Study of IMC-1121B (Ramucirumab) With Best Supportive Care in Participants With Gastric Cancer and Adenocarcinoma
A Phase 3, Randomized, Double-Blinded Study of IMC-1121B and Best Supportive Care (BSC) Versus Placebo and BSC in the Treatment of Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma Following Disease Progression on First-Line Platinum- or Fluoropyrimidine-Containing Combination Therapy
研究概览
详细说明
Placebo-controlled, multicenter Phase 3 study of participants with metastatic gastric cancer [including adenocarcinomas of the gastroesophageal junction (GEJ)] and disease progression on standard first-line chemotherapeutic regimens. Participants will be randomized on a 2:1 basis to receive best supportive care plus ramucirumab administered every 2 weeks or best supportive care plus placebo administered every 2 weeks, respectively. Participants will undergo radiographic assessment of disease status every 6 weeks. Participant will be treated until there is evidence of progressive disease, toxicity requiring cessation, withdrawal of consent, or until other withdrawal criteria are met.
Approximately 348 participants, with histologically- or cytologically-confirmed, metastatic gastric or GEJ adenocarcinoma, and radiographically measurable disease as defined by the Response Evaluation Criteria in Solid Tumors or evaluable, nonmeasurable disease, will be randomized. Participants will be enrolled from approximately 250 study centers in North America, South America, Central America, Asia, Australia, New Zealand, and Europe.
研究类型
注册 (实际的)
阶段
- 第三阶段
联系人和位置
学习地点
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Chelyabinsk、俄罗斯联邦、454087
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Kursk、俄罗斯联邦、305035
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Moscow、俄罗斯联邦、115478
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Moscow、俄罗斯联邦、125367
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Pyatigorsk、俄罗斯联邦、357524
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St. Petersburg、俄罗斯联邦、197022
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St. Petersburg、俄罗斯联邦、197758
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St. Petersburg、俄罗斯联邦、195067
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Osijek、克罗地亚、31 100
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Pula、克罗地亚、52100
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Slavonski Brod、克罗地亚、35 000
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Zagreb、克罗地亚、10 000
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Alberta
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Edmonton、Alberta、加拿大、T6G 1Z2
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Quebec
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Montreal、Quebec、加拿大、H2L 4M1
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Sherbrooke、Quebec、加拿大、J1G 2E8
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Cape Town、南非、7925
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Bangalore、印度、560 029
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Chennai、印度、600010
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Hyderabad、印度、500 033
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Hyderabad、印度、500004
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Kolkata、印度、700053
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Mumbai、印度、400 012
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Mumbai、印度、400016
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Pune、印度、411001
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West Bengal、印度、700054
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Andh Prad
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Hyderabad、Andh Prad、印度、500004
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Hyderabad、Andh Prad、印度、500033
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Delhi
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New Delhi、Delhi、印度、110085
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Karna
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Bangalore、Karna、印度、560 025
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Bangalore、Karna、印度、560054
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Kerala
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Cochin、Kerala、印度、682304
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Thiruvananthapuram、Kerala、印度、695011
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Trivandrum、Kerala、印度、695011
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Kilpauk
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Chennai、Kilpauk、印度、600 010
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Madh Prad
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Bhopal、Madh Prad、印度、462001
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Indore、Madh Prad、印度、452008
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Mahara
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Mumbai、Mahara、印度、400016
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Nashik、Mahara、印度、422 004
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Pune、Mahara、印度、411001
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Tamilnadu
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Chennai、Tamilnadu、印度、600010
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Chennai、Tamilnadu、印度、600035
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W Bengal
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Kolkata、W Bengal、印度、700053
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Kolkata、W Bengal、印度、700054
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Jakarta、印度尼西亚、10440
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Jakarta、印度尼西亚、11420
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Jakarta、印度尼西亚、14450
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Sumatera Utara、印度尼西亚、20136
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West Java、印度尼西亚、40161
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Guatemala、危地马拉、01010
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Guatemala、危地马拉
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Kaohsiung、台湾、807
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Taichung County、台湾、433
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Taipei、台湾、111
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Taipei、台湾、116
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Monteria、哥伦比亚
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Alexandria、埃及、21131
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Cairo、埃及、11796
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Aguascelientes、墨西哥、20217
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Seoul、大韩民国、120-752
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Seoul、大韩民国、135-720
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Seoul、大韩民国、136-705
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Seoul、大韩民国、137-701
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Barretos、巴西、14784-400
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Belo Horizonte、巴西、30150-281
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Belo Horizonte、巴西、30110-090
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Brasilia、巴西、70390-150
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Curitiba、巴西、80730-130
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Curitiba、巴西、81520-060
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Florianopolis、巴西、88034-000
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Ijui、巴西、98700-000
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Lajeados、巴西、95900-000
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Londrina、巴西、86050-190
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Passo Fundo、巴西、99010-260
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Porto Alegre、巴西、90035-903
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Porto Alegre、巴西、90610-970
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Porto Alegre、巴西、90840-440
