Cervical Cancer
Conditions
Keywords
Seattle Genetics
Brief summary
This trial is being done to find out whether tisotumab vedotin works better than chemotherapy to treat cervical cancer. People in this study have cervical cancer that has spread to other parts of the body (metastatic) or has come back after being treated (recurrent). Participants in this trial will be randomly assigned to one of two groups. One group will be treated with tisotumab vedotin. Participants in the other group will get one of five different chemotherapy drugs (topotecan, vinorelbine, gemcitabine, pemetrexed, or irinotecan). Participants and their doctors will know which group they are in. Participants in the chemotherapy group will decide with their study doctor which drug they will take.
Interventions
2.0 mg/kg every 3 weeks (Q3W)
1 or 1.25 mg/m2 intravenous (IV) on Days 1 to 5, every 21 days
30 mg/m2 IV on Days 1 and 8, every 21 days
1000 mg/m2 IV on Days 1 and 8, every 21 days
100 or 125 mg/m2 IV weekly for 28 days, every 42 days
500 mg/m2 IV on Day 1, every 21 days
Sponsors
Study design
Eligibility
Inclusion criteria
* Has recurrent or metastatic cervical cancer with squamous cell, adenocarcinoma, or adenosquamous histology, and: * Has experienced disease progression during or after treatment with a standard of care systemic chemotherapy doublet, or platinum-based therapy (if eligible), defined as either: * paclitaxel + cisplatin + bevacizumab + anti-PD-(L)1 agent, or * paclitaxel + carboplatin + bevacizumab + anti-PD-(L)1 agent, or * paclitaxel + topotecan/nogitecan + bevacizumab + anti-PD-(L)1 agent * Note: In cases where bevacizumab and/or anti-PD-(L)1 agent is not a standard of care therapy or the participant was ineligible for such treatment according to local standards, prior treatment with bevacizumab and/or anti-PD-(L)1 agent is not required. * Has received 1 or 2 prior systemic therapy regimens for recurrent and/or metastatic cervical cancer. Chemotherapy administered in the adjuvant or neoadjuvant setting, or in combination with radiation therapy, should not be counted as a systemic therapy regimen. Single agent therapy with an anti-PD(L)1 agent for r/mCC cancer should be counted. * Measurable disease according to RECIST v1.1 as assessed by the investigator. * Has ECOG performance status of 0 or 1 prior to randomization. * Has life expectancy of at least 3 months.
Exclusion criteria
* Has primary neuroendocrine, lymphoid, sarcomatoid, or other histologies not mentioned as part of the inclusion criteria above. * Has clinically significant bleeding issues or risks. This includes known past or current coagulation defects leading to an increased risk of bleeding; diffuse alveolar hemorrhage from vasculitis; known bleeding diathesis; ongoing major bleeding; trauma with increased risk of life-threatening bleeding or history of severe head trauma or intracranial surgery within 8 weeks of trial entry. * Has any history of intracerebral arteriovenous malformation, cerebral aneurysm, or stroke (transient ischemic attack \>1 month prior to screening is allowed). * Active ocular surface disease or a history of cicatricial conjunctivitis or inflammatory conditions that predispose to cicatrizing conjunctivitis (e.g. Wagner syndrome, atopic keratoconjunctivitis, autoimmune disease affecting the eyes), ocular Stevens-Johnson syndrome or toxic epidermal necrolysis, mucus pemphigoid, and participants with penetrating ocular transplants. Cataracts alone is not an exclusion criterion. * Major surgery within 4 weeks or minor surgery within 7 days prior to the first study treatment administration. * Peripheral neuropathy ≥grade 2. * Any prior treatment with monomethyl auristatin E (MMAE)-containing drugs. There are additional inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From randomization to date of death due to any cause or censoring date, whichever occurred first (maximum up to 25 months) | Overall survival is defined as the time from the date of randomization to the date of death due to any cause. In the absence of confirmation of death, survival time was censored at the last date the participant was known to be alive. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) as Assessed by Investigator | From the date of randomization to first documentation of PD or death due to any cause, or censoring date whichever occurred first (maximum up to 25 months) | PFS per investigator was defined as the time from the date of randomization to the first documentation of disease progression (PD) as assessed by investigator per Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1, or death due to any cause, whichever occurred earlier. PD: at least a 20 percent (%) increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeter (mm). Participants without evidence of radiographic disease progression or death were censored at the date of last adequate tumor assessment prior to data cut-off date or start of new anti-cancer therapy. Participants with disease progression or death that occurred after 2 or more missed scans were censored at the last adequate tumor assessment prior to missed scans. Participants without post-baseline scan data were censored at the day of randomization. |
