Glioblastoma, Gliosarcoma
Conditions
Keywords
Newly Diagnosed Glioblastoma, Epithelial Growth Factor Receptor (EGFR), Temozolomide, ABT-414, Radiology Therapy Oncology Group, Antibody Drug Conjugate, Brain Tumor, Brain Tumor Group, EGFRvIII, EGFR Amplified, First Line Therapy, Brain Cancer
Brief summary
This study seeks to determine whether the addition of ABT-414 to concomitant radiotherapy and temozolomide (TMZ) followed by combination of ABT-414 with adjuvant TMZ prolongs overall survival (OS) among participants with newly diagnosed glioblastoma (GBM) with epidermal growth factor receptor (EGFR) amplification. In addition, there is a Phase 1, open-label, multicenter sub-study to assess the pharmacokinetics, safety and tolerability of ABT-414 in participants with newly diagnosed EGFR-amplified GBM who have mild or moderate hepatic impairment.
Interventions
Oral Capsule
Intravenous (IV) Infusion
IV Infusion (IV)
Sponsors
Study design
Masking description
Sub-study was open-label.
Eligibility
Inclusion criteria
* Must have a clinical diagnosis of glioblastoma (GBM). * Must have a confirmed epidermal growth factor receptor amplification in tumor tissue. * Must have a Karnofsky Performance Status (KPS) \>= 70 at assessment \<= 14 days prior to randomization (N/A to the sub-study). * Must have recovered from effects of surgery, postoperative infection and other complications of surgery. * Must have adequate bone marrow, renal, and hepatic function (For the sub-study, the participant must have adequate bone marrow and renal function and have mild-to-moderate hepatic impairment).
Exclusion criteria
* Multifocal, recurrent or metastatic GBM or gliomatosis cerebri (For the sub-study, the participant can have multifocal GBM and glimatosis cerebri but can't have recurrent or metastatic GBM). * Prior chemo therapy or radiosensitizer for head and neck cancer. * Prior radiotherapy to the head or neck in overlap of radiation fields. * Prior therapy for glioblastoma or other invasive malignancy. * Prior, concomitant or planned treatment with Novo Tumor Treatment Fields (Novo-TTF), EGFR-targeted therapy, bevacizumab, Gliadel wafers or other intratumoral or intracavity anti-neoplastic therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| OS for the MGMT Methylated Group | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause. |
| OS for the Epidermal Growth Factor Receptor (EGFR)vIII-Mutated Tumor Subgroup | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause. |
| Progression-Free Survival (PFS) | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | PFS will be defined as the number of days from the date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology (RANO) criteria (see Wen et al. J Clin Oncol. 2010 Apr 10;28(11):1963-72) or to the date of death, if disease progression does not occur. |
| OS for the O6-methylguaninemethlytransferese (MGMT) Unmethylated Group | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause. Unmethylated MGMT promoter is associated with a worse prognosis in GBM |
| Deterioration Free Survival in M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) Symptom Severity Score | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | The MDASI-BT assesses the severity of multiple brain tumor-related symptoms and the impact of these symptoms on daily functioning in the last 24 hours. It consists of 22 symptom items and 6 interference items, each rated from 0 to 10. MDASI-BT symptom severity score is defined as average over 13 core symptom items and 9 brain tumor symptom items, with a total score of 0 to 10, with higher score indicating worse symptoms/interference. Changes in symptom severity score were classified into 3 categories: improved (≤ -1), stable (\> -1 and \< 1), and deteriorated (≥ 1). Deterioration is defined as satisfying the deterioration criteria (i.e., increase in symptom severity score by ≥ 1 unit) without further improvement (i.e., failing to satisfy deterioration criteria) within 8 weeks or occurrence of death. |
| Deterioration Free Survival in MDASI-BT Symptom Interference Score | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | The MDASI-BT assesses the severity of multiple brain tumor-related symptoms and the impact of these symptoms on daily functioning in the last 24 hours. It consists of 22 symptom items and 6 interference items, each rated from 0 to 10. MDASI-BT symptom interference score is defined as an average of 6 interference items, with a total score of 0 to 10, where higher scores indicate worse interference. Changes in symptom interference score were classified into 3 categories: improved (≤ -1), stable (\> -1 and \< 1), and deteriorated (≥ 1). Deterioration is defined as satisfying the deterioration criteria (i.e., increase in symptom interference score by ≥ 1 unit) without further improvement (i.e., failing to satisfy deterioration criteria) within 8 weeks or occurrence of death. |
| Deterioration Free Survival in Neurocognitive Functioning on the Hopkins Verbal Learning Test Revised (HVLT-R) Total Recall Score | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | The HVLT-R consists of 3 parts. Free call has a range of 0 to 36, delayed recall has a range from 0 to 12, and delayed recognition has a range of -12 to 12. Higher scores indicating better function in all 3 parts. When scoring the HVLT-R, the 3 learning trials are combined to calculate a total recall score (range -12 to 60). Deterioration is defined as satisfying the deterioration criteria (i.e., decrease in HVLT-R total recall score by 5 units) without further improvement within 8 weeks or occurrence of death. |
| PFS for EGFRvIII-Mutated Tumor Subgroup | Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6). | PFS will be defined as the number of days from the date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology (RANO) criteria or to the date of death, if disease progression does not occur. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Canada, China, Colombia, Czechia, France, Germany, Hong Kong, Ireland, Israel, Italy, Mexico, Netherlands, New Zealand, Portugal, Russia, Singapore, South Africa, South Korea, Spain, Switzerland, Taiwan, United Kingdom, United States
Participant flow
Pre-assignment details
An efficacy futility analysis, conducted in accordance with the SAP, generated a conclusive result of futility, meeting the main study's objective of determining whether the addition of Depatux-M to standard therapy improves overall survival. The study was modified at that point, remaining open until after all participants had discontinued study treatment. AbbVie therefore considered this study completed (according to the rules set out for the study) and not terminated.