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Sao Paulo、巴西、01406-100
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Aviano、意大利、33081
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Bologna、意大利、40138
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Brescia、意大利、25123
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Cremona、意大利、26100
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Lido di Camaiore、意大利、55043
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Lucca、意大利、55043
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Meldola、意大利、47014
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Mirano、意大利、30035
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Noale、意大利、30033
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Potenza、意大利、85100
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Rimini、意大利、47900
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Udine、意大利、33100
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Brno、捷克语、656 53
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Hradec Kralove、捷克语、500 05
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Liberec、捷克语、460 63
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Nova Ves pod Plesi、捷克语、262 04
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Olomouc、捷克语、775 20
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Pardubice、捷克语、532 03
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Prague、捷克语、180 81
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Praha 10、捷克语、100 34
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Praha 2、捷克语、128 08
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Pribram、捷克语、261 95
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Christchurch、新西兰、8011
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Concepcion、智利、407-0038
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La Serena、智利
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Santiago、智利、6570917
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Gdansk、波兰、80-219
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Krakow、波兰、31-108
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Olsztyn、波兰、10-513
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Sarajevo、波斯尼亚和黑塞哥维那、71000
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Bangkok、泰国、10400
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Chiang Mai、泰国、50002
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Rajathevee District、泰国、10400
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Bedford Park、澳大利亚、5042
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St. Leonards、澳大利亚、NSW 2065
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Woodville、澳大利亚、5011
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New South Wales
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Wodonga、New South Wales、澳大利亚、3690
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Tasmania
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Hobart、Tasmania、澳大利亚、7000
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Victoria
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East Melbourne、Victoria、澳大利亚、3002
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Western Australia
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Perth、Western Australia、澳大利亚、6000
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Adana、火鸡、01330
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Gaziantep、火鸡、27310
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Istanbul、火鸡、34718
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Izmir、火鸡、35100
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Baia Mare、罗马尼亚、430031
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Cluj Napoca、罗马尼亚、400015
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Cluj Napoca、罗马尼亚、400058
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Suceava、罗马尼亚、720237
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California
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Bakersfield、California、美国、93309
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La Jolla、California、美国、92093
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Redlands、California、美国、92374
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Illinois
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Chicago、Illinois、美国、60612
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Louisiana
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New Orleans、Louisiana、美国、70112
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Massachusetts
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Boston、Massachusetts、美国、02115
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Nebraska
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Omaha、Nebraska、美国、68114
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New York
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New York、New York、美国、10003
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Pennsylvania
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West Reading、Pennsylvania、美国、19611
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Rhode Island
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Providence、Rhode Island、美国、02903
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South Carolina
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Charleston、South Carolina、美国、29425
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Tennessee
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Knoxville、Tennessee、美国、37920
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Memphis、Tennessee、美国、38119
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Texas
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Houston、Texas、美国、77030
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London、英国、SE1 7EH
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Sutton、英国、SM2 5PT
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Wolverhampton、英国、WV10 0QP
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Wirral
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Bebington、Wirral、英国、L83 4JY
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Cebu City、菲律宾、6000
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Pasig City、菲律宾、1604
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Alcorcon、西班牙、28922
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Barcelona、西班牙、08036
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Barcelona、西班牙、08035
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Elche、西班牙、03203
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Madrid、西班牙、28034
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Santander、西班牙、39008
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Sevilla、西班牙、41021
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Buenos Aires、阿根廷、1425
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Capital Federal、阿根廷、1264
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Ciudad Autonoma de Buenos Aires、阿根廷、C1437JCP
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Ciudada Autonoma、阿根廷、C1199ABD
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Cordoba、阿根廷、5000
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Rosario、阿根廷、S2002KDS
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Floriana、马耳他、1941
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Floriana、马耳他、FRN 1941
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Beirut、黎巴嫩
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Histologically or cytologically confirmed gastric carcinoma, including gastric adenocarcinoma or GEJ adenocarcinoma
- Metastatic disease or locally recurrent, unresectable disease with measurable lymph node metastases
- Measurable disease and/or evaluable disease. Measurable disease is defined as at least one unidimensionally-measurable target lesion [≥ 2 centimeter (cm) with conventional techniques or ≥ 1 cm by spiral computed tomography (CT)], as defined by Response using Response Evaluation Criteria in Solid Tumors (RECIST).