| Confirmed Objective Response Rate (ORR) as Assessed by Investigator | From the date of randomization until date of confirmed CR or PR (maximum up to 25 months) | Confirmed objective response rate was defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) per RECIST v.1.1. CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. The minimum criteria for stable disease (SD) duration are defined as ≥ 5 weeks after the date of randomization. For a response to be considered as confirmed, the subsequent response had to be at least 4 weeks after the initial response. Two-sided 95% exact confidence interval (CI) was computed using the Clopper-Pearson method. |
| Time-to-Response (TTR) as Assessed by the Investigator | From the date of randomization to date of date of the first confirmed objective response (maximum up to 25 months) | TTR was defined as the time from the randomization date to the date of the first confirmed objective response (CR or PR that was subsequently confirmed). CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
| Duration of Response (DOR) by Investigator Assessment | From the date of first documented response of CR or PR to the first documented PD or death from any cause, whichever occurred first (maximum up to 25 months) | DOR was defined as the time from the date of the first confirmed objective response (CR or PR that was subsequently confirmed) to the date of the first documented PD per RECIST v1.1 or death from any cause, whichever occurred first. CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. PD: at least a 20 percent (%) increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. |
| Number of Participants With Treatment Emergent Adverse Events (TEAEs) | From start of treatment up to 30 days after last dose of study treatment (up to 25 months) | An AE was any untoward medical occurrence in a clinical study participant temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.. TEAE was defined as a newly occurring or worsening AE after the first dose of study treatment and with onset date on or before 30 days after the last dose of study treatment. |
| EuroQOL Five Dimensions Five Level (EQ-5D-5L) Index Score | From start of treatment until end of follow-up | The EQ-5D-5L questionnaire is a 5-item self-reported measure of functioning and well-being, which assesses 5 dimensions of health, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension comprises 5 levels (no problems, slight problems, moderate problems, severe problems and extreme problems). Responses to the 5 items are then converted to a weighted health state index (utility score) based on values derived from general population samples. This health utility score is between 0 and 1, where 0 is death and 1 is perfect health. |
| EQ-5D Visual Analog Scale (VAS) Scores | From start of treatment until end of follow-up | EQ5D is a participant rated questionnaire to assess health-related QoL in terms of a single index value. The VAS component rates current health state on a scale from 0 mm (worst imaginable health state) to 100 mm (best imaginable health state) ; higher scores indicate a better health state. |
| European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Total Score | From start of treatment until end of follow-up | The EORTC-QLQ-C30 questionnaire is composed of 30 questions for which the answers ranges either from 1 (not at all) to 4 (very much) for items 1 to 28, or from 1 (very poor) to 7 (excellent) for items 29 to 30. The EORTC QLQ-C30 scale scores will be calculated using the EORTC QLQ-C30 Scoring Manual. These include 5 functional scales, 3 symptom scales, a global health status/QoL scale, and 6 single items. Each of the multi-item scales includes a different set of items (i.e., no item occurs in more than one scale). All of the scales and single-item measures range in score from 0 to 100, with a high scale score representing a higher response level (e.g., a high level of functioning, a high QoL, or a high level of symptomatology/problems) |
| EORTC Quality of Life Questionnaire Cervical Cancer Module (QLQ-CX24) Total Scores | From start of treatment until end of follow-up | The EORTC QLQ-CX24 questionnaire is meant for use among cervical cancer participants varying in disease stage and treatment modality. The EORTC-QLQ-CX24 questionnaire is composed of 24 questions for which the answers ranged from 1 (Not at all) to 4 (Very much). Four functional scales and 5 symptom scales will be calculated using the EORTC QLQ-CX24 Scoring Manual. The 9 scores computed from the EORTC-QLQ-CX24 questionnaire will be summarized by treatment arm using descriptive statistics. |
Countries
Argentina, Austria, Belgium, Brazil, Canada, China, Czechia, Finland, France, Germany, Hungary, Italy, Japan, Mexico, Netherlands, Norway, Peru, Poland, Singapore, South Korea, Spain, Sweden, Taiwan, United Kingdom, United States
Contacts
Pfizer
Participant flow
Recruitment details
Participants with recurrent/metastatic cervical cancer (rCC/mCC) who received 1 or 2 prior lines of systemic therapy for their recurrent or metastatic disease were included.
Pre-assignment details
A total of 660 participants were screened of which 158 participants failed screening and 502 participants were enrolled in the study.
