BI 6727 (Volasertib) Randomised Trial in Ovarian Cancer

NCT01121406CompletedPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Boehringer Ingelheim

Enrollment

110

Start Date

2010-04-01

Completion Date

2014-06-01

Study Type

INTERVENTIONAL

Official Title

Phase II Randomized Trial of the Polo-like Kinase 1 Inhibitor BI 6727 Monotherapy Versus Investigator´s Choice Chemotherapy in Ovarian Cancer Patients Resistant or Refractory to Platinum-based Cytotoxic Therapy

Interventions

PaclitaxelGemcitabineTopotecanPegylated liposomal doxorubicin (PLD)BI 6727

Conditions

Ovarian Neoplasms

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion criteria:

1. Confirmed recurrent epithelial ovarian carcinoma, peritoneal carcinoma or fallopian tube carcinoma.
2. Platinum resistant or platinum refractory disease.
3. Eastern Collaborative Oncology Group performance status \< = 2.
4. Life expectancy \> = 3 months.
5. At least one measurable lesion (Response Evaluation Criteria In Solid Tumours version 1.1).
6. Adequate hepatic, renal and bone marrow functions.
7. signed written informed consent prior to admission to the study.

Exclusion criteria:

1. Contre-indications for cytotoxic treatment according to the Summary of Product Characteristics (Arm B).
2. Clinical evidence of active brain metastasis or leptomeningeal involvement.
3. Other malignancy currently requiring active therapy.
4. QTc prolongation according to Fridericia formula deemed clinically relevant by the investigator (e.g., congenital long QT syndrome, QTc according to Fridericia formula \> 470 ms).
5. Hypersensitivity to one of the trial drugs or the excipients.
6. Serious illness or concomitant non- oncological disease.
7. Systemic anticancer therapy within 4 weeks before the start of the study.
8. Evidence of ileus sor sub ileus.

Outcome Measures

Primary Outcomes

Disease Control Rate (DCR) at Week 24 According to Response Evaluation Criteria In Solid Tumours (RECIST) Version 1.1

DCR was defined as the proportion of patients who had an overall response of complete response (CR), partial response (PR), or stable disease (SD).

Time frame: Week 24

Secondary Outcomes

Progression Free Survival (PFS)

Progression-free survival of a patient was based on the investigator's assessment; it was defined as the number of days from the date of randomisation until the date of either disease progression or death from any cause, whichever occurred first. Definition of disease progression according to RECIST version 1.1; Patients with measurable tumour lesions at baseline, Target-lesions: at least a 20% increase in the sum of diameters of target lesions, the sum of diameters must also demonstrate an absolute increase of at least 5 mm,taking as reference the smallest sum on study, or appearance of 1 or more new lesions. Non-target lesions: unequivocal progression of existing non-target lesions or appearance of 1 or more new lesions Patients with non-measurable tumour lesions at baseline, Non-target lesions: requires unequivocal progression of existing non-target lesions or appearance of 1 or more new lesions

Time frame: From randomization until disease progression, death or study discontinuation; Up to 213 weeks

Overall Survival (OS)

OS is defined as time from randomisation to death irrespective of the cause of the death.

Time frame: From randomization until death or study discontinuation; Up to 213 weeks

Best Overall Response

Best overall response (BOR) is defined as the best response recorded at any time from the date of randomisation until the end of treatment. Missing categories signify that no tumour imaging has been performed post baseline, and therefore the response status could not be assessed.

Time frame: time from the date of randomisation until study completion/discontinuation; Up to 213 weeks

Biological Tumour Response Based on Serum Cancer Antigen 125 (CA-125) According to the Gynaecologic Cancer Intergroup (GCIG) Criteria

Patients were to have a pre-treatment CA-125 of at least twice the upper limit of normal to be considered for CA-125 response. Patients were not evaluable by CA-125 if they had received mouse antibodies or if they had undergone medical and/or surgical interference with their peritoneum or pleura during the previous 28 days. In eligible patients, a CA-125 response was defined as the moment the CA- 25 was reduced by 50%, with this being confirmed with a consecutive CA-125 assessment not earlier than 28 days after the previous one. Biological response rate based on serum CA-125 levels was assessed according to the guidelines by the Gynaecologic Cancer Intergroup. Monitoring of blood levels of the tumour marker CA-125 was performed at screening and every 6 weeks thereafter.

