Low Dose Cyclophosphamide +/-- Nintedanib in Advanced Ovarian Cancer (METRO-BIBF)

Phase II, Randomised, Placebo Controlled, Multicentre, Feasibility Study of Low Dose (Metronomic) Cyclophosphamide With and Without Nintedanib (BIBF 1120) in Advanced Ovarian Cancer

The primary objective is to explore the efficacy and safety of an all oral combination of BIBF 1120 (an inhibitor of angiogenic signalling) and metronomic cyclophosphamide in patients with multiply-relapsed advanced ovarian cancer, who have completed a minimum of two lines of previous chemotherapy and who for any reason are not suitable for further 'standard' intravenous chemotherapy treatments.

Study Overview

• Status: Completed
• Conditions: Ovarian Cancer; Fallopian Tube Cancer
• Intervention / Treatment: Drug: BIBF 1120

Detailed Description

A randomised placebo controlled double blind multi-centre phase II trial: BIBF 1120 200mg bd plus 100mg daily of oral cyclophosphamide (experimental arm) or oral cyclophosphamide 100mg daily plus placebo (control arm). Patients will receive oral BIBF 1120 and cyclophosphamide or cyclophosphamide and placebo continuously until disease progression or unacceptable toxicity.

• Study Type: Interventional
• Enrollment (Actual): 117
• Phase: Phase 2

Contacts and Locations

Study Locations

• United Kingdom
  • Bath, United Kingdom
    • Royal United Hospital
  • Cambridge, United Kingdom
    • Addenbrookes Hospital
  • Derby, United Kingdom
    • Royal Derby Hospital
  • Guildford, United Kingdom
    • Royal Surrey County Hospital
  • Leeds, United Kingdom
    • St James's University Hospital
  • Liverpool, United Kingdom
    • Clatterbridge Centre for Oncology
  • London, United Kingdom
    • St Bartholomew's Hospital
  • London, United Kingdom
    • Royal Marsden Hospital
  • London, United Kingdom
    • University College London Hospital (UCLH)
  • London, United Kingdom
    • Mount Vernon Hospital
  • Manchester, United Kingdom
    • Christie Hospital
  • Oxford, United Kingdom
    • Churchill Hospital
  • Slough, United Kingdom
    • Wexham Park Hospital
  • Kent
    • Maidstone, Kent, United Kingdom
      • Kent Oncology Centre
  • Scotland
    • Glasgow, Scotland, United Kingdom
      • Beatson West of Scotland Cancer Centre
  • Wales
    • Cardiff, Wales, United Kingdom
      • Velindre Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Female subjects, ≥18 years, histologically proven recurrent advanced epithelial ovarian, fallopian tube or primary peritoneal carcinomas
• Have either undergone a hysterectomy or bilateral oophorectomy/salpingectomy and/or have been postmenopausal for 24 consecutive months (i.e. who have not had menses at any time in the preceding 24 consecutive months without an alternative medical cause)
• Performance status 0-2
• Adequate organ function
• Life expectancy >6 weeks
• Has received 2 or more lines of chemotherapy for ovarian cancer and patient is platinum resistant or platinum intolerant or not suitable for any further standard intravenous chemotherapy
• No previous oral cyclophosphamide, nintedanib, or other tyrosine kinase inhibitors such as cediranib but patients can have received anti-VEGF therapies such as bevacizumab as they will be stratified for this
• Measurable lesions according to RECIST 1.1 criteria or serum CA125 levels for evaluation by GCIG CA125 criteria are welcomed but not a prerequisite for inclusion as response will only be assessed for those with evaluable disease
• Able to give written informed consent and to complete QoL

