A Study Comparing the Combination of Trabectedin (YONDELIS) and DOXIL/CAELYX With DOXIL/CAELYX for the Treatment of Advanced-Relapsed Epithelial Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

A Randomized, Open-Label Study Comparing the Combination of YONDELIS and DOXIL/CAELYX With DOXIL/CAELYX Monotherapy for the Treatment of Advanced-Relapsed Epithelial Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

The purpose of this study is to assess the efficacy and safety of trabectedin+DOXIL as a third-line chemotherapy regimen (treatment) in patients with platinum-sensitive advanced-relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer who received 2 previous lines of platinum-based chemotherapy.

Study Overview

• Status: Completed
• Conditions: Ovarian Neoplasms; Fallopian Tube Neoplasms; Peritoneal Neoplasms
• Intervention / Treatment: Drug: Trabectedin; Drug: DOXIL; Drug: Dexamethasone; Drug: DOXIL

Detailed Description

This is a randomized (individuals assigned to study treatment by chance), open - label (identity of assigned study drug will be known), active - controlled study in adult female patients with platinum-sensitive advanced - relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer who received 2 previous lines of platinum - based chemotherapy. Approximately 670 participants will be enrolled. Patients will be stratified by 4 criteria defined in the protocol and randomly assigned in a 1:1 ratio to the trabectedin+DOXIL combination therapy group (Arm A) or to the DOXIL (pegylated liposomal doxorubicin) monotherapy group (Arm B). During the treatment phase, patients will receive study drug infusions according to 21 - day cycles in Arm A and 28 - day cycles in Arm B. Treatment will continue until the occurrence of disease progression or unacceptable treatment toxicity, or until 2 cycles after assessment of a complete response (CR). Efficacy assessments will be evaluated using Response Evaluation Criteria in Solid Tumors. Disease assessments, including assessments for patients who discontinue treatment for reasons other than disease progression, will be performed until disease progression, the start of subsequent anticancer therapy, withdrawal of consent, or the clinical cutoff date. Collection of survival status will continue until at least 514 deaths have been observed or until the clinical data cutoff date. Serial pharmacokinetic (PK) samples will be collected in a subset of patients who voluntarily consent to the PK portion of the study. Safety will be monitored throughout the study. An interim analysis of overall survival (OS) will be performed after approximately 308 participants have died. The final analysis of OS will occur when approximately 514 deaths have been observed or until the clinical cutoff date. As of Amendment 6, no new participants will be randomized to study treatment, and treatment with trabectedin should be immediately discontinued for participants assigned to Arm A (trabectedin+DOXIL). All study participants (Arm A or Arm B) currently on study who, in the opinion of the investigator, are deriving clinical benefit may continue treatment with single-agent DOXIL as per the local standard of care.