Participants by arm
| Arm | Count |
|---|---|
| Tisotumab Vedotin Participants with rCC/mCC were administered tisotumab vedotin 2.0 milligram per kilogram (mg/kg) as an intravenous (IV) infusion once every 3 weeks (Q3W). | 253 |
| Chemotherapy Participants with rCC/mCC were treated with investigator's choice of chemotherapy which included either topotecan 1 or 1.25 milligram per meter square \[mg/m\^2\] IV on Days 1 to 5, every 21 days or vinorelbine 30 mg/m\^2 IV on Days 1 and 8, every 21 days or gemcitabine 1000 mg/m\^2 IV on Days 1 and 8, every 21 days or irinotecan 100 or 125 mg/m\^2 IV weekly for 28 days, every 42 days or pemetrexed 500 mg/m\^2 on Day 1, every 21 days. | 249 |
| Total | 502 |
Baseline characteristics
| Characteristic | Total | Tisotumab Vedotin | Chemotherapy |
|---|---|---|---|
| Age, Continuous | 51.4 Years STANDARD_DEVIATION 11.7 | 51.9 Years STANDARD_DEVIATION 11.8 | 51.0 Years STANDARD_DEVIATION 11.6 |
| Race/Ethnicity, Customized Ethinicity Hispanic or Latino/a, or of Spanish Origin | 102 Participants | 52 Participants | 50 Participants |
| Race/Ethnicity, Customized Ethinicity Not of Hispanic or Latino/a, or Spanish Origin | 353 Participants | 176 Participants | 177 Participants |
| Race/Ethnicity, Customized Ethinicity Not Reported | 36 Participants | 19 Participants | 17 Participants |
| Race/Ethnicity, Customized Ethinicity Unknown | 11 Participants | 6 Participants | 5 Participants |
| Race/Ethnicity, Customized Race American Indian or Alaska Native | 14 Participants | 7 Participants | 7 Participants |
| Race/Ethnicity, Customized Race Asian | 180 Participants | 90 Participants | 90 Participants |
| Race/Ethnicity, Customized Race Black or African American | 10 Participants | 4 Participants | 6 Participants |
| Race/Ethnicity, Customized Race Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Race Not Reported | 36 Participants | 19 Participants | 17 Participants |
| Race/Ethnicity, Customized Race Other | 3 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized Race Unknown | 14 Participants | 8 Participants | 6 Participants |
| Race/Ethnicity, Customized Race White | 244 Participants | 122 Participants | 122 Participants |
| Sex: Female, Male Female | 502 Participants | 253 Participants | 249 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 123 / 253 | 140 / 249 |
| other Total, other adverse events | 233 / 250 | 223 / 239 |
| serious Total, serious adverse events | 82 / 250 | 94 / 239 |
Outcome results
Overall Survival
Overall survival is defined as the time from the date of randomization to the date of death due to any cause. In the absence of confirmation of death, survival time was censored at the last date the participant was known to be alive.
Time frame: From randomization to date of death due to any cause or censoring date, whichever occurred first (maximum up to 25 months)
Population: ITT analysis set included all randomized participants. Participants were included in the treatment group assigned at randomization regardless of any actual treatment received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tisotumab Vedotin | Overall Survival | 11.5 Months |
| Chemotherapy | Overall Survival | 9.5 Months |
Confirmed Objective Response Rate (ORR) as Assessed by Investigator
Confirmed objective response rate was defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) per RECIST v.1.1. CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. The minimum criteria for stable disease (SD) duration are defined as ≥ 5 weeks after the date of randomization. For a response to be considered as confirmed, the subsequent response had to be at least 4 weeks after the initial response. Two-sided 95% exact confidence interval (CI) was computed using the Clopper-Pearson method.
Time frame: From the date of randomization until date of confirmed CR or PR (maximum up to 25 months)
Population: ITT analysis set included all randomized participants. Participants were included in the treatment group assigned at randomization regardless of any actual treatment received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tisotumab Vedotin | Confirmed Objective Response Rate (ORR) as Assessed by Investigator | 17.8 Percentage of participants |
| Chemotherapy | Confirmed Objective Response Rate (ORR) as Assessed by Investigator | 5.2 Percentage of participants |
Duration of Response (DOR) by Investigator Assessment
DOR was defined as the time from the date of the first confirmed objective response (CR or PR that was subsequently confirmed) to the date of the first documented PD per RECIST v1.1 or death from any cause, whichever occurred first. CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. PD: at least a 20 percent (%) increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.
Time frame: From the date of first documented response of CR or PR to the first documented PD or death from any cause, whichever occurred first (maximum up to 25 months)
Population: ITT analysis set included all randomized participants. Participants were included in the treatment group assigned at randomization regardless of any actual treatment received. Here, 'Number of Participants Analyzed' signifies participants evaluable for this outcome measure. Only participants who achieved a confirmed CR or PR based on investigator assessment were included in the analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tisotumab Vedotin | Duration of Response (DOR) by Investigator Assessment | 5.3 Months |
| Chemotherapy | Duration of Response (DOR) by Investigator Assessment | 5.7 Months |
EORTC Quality of Life Questionnaire Cervical Cancer Module (QLQ-CX24) Total Scores
The EORTC QLQ-CX24 questionnaire is meant for use among cervical cancer participants varying in disease stage and treatment modality. The EORTC-QLQ-CX24 questionnaire is composed of 24 questions for which the answers ranged from 1 (Not at all) to 4 (Very much). Four functional scales and 5 symptom scales will be calculated using the EORTC QLQ-CX24 Scoring Manual. The 9 scores computed from the EORTC-QLQ-CX24 questionnaire will be summarized by treatment arm using descriptive statistics.