Participants by arm
| Arm | Count |
|---|---|
| Placebo, Radiation and TMZ Placebo is given on Day 1 of Week 1, 3 and 5 along with the standard therapy of TMZ and radiation during the chemoradiation phase. Placebo is given on Day 1 and 15 of each cycle along with TMZ (Days 1-5 of each cycle) per standard of care during the adjuvant phase. | 341 |
| Depatuxizumab Mafodotin, Radiation and TMZ Depatuxizumab mafodotin is given on Day 1 of Week 1, 3 and 5 along with the standard therapy of TMZ and radiation during the chemoradiation phase. Depatuxizumab mafodotin is given on Day 1 and 15 of each cycle along with TMZ (Days 1-5 of each cycle) per standard of care during the adjuvant phase. | 344 |
| Open-Label Substudy: Depatuxizumab Mafodotin, Radiation and TMZ Depatuxizumab mafodotin is given to participants with hepatic impairment on Day 1 of Week 1, 3 and 5 along with the standard therapy of TMZ and radiation during the chemoradiation phase. Depatuxizumab mafodotin is given on Day 1 and 15 of each cycle along with TMZ (Days 1-5 of each cycle) per standard of care during the adjuvant phase. | 6 |
| Total | 691 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 182 | 200 | 1 |
| Overall Study | Lost to Follow-up | 4 | 5 | 0 |
| Overall Study | Other, Not Specified | 20 | 27 | 0 |
| Overall Study | Study Terminated by Sponsor | 107 | 89 | 2 |
| Overall Study | Unknown Reason | 2 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 26 | 23 | 3 |
Baseline characteristics
| Characteristic | Total | Placebo, Radiation and TMZ | Open-Label Substudy: Depatuxizumab Mafodotin, Radiation and TMZ | Depatuxizumab Mafodotin, Radiation and TMZ |
|---|---|---|---|---|
| Age, Continuous | 58.1 years STANDARD_DEVIATION 10.27 | 58.1 years STANDARD_DEVIATION 10.42 | 55.3 years STANDARD_DEVIATION 10.58 | 58.2 years STANDARD_DEVIATION 10.14 |
| Race/Ethnicity, Customized Han Chinese (First Generation) | 53 Participants | 28 Participants | 2 Participants | 23 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 71 Participants | 35 Participants | 1 Participants | 35 Participants |
| Race/Ethnicity, Customized Missing | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Other, Not Specified | 566 Participants | 278 Participants | 3 Participants | 285 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 13 Participants | 6 Participants | 0 Participants | 7 Participants |
| Race (NIH/OMB) Asian | 92 Participants | 47 Participants | 5 Participants | 40 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants | 4 Participants | 0 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 2 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) White | 572 Participants | 282 Participants | 1 Participants | 289 Participants |
| Sex: Female, Male Female | 266 Participants | 137 Participants | 0 Participants | 129 Participants |
| Sex: Female, Male Male | 425 Participants | 204 Participants | 6 Participants | 215 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 4 / 335 | 13 / 285 | 180 / 326 | 4 / 342 | 22 / 273 | 188 / 326 | 0 / 6 | 0 / 6 | 1 / 5 |
| other Total, other adverse events | 290 / 335 | 255 / 285 | 1 / 326 | 337 / 342 | 252 / 273 | 2 / 326 | 6 / 6 | 6 / 6 | 0 / 5 |
| serious Total, serious adverse events | 56 / 335 | 85 / 285 | 0 / 326 | 68 / 342 | 107 / 273 | 2 / 326 | 1 / 6 | 1 / 6 | 0 / 5 |
Outcome results
Overall Survival (OS)
Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | Overall Survival (OS) | 18.7 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | Overall Survival (OS) | 18.9 months |
Deterioration Free Survival in M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) Symptom Severity Score
The MDASI-BT assesses the severity of multiple brain tumor-related symptoms and the impact of these symptoms on daily functioning in the last 24 hours. It consists of 22 symptom items and 6 interference items, each rated from 0 to 10. MDASI-BT symptom severity score is defined as average over 13 core symptom items and 9 brain tumor symptom items, with a total score of 0 to 10, with higher score indicating worse symptoms/interference. Changes in symptom severity score were classified into 3 categories: improved (≤ -1), stable (\> -1 and \< 1), and deteriorated (≥ 1). Deterioration is defined as satisfying the deterioration criteria (i.e., increase in symptom severity score by ≥ 1 unit) without further improvement (i.e., failing to satisfy deterioration criteria) within 8 weeks or occurrence of death.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | Deterioration Free Survival in M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) Symptom Severity Score | 11.0 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | Deterioration Free Survival in M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) Symptom Severity Score | 6.1 months |
Deterioration Free Survival in MDASI-BT Symptom Interference Score