• Study Type: Interventional
• Enrollment (Actual): 581
• Phase: Phase 3

Contacts and Locations

Study Locations

• Australia
  • Adelaide, Australia
  • Ballarat, Australia
  • Brisbane, Australia
  • Gosford, Australia
  • Parkville, Australia
  • Subiaco, Australia
  • Toorak Gardens, Australia
  • Townsville, Australia
  • Wodonga, Australia
  • Woodville, Australia
• China
  • Guangzhou, China
  • Jinan, China
  • Shanghai, China
  • Shenyang, China
• Israel
  • Beer Sheva, Israel
  • Haifa, Israel
  • Holon, Israel
  • Jerusalem, Israel
  • Kfar Saba, Israel
  • Petah Tikva, Israel
  • Ramat-Gan, Israel
  • Rehovot, Israel
  • Tel Aviv, Israel
  • Zerifin, Israel
• New Zealand
  • Auckland, New Zealand
  • Wellington, New Zealand
• Poland
  • Bydgoszcz, Poland
  • Gdańsk, Poland
  • Lublin, Poland
  • Poznan, Poland
  • Warszawa, Poland
• Russian Federation
  • Arkhangelsk, Russian Federation
  • Chelyabinsk, Russian Federation
  • Ivanovo, Russian Federation
  • Kirov, Russian Federation
  • Krasnodar, Russian Federation
  • Moscow, Russian Federation
  • Moscow N/a, Russian Federation
  • Nalchik, Russian Federation
  • Nizhniy Novgorod, Russian Federation
  • Nizhny Novgorod, Russian Federation
  • Omsk, Russian Federation
  • Orenburg, Russian Federation
  • Pyatigorsk, Russian Federation
  • Ryazan, Russian Federation
  • Saint Petersburg, Russian Federation
  • Saint-Petersburg,, Russian Federation
  • Sochi, Russian Federation
  • St Petersburg, Russian Federation
  • Ufa, Russian Federation
  • Yaroslavl, Russian Federation
• South Africa
  • Amanzimtoti, South Africa
  • Cape Town, South Africa
  • Durban, South Africa
  • Johannesburg, South Africa
  • Port Elizabeth, South Africa
  • Pretoria, South Africa
• Switzerland
  • Bern, Switzerland
  • Zurich, Switzerland
• United Kingdom
  • Bebington, United Kingdom
  • Glasgow, United Kingdom
  • Guilford, United Kingdom
  • London, United Kingdom
  • Maidstone, United Kingdom
  • Manchester, United Kingdom
  • Plymouth, United Kingdom
  • Swansea, United Kingdom
• United States
  • Alabama
    • Birmingham, Alabama, United States
  • Arizona
    • Phoenix, Arizona, United States
    • Scottsdale, Arizona, United States
    • Sedona, Arizona, United States
    • Tucson, Arizona, United States
  • Arkansas
    • Hot Springs, Arkansas, United States
  • California
    • Greenbrae, California, United States
    • La Jolla, California, United States
    • Los Angeles, California, United States
    • Orange, California, United States
    • Sacramento, California, United States
  • Colorado
    • Englewood, Colorado, United States
  • Connecticut
    • New Britain, Connecticut, United States
    • New Haven, Connecticut, United States
    • Stamford, Connecticut, United States
  • Florida
    • Fort Myers, Florida, United States
    • Jacksonville, Florida, United States
    • Miami, Florida, United States
    • Saint Petersburg, Florida, United States
    • Sarasota, Florida, United States
    • Tampa, Florida, United States
  • Georgia
    • Atlanta, Georgia, United States
    • Savannah, Georgia, United States
  • Illinois
    • Chicago, Illinois, United States
    • Park Ridge, Illinois, United States
  • Indiana
    • Indianapolis, Indiana, United States
  • Kentucky
    • Louisville, Kentucky, United States
  • Louisiana
    • Covington, Louisiana, United States
    • New Orleans, Louisiana, United States
  • Maine
    • Scarborough, Maine, United States
  • Massachusetts
    • Worcester, Massachusetts, United States
  • Michigan
    • Detroit, Michigan, United States
    • Lansing, Michigan, United States
  • Minnesota
    • Duluth, Minnesota, United States
    • Edina, Minnesota, United States
  • Missouri
    • Columbia, Missouri, United States
    • Kansas City, Missouri, United States
  • New Jersey
    • Hackensack, New Jersey, United States
    • Morristown, New Jersey, United States
    • New Brunswick, New Jersey, United States
    • Summit, New Jersey, United States
  • New York
    • Brightwaters, New York, United States
    • Hawthorne, New York, United States
    • New York, New York, United States
  • North Carolina
    • Pinehurst, North Carolina, United States
  • Ohio
    • Akron, Ohio, United States
    • Cincinnati, Ohio, United States
    • Cleveland, Ohio, United States
    • Columbus, Ohio, United States
  • Oklahoma
    • Tulsa, Oklahoma, United States
  • Oregon
    • Portland, Oregon, United States
  • Pennsylvania
    • Abington, Pennsylvania, United States
    • Pittsburgh, Pennsylvania, United States
  • Rhode Island
    • Providence, Rhode Island, United States
  • South Carolina
    • Charleston, South Carolina, United States
    • Greenville, South Carolina, United States
  • Tennessee
    • Nashville, Tennessee, United States
  • Texas
    • Austin, Texas, United States
    • Bedford, Texas, United States
    • Dallas, Texas, United States
    • Fort Worth, Texas, United States
    • Houston, Texas, United States
    • San Antonio, Texas, United States
    • The Woodlands, Texas, United States
    • Webster, Texas, United States
  • Utah
    • Salt Lake City, Utah, United States
  • Virginia
    • Annandale, Virginia, United States
    • Newport News, Virginia, United States
    • Roanoke, Virginia, United States
  • Washington
    • Spokane, Washington, United States
    • Vancouver, Washington, United States
  • Wisconsin
    • Green Bay, Wisconsin, United States
    • Madison, Wisconsin, United States
    • Milwaukee, Wisconsin, United States
    • Wauwatosa, Wisconsin, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Histologically proven advanced-relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer
• Eastern Cooperative Oncology Group (ECOG) performance status grade of 0 or 1
• Received first-line treatment with a platinum-based regimen and had no evidence of disease progression for >= 6 months after the last dose
• Received second-line treatment with a platinum-based regimen, with progression of disease after attaining a response
• Progression of disease based on imaging after the second-line platinum-based regimen (individuals treated with a pegylated liposomal doxorubicin-containing regimen as a second-line therapy are eligible if subsequent disease progression occurs >=9 months from the first dose)
• Evidence of measurable disease at screening as evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) (Version 1.1)
• Participants no longer need to be able to receive intravenous (IV) dexamethasone or an equivalent IV corticosteroid
• Have a known BRCA 1/2 mutation status (for participants who do not have a known BRCA 1/2 status at screening, a blood sample will be collected to determine the status with the results available prior to randomization
• Laboratory values within protocol -defined parameters
• Have left ventricular ejection fraction by multigated acquisition scan (MUGA) scan or 2D-ECHO within normal limits for the institution
• Have side effects (except alopecia) of prior treatment resolved to at least Grade 1 according to the National Cancer Institute - Common Terminology Criteria of Adverse Events (NCICTCAE) (Version 4.0)
• Have a negative urine or serum pregnancy test at screening
• Agrees to protocol-defined use of effective contraception