Exclusion Criteria

• Carcinosarcoma or malignant tumour of non-epithelial origin (e.g. germ cell tumour, sex cord-stromal tumour) of the ovary, fallopian tube or peritoneum
• Clinically relevant non-healing wound, ulcer (intestinal tract, skin) or bone fracture
• Symptoms or signs of gastrointestinal obstruction requiring parenteral nutrition or hydration or any other GI disorders or abnormalities that would interfere with drug absorption or inability to take oral medication
• Active brain metastases (i.e. symptoms deteriorating, changing condition in < 4 weeks) or leptomeningeal disease. Trial entry is allowed if the brain metastases are stable (asymptomatic or condition stable for > 4 weeks).
• Dexamethasone for brain metastases is allowed if administered as stable dose for > 4 weeks before randomisation (if < 4 weeks then the patient is not eligible)
• Clinically relevant therapy-related toxicity from previous chemotherapy and radiotherapy
• History of major thromboembolic event within the last 6 months, such as pulmonary embolism or proximal deep vein thrombosis, unless on stable therapeutic anticoagulation (>3 months if on warfarin, PT / INR needs to be monitored regularly as per table 8.1 in protocol)
• Known inherited or acquired bleeding disorder
• Significant cardiovascular diseases, including uncontrolled hypertension, clinically relevant cardiac arrhythmia, unstable angina or myocardial infarction within the past 6 months, congestive heart failure > NYHA II, severe peripheral vascular disease, significantly relevant pericardial effusion
• History of a cerebral vascular accident, transient ischemic attack or subarachnoid hemorrhage within the past 6 months
• Radiographic evidence of cavitating or necrotic tumours with invasion of adjacent major blood vessels

• Laboratory values indicating an increased risk for adverse events:

  1. calculated GFR < 45 ml/min. Sites can use any calculation method according to local practice.
  2. absolute neutrophil count (ANC) < 1.5x109/L
  3. platelets < 100 x109/L
  4. haemoglobin < 90 g/L
  5. proteinuria CTCAE 2 or greater
  6. total bilirubin > x 2 ULN
  7. ALT and/or AST > 1.5 x ULN
  8. unless liver metastases present when ALT or AST > 2.5 ULN
  9. International normalized ratio (INR) > 2 or activated partial thromboplastin time (APTT) >1.5 x ULN in the absence of therapeutic anticoagulation. INR > 4 or APTT > 2.5 x ULN in presence of therapeutic anticoagulation
• Serious infections in particular if requiring systemic antibiotic (antimicrobial, antifungal or antiviral therapy), including hepatitis B and/or C infection, HIV- infection
• Poorly controlled diabetes mellitus or patient on sulphonylurea-type hypoglycaemics (e.g. gliclazide) as main diabetic control (as contraindicated with cyclophosphamide)
• Previous breast cancer patients are permitted only if diagnosis and any chemotherapy treatment for this was > 5 years previously and there is no evidence of metastatic breast cancer at trial entry (Please contact UCL CTC / CI if patient still on hormone treatment for breast cancer).

• Other malignancy diagnosed within the past 5 years. In exception to this rule, the following malignancies may be included:

  1. non-melanoma skin cancer (if adequately treated)
  2. cervical carcinoma in situ (if adequately treated)
  3. prior or synchronous endometrial cancer (if adequately treated), provided all of the following criteria are met: G1 or G2, no LVSI and FIGO (2010) stage IA only
• Serious illness or concomitant non-oncological disease such as neurologic, psychiatric or infectious disease or a laboratory abnormality that may increase the risk associated with study participation or study drug administration and in the judgment of the investigator would make the patient inappropriate for entry into the study
• Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up schedule e.g. active alcohol or drug abuse
• Any contraindications for therapy with cyclophosphamide, e.g. a history of severe hypersensitivity reactions to listed excipients for cyclophosphamide treatment with other investigational drugs
• Patients should not commence trial treatment within 6 weeks of any major surgical procedure
• Participation in another clinical trial testing a drug within the past four weeks before start of therapy or concomitantly with this trial
• Chemotherapy, including immunotherapy or monoclonal antibody treatment (VEGF) within 4 weeks of starting study treatment
• Hormone treatment for ovarian cancer within 2 weeks of starting study treatment (ongoing HRT is allowable)
• Any previous tyrosine kinase inhibitor treatment that has predominantly anti-angiogenic action
• Radiotherapy within 3 months not allowed except when given for symptom control >28d previously. All patients receiving any radiotherapy will require evidence of recurrent ovarian cancer outside the irradiated field either on imaging or via rising CA125
• Hypersensitivity to nintedanib, peanut or soya, or to any of the excipients of nintedanib