Time frame: From start of treatment until end of follow-up
EQ-5D Visual Analog Scale (VAS) Scores
EQ5D is a participant rated questionnaire to assess health-related QoL in terms of a single index value. The VAS component rates current health state on a scale from 0 mm (worst imaginable health state) to 100 mm (best imaginable health state) ; higher scores indicate a better health state.
Time frame: From start of treatment until end of follow-up
European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Total Score
The EORTC-QLQ-C30 questionnaire is composed of 30 questions for which the answers ranges either from 1 (not at all) to 4 (very much) for items 1 to 28, or from 1 (very poor) to 7 (excellent) for items 29 to 30. The EORTC QLQ-C30 scale scores will be calculated using the EORTC QLQ-C30 Scoring Manual. These include 5 functional scales, 3 symptom scales, a global health status/QoL scale, and 6 single items. Each of the multi-item scales includes a different set of items (i.e., no item occurs in more than one scale). All of the scales and single-item measures range in score from 0 to 100, with a high scale score representing a higher response level (e.g., a high level of functioning, a high QoL, or a high level of symptomatology/problems)
Time frame: From start of treatment until end of follow-up
EuroQOL Five Dimensions Five Level (EQ-5D-5L) Index Score
The EQ-5D-5L questionnaire is a 5-item self-reported measure of functioning and well-being, which assesses 5 dimensions of health, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension comprises 5 levels (no problems, slight problems, moderate problems, severe problems and extreme problems). Responses to the 5 items are then converted to a weighted health state index (utility score) based on values derived from general population samples. This health utility score is between 0 and 1, where 0 is death and 1 is perfect health.
Time frame: From start of treatment until end of follow-up
Number of Participants With Treatment Emergent Adverse Events (TEAEs)
An AE was any untoward medical occurrence in a clinical study participant temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.. TEAE was defined as a newly occurring or worsening AE after the first dose of study treatment and with onset date on or before 30 days after the last dose of study treatment.
Time frame: From start of treatment up to 30 days after last dose of study treatment (up to 25 months)
Population: Safety analysis set included all randomized participants who received at least 1 dose of study treatment (tisotumab vedotin or chemotherapy).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Tisotumab Vedotin | Number of Participants With Treatment Emergent Adverse Events (TEAEs) | 246 Participants |
| Chemotherapy | Number of Participants With Treatment Emergent Adverse Events (TEAEs) | 237 Participants |
Progression Free Survival (PFS) as Assessed by Investigator
PFS per investigator was defined as the time from the date of randomization to the first documentation of disease progression (PD) as assessed by investigator per Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1, or death due to any cause, whichever occurred earlier. PD: at least a 20 percent (%) increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeter (mm). Participants without evidence of radiographic disease progression or death were censored at the date of last adequate tumor assessment prior to data cut-off date or start of new anti-cancer therapy. Participants with disease progression or death that occurred after 2 or more missed scans were censored at the last adequate tumor assessment prior to missed scans. Participants without post-baseline scan data were censored at the day of randomization.
Time frame: From the date of randomization to first documentation of PD or death due to any cause, or censoring date whichever occurred first (maximum up to 25 months)
Population: ITT analysis set included all randomized participants. Participants were included in the treatment group assigned at randomization regardless of any actual treatment received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tisotumab Vedotin | Progression Free Survival (PFS) as Assessed by Investigator | 4.2 Months |
| Chemotherapy | Progression Free Survival (PFS) as Assessed by Investigator | 2.9 Months |
Time-to-Response (TTR) as Assessed by the Investigator
TTR was defined as the time from the randomization date to the date of the first confirmed objective response (CR or PR that was subsequently confirmed). CR was defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \<10 mm. PR was defined as at least 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From the date of randomization to date of date of the first confirmed objective response (maximum up to 25 months)
Population: ITT analysis set included all randomized participants. Participants were included in the treatment group assigned at randomization regardless of any actual treatment received. Here, 'Number of Participants Analyzed' signifies participants evaluable for this outcome measure. Only participants who achieved a confirmed CR or PR based on investigator assessment were included in the analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tisotumab Vedotin | Time-to-Response (TTR) as Assessed by the Investigator | 1.58 Months |
| Chemotherapy | Time-to-Response (TTR) as Assessed by the Investigator | 1.74 Months |