Time frame: At screening and every 6 weeks thereafter (Up to 213 weeks)

Biological Progression-free Survival Based on Serum Cancer Antigen 125 (CA-125) According to the Gynaecologic Cancer Intergroup (GCIG) Criteria

Biological PFS including assessment of CA-125 levels was defined as the time from randomisation until the first occurrence of progressive disease according to CA-125, progressive disease according to radiological evidence, or death. Also according to the below criterias, * In patients with radiological measurable disease, disease progression during study treatment could not be declared on the basis of CA-125 alone. * Patients with elevated CA-125 pre-treatment and normalization of CA-125 had to show evidence of CA-125 ≥ to two times the upper normal limit on two occasions at least one week apart or * Patients with elevated CA-125 pre-treatment, which never normalized, had to show evidence of CA-125 ≥ to two times the nadir value on two occasions at least one week apart or * Patients with CA-125 in the normal range pre-treatment had to show evidence of CA-125 ≥ to two times the upper normal limit on two occasions at least one week apart.

Time frame: At screening and every 6 weeks thereafter (Up to 213 weeks )

Time to Deterioration in Global Health Status/Quality of Life (QOL)

Time to deterioration in global health status/Quality of life (QOL) and symptom control assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-OV28, and individual symptom questionnaires. The time to deterioration was defined as the time from randomisation to a score increased (i.e. worsened) by at least 10 points from baseline (0-100 point scale). If score is missing, and patient died within 28 days after scheduled time for completion, the patient was considered deteriorated. In this case, time to deterioration is time to death.

Time frame: Every 6 weeks (Up to 213 weeks )

Time to Deterioration in Fatigue/Quality of Life (QOL)

Time to deterioration in fatigue/Quality of life (QOL) and symptom control assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-OV28, and individual symptom questionnaires. The time to deterioration was defined as the time from randomisation to a score increased (i.e. worsened) by at least 10 points from baseline (0-100 point scale). If score is missing, and patient died within 28 days after scheduled time for completion, the patient was considered deteriorated. In this case, time to deterioration is time to death.

Time frame: Every 6 weeks (Up to 213 weeks )

Time to Deterioration in Pain/ Quality of Life (QOL)

Time to deterioration in pain/ Quality of life (QOL) and symptom control assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-OV28, and individual symptom questionnaires. The time to deterioration was defined as the time from randomisation to a score increased (i.e. worsened) by at least 10 points from baseline (0-100 point scale). If score is missing, and patient died within 28 days after scheduled time for completion, the patient was considered deteriorated. In this case, time to deterioration is time to death.

Time frame: Every 6 weeks (Up to 213 weeks )

Time to Deterioration in Abdominal Bloating/ Quality of Life (QOL)

Time to deterioration in abdominal bloating/ Quality of life (QOL) and symptom control assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-OV28, and individual symptom questionnaires. The time to deterioration was defined as the time from randomisation to a score increased (i.e. worsened) by at least 10 points from baseline (0-100 point scale). If score is missing, and patient died within 28 days after scheduled time for completion, the patient was considered deteriorated. In this case, time to deterioration is time to death.

Time frame: Every 6 weeks (Up to 213 weeks )

Time to Deterioration in the Three Most Troublesome Disease Specific Symptoms/ Quality of Life (QOL)

Three most troublesome disease specific symptoms, defined by the patient at baseline. Patients that have defined more than 3 most troublesome symptoms have not been taken into account in the analysis. Quality of life (QOL) and symptom control assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-OV28, and individual symptom questionnaires. The time to deterioration was defined as the time from randomisation to a score increased (i.e. worsened) by at least 10 points from baseline (0-100 point scale). If score is missing, and patient died within 28 days after scheduled time for completion, the patient was considered deteriorated. In this case, time to deterioration is time to death.