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cyclophosphamide and BIBF-1120; Patients will receive oral BIBF 1120 (200mg bd) and cyclophosphamide (100mg) on a daily basis until disease progression or unacceptable toxicity.	Drug: BIBF 1120; Patients will receive either cyclophosphamide (100mg)and oral BIBF 1120 (200mg bd) or cyclophosphamide (100mg) and placebo.; Other Names: BIBF 1120 brand name: Nintedanib.
Placebo Comparator: Cyclophosphamide and placebo; Patients will receive oral BIBF 1120 (200mg bd) and placebo capsules on a daily basis until disease progression or unacceptable toxicity.	Drug: BIBF 1120; Patients will receive either cyclophosphamide (100mg)and oral BIBF 1120 (200mg bd) or cyclophosphamide (100mg) and placebo.; Other Names: BIBF 1120 brand name: Nintedanib.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall survival	To be measured in days, from the date of randomisation to the date of death.	After follow-up is complete (year 3-4 of the trial)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of life and qualitative health data	Health questionnaires which record qualitative health data on the patient perspective of their illness and treatment. This will be measured on a 6 weekly basis, from baseline to the end of treatment.	After follow-up is complete (year 3-4 of the trial)
Adverse events for all patients	Adverse events will be collected for patients in both groups during treatment and the groups compared during analysis. This will be measured on a 6 weekly basis, from baseline to the end of treatment. The first 12 patients will be assessed on a 3 weekly basis, from baseline to end of treatment.	After follow-up is complete (year 3-4 of the trial)
Progression free survival	Progression free survival will be determined by measurement of tumour size using RECIST 1.1 at progression or by a rise in CA-125 tumour marker. Measured from the date of randomisation until date of confirmed disease progression. Tumour assessment carried out on 3 monthly basis, CA-125 carried out on 6 weekly basis.	After follow-up is complete (year 3-4 of the trial)

Collaborators and Investigators

• Sponsor: University College, London
• Collaborators: Boehringer Ingelheim
• Investigators: Principal Investigator: Dr Marcia Hall, Mount Vernon Cancer Centre

Publications and helpful links

General Publications

• Hall MR, Dehbi HM, Banerjee S, Lord R, Clamp A, Ledermann JA, Nicum S, Lilleywhite R, Bowen R, Michael A, Feeney A, Glasspool R, Hackshaw A, Rustin G. A phase II randomised, placebo-controlled trial of low dose (metronomic) cyclophosphamide and nintedanib (BIBF1120) in advanced ovarian, fallopian tube or primary peritoneal cancer. Gynecol Oncol. 2020 Dec;159(3):692-698. doi: 10.1016/j.ygyno.2020.09.048. Epub 2020 Oct 16.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2014
• Primary Completion (Actual): January 11, 2018
• Study Completion (Actual): January 11, 2018

Study Registration Dates

• First Submitted: November 25, 2011
• First Submitted That Met QC Criteria: May 31, 2012
• First Posted (Estimate): June 4, 2012

Study Record Updates

• Last Update Posted (Actual): May 29, 2019
• Last Update Submitted That Met QC Criteria: May 24, 2019
• Last Verified: October 1, 2018

More Information

Terms related to this study

• Keywords: Carcinoma; Neoplasms; Ovarian Neoplasms; Recurrence; Neoplasms by site; Ovarian Diseases; Fallopian Tube Neoplasms
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Genital Neoplasms, Female; Endocrine System Diseases; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Endocrine Gland Neoplasms; Fallopian Tube Diseases; Ovarian Neoplasms; Fallopian Tube Neoplasms; Carcinoma, Ovarian Epithelial; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Nintedanib
• Other Study ID Numbers: UCL/10/0470; 2011-005814-12 (Other Grant/Funding Number: Boehringer Ingelheim Ltd)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No