Response Rate (ORR) | 41.1 percentage of participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Andecaliximab + mFOLFOX6 | Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs) | 99.1 percentage of participants |
| Placebo + mFOLFOX6 | Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs) | 99.5 percentage of participants |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Andecaliximab + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Hematology | 94.4 percentage of participants |
| Andecaliximab + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Serum Chemistry | 91.7 percentage of participants |
| Andecaliximab + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Coagulation | 7.4 percentage of participants |
| Placebo + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Hematology | 89.5 percentage of participants |
| Placebo + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Serum Chemistry | 92.9 percentage of participants |
| Placebo + mFOLFOX6 | Percentage of Participants With Clinically Relevant Treatment-emergent Laboratory Abnormalities | Coagulation | 3.3 percentage of participants |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Andecaliximab + mFOLFOX6 | Progression-free Survival (PFS) | 7.46 months |
| Placebo + mFOLFOX6 | Progression-free Survival (PFS) | 7.06 months |