Time frame: Every 6 weeks (Up to 213 weeks)

Incidence and Intensity of Adverse Events According to the United States National Cancer Institute (US NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0

Incidence and intensity of adverse events according to the United States National Cancer Institute (US NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0

Time frame: From first treatment administration to 21 days after the last drug administration (Up to 1403 days)

Clinically Relevant Changes in Laboratory and ECG Data

Clinically relevant changes in laboratory and ECG data

Time frame: From first treatment administration to 21 days after the last drug administration (Up to 1403 days)

AUC (0-24); Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 to 24 Hours for BI 6727 BS

AUC (0-24); area under the concentration-time curve in plasma over the time interval from 0 to 24 hours for BI 6727 BS

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

AUC (0-24); Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 to 24 Hours for CD 10899 BS

AUC (0-24); area under the concentration-time curve in plasma over the time interval from 0 to 24 hours for CD 10899 BS (metabolite of Volasertib BI 6727)

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

AUC (0-inf); Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 Extrapolated to Infinity for BI 6727 BS

AUC (0-inf); area under the concentration-time curve in plasma over the time interval from 0 extrapolated to infinity for BI 6727 BS

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

AUC (0-inf); Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 Extrapolated to Infinity for CD 10899 BS

AUC (0-inf); area under the concentration-time curve in plasma over the time interval from 0 extrapolated to infinity for CD 10899 BS (metabolite of Volasertib BI 6727)

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Cmax; Maximum Measured Concentration of BI 6727 BS in Plasma

Cmax; maximum measured concentration of BI 6727 BS in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Cmax; Maximum Measured Concentration of CD 10899 BS in Plasma

Cmax; maximum measured concentration of CD 10899 BS (metabolite of Volasertib BI 6727) in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Tmax; Time From Dosing to Maximum Measured Concentration of BI 6727 BS in Plasma

tmax; time from dosing to maximum measured concentration of BI 6727 BS in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Tmax; Time From Dosing to Maximum Measured Concentration of CD 10899 BS in Plasma

tmax; time from dosing to maximum measured concentration of CD 10899 BS (metabolite of Volasertib BI 6727) in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

t1/2; Terminal Half-life of BI 6727 BS in Plasma

t1/2; Terminal half-life of BI 6727 BS in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

t1/2; Terminal Half-life of CD 10899 BS in Plasma

t1/2; Terminal half-life of CD 10899 BS in plasma

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

MRT; Mean Residence Time of BI 6727 BS in the Body

MRT; Mean residence time of BI 6727 BS in the body

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

CL; Total Clearance of BI 6727 BS in Plasma After Intravenous Administration

CL; total clearance of BI 6727 BS in plasma after intravenous administration

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Vss;Apparent Volume of Distribution at Steady State Following Intravenous Administration for BI 6727 BS

Vss;apparent volume of distribution at steady state following intravenous administration for BI 6727 BS

Time frame: -0.083 hours (h), 2h, 4h, 6h, 24h, 168h and 336 h after first drug administration

Biomarkers and Pharmacogenetics Analysis (Optional)