Exclusion Criteria:

• Diagnosis of ovarian carcinoma with mucinous histology
• Had more than 2 prior lines of systemic therapy. Maintenance therapies and hormonal therapies are not considered additional lines of therapy
• Participants who had a prior exposure to trabectedin or hypersensitivity to any of the excipients will not be excluded from receiving single-agent Doxil
• Prior treatment with doxorubicin or other anthracycline at cumulative doses greater than 300 mg/m2 (calculated using doxorubicin equivalent doses: 1 mg doxorubicin = 1 mg Doxil/Caelyx = 1.8 mg epirubicin = 0.3 mg mitoxantrone = 0.25 mg idarubicin)
• Participants unwilling or unable to have a central venous catheter placed will not be excluded from receiving single-agent Doxil
• Pregnant or breast-feeding
• Would receive study treatment within 3 weeks from radiation therapy, experimental therapy, hormonal therapy, prior chemotherapy, or biological therapy; use an invasive investigational device; or is currently enrolled in an investigational study
• History of another invasive malignancy (except non-metastatic basal cell carcinoma or squamous cell carcinoma of the skin or cervical carcinoma in situ adequately treated) unless in remission for >=5 years, or a non - invasive malignancy requiring ongoing therapy
• Known allergies, hypersensitivity, or intolerance to Doxil, dexamethasone, or their excipients
• Known history of central nervous system metastasis
• Known significant chronic liver disease, such as cirrhosis or active hepatitis (potential participants who test positive for hepatitis B surface antigen or hepatitis C antibodies are allowed provided they do not have active disease requiring antiviral therapy)
• Had a myocardial infarct within 6 months before enrollment, New York Heart Association (NYHA) Class II or greater heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, clinically significant pericardial disease, or electrocardiographic evidence of acute ischemic or active conduction system abnormalities
• Has any of the following medical conditions: uncontrolled diabetes, psychiatric disorder (including dementia) that prevents compliance with protocol, uncontrolled seizures, newly diagnosed deep vein thrombosis, active systemic infection that is likely to interfere with study procedure or results
• Has any condition that, in the opinion of the investigator, would compromise the well-being of the participant or the study or prevent the participant from meeting or performing study requirements