The MDASI-BT assesses the severity of multiple brain tumor-related symptoms and the impact of these symptoms on daily functioning in the last 24 hours. It consists of 22 symptom items and 6 interference items, each rated from 0 to 10. MDASI-BT symptom interference score is defined as an average of 6 interference items, with a total score of 0 to 10, where higher scores indicate worse interference. Changes in symptom interference score were classified into 3 categories: improved (≤ -1), stable (\> -1 and \< 1), and deteriorated (≥ 1). Deterioration is defined as satisfying the deterioration criteria (i.e., increase in symptom interference score by ≥ 1 unit) without further improvement (i.e., failing to satisfy deterioration criteria) within 8 weeks or occurrence of death.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | Deterioration Free Survival in MDASI-BT Symptom Interference Score | 9.7 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | Deterioration Free Survival in MDASI-BT Symptom Interference Score | 6.1 months |
Deterioration Free Survival in Neurocognitive Functioning on the Hopkins Verbal Learning Test Revised (HVLT-R) Total Recall Score
The HVLT-R consists of 3 parts. Free call has a range of 0 to 36, delayed recall has a range from 0 to 12, and delayed recognition has a range of -12 to 12. Higher scores indicating better function in all 3 parts. When scoring the HVLT-R, the 3 learning trials are combined to calculate a total recall score (range -12 to 60). Deterioration is defined as satisfying the deterioration criteria (i.e., decrease in HVLT-R total recall score by 5 units) without further improvement within 8 weeks or occurrence of death.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | Deterioration Free Survival in Neurocognitive Functioning on the Hopkins Verbal Learning Test Revised (HVLT-R) Total Recall Score | 13.2 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | Deterioration Free Survival in Neurocognitive Functioning on the Hopkins Verbal Learning Test Revised (HVLT-R) Total Recall Score | 10.7 months |
OS for the Epidermal Growth Factor Receptor (EGFR)vIII-Mutated Tumor Subgroup
Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study) Participants with EGFR-VIII mutation status=mutated.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | OS for the Epidermal Growth Factor Receptor (EGFR)vIII-Mutated Tumor Subgroup | 18.2 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | OS for the Epidermal Growth Factor Receptor (EGFR)vIII-Mutated Tumor Subgroup | 19.8 months |
OS for the MGMT Methylated Group
Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study) Participants with methylated MGMT promoter status.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | OS for the MGMT Methylated Group | NA months |
| Depatuxizumab Mafodotin, Radiation and TMZ | OS for the MGMT Methylated Group | 25.4 months |
OS for the O6-methylguaninemethlytransferese (MGMT) Unmethylated Group
Time to OS is defined as the number of days from the date of randomization to the date of death due to any cause. Unmethylated MGMT promoter is associated with a worse prognosis in GBM
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study) Participants with unmethylated MGMT promoter status.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | OS for the O6-methylguaninemethlytransferese (MGMT) Unmethylated Group | 16.2 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | OS for the O6-methylguaninemethlytransferese (MGMT) Unmethylated Group | 16.1 months |
PFS for EGFRvIII-Mutated Tumor Subgroup
PFS will be defined as the number of days from the date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology (RANO) criteria or to the date of death, if disease progression does not occur.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study) Participants with EGFR-VIII mutation status=mutated.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | PFS for EGFRvIII-Mutated Tumor Subgroup | 5.9 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | PFS for EGFRvIII-Mutated Tumor Subgroup | 8.3 months |
Progression-Free Survival (PFS)
PFS will be defined as the number of days from the date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology (RANO) criteria (see Wen et al. J Clin Oncol. 2010 Apr 10;28(11):1963-72) or to the date of death, if disease progression does not occur.
Time frame: Overall median duration of follow-up was 15.5 months (range: 0.1, 35.6).
Population: Full Analysis Set (FAS): all randomized participants (regardless of whether they received study treatment) satisfying the following criteria:~* Enrollment date was on or prior to 31-Mar-2018~* Enrolled in the main study (not in the open-label hepatic sub-study)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo, Radiation and TMZ | Progression-Free Survival (PFS) | 6.3 months |
| Depatuxizumab Mafodotin, Radiation and TMZ | Progression-Free Survival (PFS) | 8.0 months |