This endpoint has not been statistically analysed in the study report

Time frame: 6 months

Locations

1230.18.32003 Boehringer Ingelheim Investigational Site, Brussels, Belgium

1230.18.32004 Boehringer Ingelheim Investigational Site, Edegem, Belgium

1230.18.32002 Boehringer Ingelheim Investigational Site, Ghent, Belgium

1230.18.32001 Boehringer Ingelheim Investigational Site, Leuven, Belgium

1230.18.3321A Boehringer Ingelheim Investigational Site, Angers, France

1230.18.3307A Boehringer Ingelheim Investigational Site, Bordeaux, France

1230.18.3301A Boehringer Ingelheim Investigational Site, Caen, France

1230.18.3322A Boehringer Ingelheim Investigational Site, Lille, France

1230.18.3313A Boehringer Ingelheim Investigational Site, Lyon, France

1230.18.3312A Boehringer Ingelheim Investigational Site, Nantes, France

1230.18.3308A Boehringer Ingelheim Investigational Site, Nice, France

1230.18.3302A Boehringer Ingelheim Investigational Site, Paris, France

1230.18.3314A Boehringer Ingelheim Investigational Site, Paris, France

1230.18.3309A Boehringer Ingelheim Investigational Site, Pierre-Bénite, France

1230.18.3305A Boehringer Ingelheim Investigational Site, Reims, France

1230.18.3320A Boehringer Ingelheim Investigational Site, Saint-Brieuc, France

1230.18.3311A Boehringer Ingelheim Investigational Site, Strasbourg, France

1230.18.3310A Boehringer Ingelheim Investigational Site, Toulouse, France

1230.18.3315A Boehringer Ingelheim Investigational Site, Vandœuvre-lès-Nancy, France