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A: trabectedin + DOXIL; Participants will receive DOXIL 30 millgram per meter square (mg/m^2) administered as an intravenous (IV) infusion over approximately 90 minutes followed by trabectedin 1.1 mg/m^2 administered as an IV infusion over approximately 3hours, every 3 weeks. Participants will be pretreated with 20 mg dexamethasone IV (or the IV equivalent) approximately 30 minutes before DOXIL study drug. As of Amendment 6, treatment with trabectedin will be discontinued for participants on treatment with trabectedin and no new participants will receive trabectedin. Participants who, in the opinion of the investigator, are deriving clinical benefit may continue treatment with single-agent DOXIL as per the local standard of care.	Drug: Trabectedin; 1.1 mg/m^2 administered intravenously over approximately 3 hours on Day 1 of each 21-day treatment cycle.; Drug: DOXIL; 30 mg/m^2 administered intravenously over approximately 90 minutes on Day 1 of each 21-day treatment cycle.; Drug: Dexamethasone; 20 mg administered intravenously on Day 1 of each 21-day treatment cycle approximately 30 minutes prior to study drug infusion.; Drug: DOXIL; 50 mg/m^2 administered intravenously over approximately 90 minutes on Day 1 of each 28-day treatment cycle.
Active Comparator: Arm B: DOXIL; Participants will receive DOXIL, 50 mg/m^2 administered as an IV infusion over approximately 90 minutes every 4 weeks.	Drug: DOXIL; 30 mg/m^2 administered intravenously over approximately 90 minutes on Day 1 of each 21-day treatment cycle.; Drug: DOXIL; 50 mg/m^2 administered intravenously over approximately 90 minutes on Day 1 of each 28-day treatment cycle.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival (OS)	OS is defined as the time between the date of randomization and the date of death. Participants who died, regardless of the cause of death, were considered to have had an event.	Up to 4.3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival (PFS)	PFS is defined as the time between the date of randomization and the date of disease progression or death. PFS was assessed using the response evaluation criteria in solid tumors (RECIST) Version 1.1. As per criteria progressive disease in case of target lesions means at least a 20 percent (%) increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeter (mm). Progressive disease in case of non-target lesions means unequivocal progression of existing non-target lesions. In both cases the appearance of one or more new lesions is also considered progression.	Up to 4.3 years
Objective Response Rate (ORR)	ORR is defined as the percentage of participants with measurable disease achieving a best overall response of either complete response (CR) or partial response (PR) based on RECIST. CR: disappearance of all target and non-target lesions and normalization of tumor marker levels in non-target lesions. PR: at least a 30 percent (%) decrease in the sum of longest diameter (LD) of target lesions or persistence of one or more non-target lesion(s) or/and maintenance of tumor marker level above the normal limits.	Up to 4.3 years

Collaborators and Investigators

• Sponsor: Janssen Research & Development, LLC
• Collaborators: PharmaMar

Publications and helpful links

General Publications

• Jones RL, Herzog TJ, Patel SR, von Mehren M, Schuetze SM, Van Tine BA, Coleman RL, Knoblauch R, Triantos S, Hu P, Shalaby W, McGowan T, Monk BJ, Demetri GD. Cardiac safety of trabectedin monotherapy or in combination with pegylated liposomal doxorubicin in patients with sarcomas and ovarian cancer. Cancer Med. 2021 Jun;10(11):3565-3574. doi: 10.1002/cam4.3903. Epub 2021 May 7.
• Monk BJ, Herzog TJ, Wang G, Triantos S, Maul S, Knoblauch R, McGowan T, Shalaby WSW, Coleman RL. A phase 3 randomized, open-label, multicenter trial for safety and efficacy of combined trabectedin and pegylated liposomal doxorubicin therapy for recurrent ovarian cancer. Gynecol Oncol. 2020 Mar;156(3):535-544. doi: 10.1016/j.ygyno.2019.12.043. Epub 2020 Jan 8.

Study record dates

Study Major Dates

• Study Start (Actual): October 16, 2013
• Primary Completion (Actual): January 18, 2018
• Study Completion (Actual): November 16, 2018

Study Registration Dates

• First Submitted: May 1, 2013
• First Submitted That Met QC Criteria: May 1, 2013
• First Posted (Estimate): May 3, 2013

Study Record Updates

• Last Update Posted (Actual): April 1, 2019
• Last Update Submitted That Met QC Criteria: March 29, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: Platinum sensitive; Trabectedin; Doxil; Yondelis; Caelyx; BRCA; Patient related outcome; Ovarian neoplasms; Peritoneal neoplasms; Fallopian tube neoplasms; Advanced-relapsed epithelial ovarian cancer; Advanced-relapsed primary peritoneal cancer; Advanced-relapsed fallopian tube cancer; Tthird-line
• Additional Relevant MeSH Terms: Digestive System Diseases; Urogenital Neoplasms; Neoplasms by Site; Peritoneal Diseases; Genital Neoplasms, Female; Endocrine System Diseases; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Digestive System Neoplasms; Endocrine Gland Neoplasms; Fallopian Tube Diseases; Abdominal Neoplasms; Neoplasms; Ovarian Neoplasms; Fallopian Tube Neoplasms; Peritoneal Neoplasms; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Anti-Inflammatory Agents; Antineoplastic Agents; Antiemetics; Gastrointestinal Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Antineoplastic Agents, Alkylating; Alkylating Agents; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Antibiotics, Antineoplastic; Dexamethasone; Doxorubicin; Liposomal doxorubicin; Trabectedin
• Other Study ID Numbers: CR100983; ET743OVC3006 (Other Identifier: Janssen Research & Development, LLC); 2012-004808-34 (EudraCT Number)