1230.18.42101 Boehringer Ingelheim Investigational Site, Bratislava, Slovakia

1230.18.42103 Boehringer Ingelheim Investigational Site, Poprad, Slovakia

1230.18.34006 Boehringer Ingelheim Investigational Site, Badalona, Spain

1230.18.34001 Boehringer Ingelheim Investigational Site, Barcelona, Spain

1230.18.34005 Boehringer Ingelheim Investigational Site, Barcelona, Spain

1230.18.34007 Boehringer Ingelheim Investigational Site, Girona, Spain

1230.18.34004 Boehringer Ingelheim Investigational Site, L'Hospitalet de Llobregat, Spain

1230.18.34002 Boehringer Ingelheim Investigational Site, Madrid, Spain

1230.18.34003 Boehringer Ingelheim Investigational Site, Madrid, Spain

1230.18.46005 Boehringer Ingelheim Investigational Site, Linköping, Sweden

1230.18.46001 Boehringer Ingelheim Investigational Site, Stockholm, Sweden

1230.18.46003 Boehringer Ingelheim Investigational Site, Uppsala, Sweden

Linked Papers

2023-07-05

Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer

Cancer of ovarian, fallopian tube and peritoneal origin, referred to collectively as ovarian cancer, is the eighth most common cancer in women and is often diagnosed at an advanced stage. Women with relapsed epithelial ovarian cancer (EOC) are less well and have a limited life expectancy, therefore maintaining quality of life with effective symptom control is an important aim of treatment. However, the unwanted effects of chemotherapy agents may be severe, and optimal treatment regimens are unclear. Pegylated liposomal doxorubicin (PLD), which contains a cytotoxic drug called doxorubicin hydrochloride, is one of several treatment modalities that may be considered for treatment of relapsed EOCs. This is an update of the original Cochrane Review which was published in Issue 7, 2013. To evaluate the efficacy and safety of PLD, with or without other anti-cancer drugs, in women with relapsed high grade epithelial ovarian cancer (EOC). We searched CENTRAL, MEDLINE (via Ovid) and Embase (via Ovid) from 1990 to January 2022. We also searched online registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. We included randomised controlled trials (RCTs) that evaluated PLD in women diagnosed with relapsed epithelial ovarian cancer. Two review authors independently extracted data to a pre-designed data collection form and assessed the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Where possible, we pooled collected data in meta-analyses. This is an update of a previous review with 12 additional studies, so this updated review includes a total of 26 RCTs with 8277 participants that evaluated the effects of PLD alone or in combination with other drugs in recurrent EOC: seven in platinum-sensitive disease (2872 participants); 11 in platinum-resistant disease (3246 participants); and eight that recruited individuals regardless of platinum sensitivity status (2079 participants). The certainty of the evidence was assessed for the three most clinically relevant comparisons out of eight comparisons identified in the included RCTs. Recurrent platinum-sensitive EOC PLD with conventional chemotherapy agent compared to alternative combination chemotherapy likely results in little to no difference in overall survival (OS) (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.83 to 1.04; 5 studies, 2006 participants; moderate-certainty evidence) but likely increases progression-free survival (PFS) (HR 0.81, 95% CI 0.74 to 0.89; 5 studies, 2006 participants; moderate-certainty evidence). The combination may slightly improve quality of life at three months post-randomisation, measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (mean difference 4.80, 95% CI 0.92 to 8.68; 1 study, 608 participants; low-certainty evidence), but this may not represent a clinically meaningful difference. PLD in combination with another chemotherapy agent compared to alternative combination chemotherapy likely results in little to no difference in the rate of overall severe adverse events (grade ≥ 3) (risk ratio (RR) 1.11, 95% CI 0.95 to 1.30; 2 studies, 834 participants; moderate-certainty evidence). PLD with chemotherapy likely increases anaemia (grade ≥ 3) (RR 1.37, 95% CI 1.02 to 1.85; 5 studies, 1961 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of PLD with conventional chemotherapy on hand-foot syndrome (HFS)(grade ≥ 3) (RR 4.01, 95% CI 1.00 to 16.01; 2 studies, 1028 participants; very low-certainty evidence) and neurological events (grade ≥ 3) (RR 0.38, 95% CI 0.20 to 0.74; 4 studies, 1900 participants; very low-certainty evidence). Recurrent platinum-resistant EOC PLD alone compared to another conventional chemotherapy likely results in little to no difference in OS (HR 0.96, 95% CI 0.77 to 1.19; 6 studies, 1995 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of PLD on PFS (HR 0.94, 95% CI 0.85 to 1.04; 4 studies, 1803 participants; very low-certainty evidence), overall severe adverse events (grade ≥ 3) (RR ranged from 0.61 to 0.97; 2 studies, 964 participants; very low-certainty evidence), anaemia (grade ≥ 3) (RR ranged from 0.19 to 0.82; 5 studies, 1968 participants; very low-certainty evidence), HFS (grade ≥ 3) (RR ranged from 15.19 to 109.15; 6 studies, 2184 participants; very low-certainty evidence), and the rate of neurological events (grade ≥ 3)(RR ranged from 0.08 to 3.09; 3 studies, 1222 participants; very low-certainty evidence). PLD with conventional chemotherapy compared to PLD alone likely results in little to no difference in OS (HR 0.92, 95% CI 0.70 to 1.21; 1 study, 242 participants; moderate-certainty evidence) and it may result in little to no difference in PFS (HR 0.94, 95% CI 0.73 to 1.22; 2 studies, 353 participants; low-certainty evidence). The combination likely increases overall severe adverse events (grade ≥ 3) (RR 2.48, 95% CI 1.98 to 3.09; 1 study, 663 participants; moderate-certainty evidence) and anaemia (grade ≥ 3) (RR 2.38, 95% CI 1.46 to 3.87; 2 studies, 785 participants; moderate-certainty evidence), but likely results in a large reduction in HFS (grade ≥ 3) (RR 0.24, 95% CI 0.14 to 0.40; 2 studies, 785 participants; moderate-certainty evidence). It may result in little to no difference in neurological events (grade ≥ 3) (RR 1.40, 95% CI 0.85 to 2.31; 1 study, 663 participants; low-certainty evidence). In platinum-sensitive relapsed EOC, including PLD in a combination chemotherapy regimen probably makes little to no difference in OS compared to other combinations, but likely improves PFS. Choice of chemotherapy will therefore be guided by symptoms from previous chemotherapy and other patient considerations. Single-agent PLD remains a useful agent for platinum-resistant relapsed EOC and choice of agent at relapse will depend on patient factors, e.g. degree of bone marrow suppression or neurotoxicity from previous treatments. Adding another agent to PLD likely increases overall grade ≥ 3 adverse events with little to no improvement in survival outcomes. The limited evidence relating to PLD in combination with other agents in platinum-resistant relapsed EOC does not indicate a benefit, but there is some evidence of increased side effects.