Examples of evaluable, nonmeasurable disease include gastric, peritoneal, or mesenteric thickening in areas of known disease, or peritoneal nodules that are too small to be considered measurable by RECIST
- Experienced disease progression during or within 4 months after the last dose of first-line therapy for metastatic disease, or during or within 6 months after the last dose of adjuvant therapy
- Disease is not amenable to potentially curative resection
- Participant is ≥ 18 years of age
- Participant has a life expectancy of ≥ 12 weeks
- Participant resolution to Grade ≤ 1 (or to Grade ≤ 2 in the case of neuropathy) by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 3.0, of all clinically significant toxic effects of prior chemotherapy, surgery, radiotherapy, or hormonal therapy (with the exception of alopecia)
- Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score of 0-1
- The participant has adequate hepatic function as defined by a total bilirubin ≤ 1.5 milligrams/deciliter (mg/dL) [25.65 micromole/liter (µmol/L)], and aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3.0 x the upper limit of normal (ULN) [or 5.0 x the ULN in the setting of liver metastases]
- The participant has adequate renal function as defined by a serum creatinine ≤ 1.5 x the ULN, or creatinine clearance (measured via 24-hour urine collection) ≥ 40 milliliters/minute (mL/min) (that is, if serum creatinine is > 1.5 x the ULN, a 24-hour urine collection to calculate creatinine clearance must be performed)
- The participant's urinary protein is ≤ 1+ on dipstick or routine urinalysis ([UA]; if urine dipstick or routine analysis is ≥ 2+, a 24-hour urine collection for protein must demonstrate < 1000 milligrams (mg) of protein in 24 hours to allow participation in the study)
- The participant has adequate hematologic function, as evidenced by an absolute neutrophil count (ANC) ≥ 1000 microliters (µL), hemoglobin ≥ 9 grams/deciliter (g/dL) [5.58 millimoles/liter (mmol/L)], and platelets ≥ 100,000/µL
- The participant must have adequate coagulation function as defined by International Normalized Ratio (INR) ≤ 1.5 and a partial thromboplastin time (PTT) ≤ 5 seconds above the ULN (unless receiving anticoagulation therapy). Participant on anticoagulation therapy with unresected primary tumors or local tumor recurrence following resection are not eligible
- If the participant has received prior anthracycline therapy as part of his or her first-line regimen, the participant is able to engage in ordinary physical activity without significant fatigue or dyspnea
- Because the teratogenicity of IMC-1121B is not known, the participant, if sexually active, must be postmenopausal, surgically sterile, or using effective contraception (hormonal or barrier methods)
- Female participant of childbearing potential must have a negative serum pregnancy test within 7 days prior to randomization
- Able to provide informed written consent and is amenable to compliance with protocol schedules and testing
Exclusion Criteria:
- Documented and/or symptomatic brain or leptomeningeal metastases
- Experienced any Grade 3-4 gastrointestinal bleeding within 3 months prior to randomization
- Experienced any arterial thromboembolic events, including but not limited to myocardial infarction, transient ischemic attack, cerebrovascular accident, or unstable angina, within 6 months prior to randomization
- Ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, symptomatic or poorly controlled cardiac arrhythmia, uncontrolled thrombotic or hemorrhagic disorder, or any other serious uncontrolled medical disorders in the opinion of the investigator
- Ongoing or active psychiatric illness or social situation that would limit compliance with study requirements
- Uncontrolled or poorly-controlled hypertension despite standard medical management
- Participant has a serious or nonhealing wound, ulcer, or bone fracture
- Received chemotherapy, radiotherapy, immunotherapy, or targeted therapy for gastric cancer within 2 weeks prior to randomization
- Received any investigational therapy within 30 days prior to randomization
- Undergone major surgery within 28 days prior to randomization, or subcutaneous venous access device placement within 7 days prior to randomization
- Received prior therapy with an agent that directly inhibits vascular endothelial growth factor (VEGF) or VEGF receptor 2 (R-2) activity (including bevacizumab), or any antiangiogenic agent
- Receiving chronic antiplatelet therapy, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, including ibuprofen, naproxen, and others), dipyridamole or clopidogrel, or similar agents. Once-daily aspirin use [maximum dose 325 milligram/day (mg/day)] is permitted
- Participant has elective or planned major surgery to be performed during the course of the clinical trial
- Participant has a known allergy to any of the treatment components
- Pregnant or lactating
- Known to be positive for infection with the human immunodeficiency virus
- Known alcohol or drug dependency
- Participant has a concurrent active malignancy other than adequately-treated nonmelanomatous skin cancer, other noninvasive carcinoma, or in situ neoplasm. A participant with previous history of malignancy is eligible, provided that he/she has been free of disease for > 3 years
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:ramucirumab
Participants receive ramucirumab, administered via intravenous infusion every 2 weeks at a dose of 8 milligrams/kilogram (mg/kg), and best supportive care (BSC) as determined appropriate by the investigator(s).
Treatment will continue until there is evidence of progressive disease (PD), the development of unacceptable toxicity, protocol noncompliance, or withdrawal of consent.
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Administered via intravenous infusion every 2 weeks at a dose of 8 mg/kg
其他名称:
BSC as determined appropriate by the investigator(s).
BSC may include but are not limited to antiemetic agents, opiate and nonopiate analgesic agents, appetite stimulants, and granulocyte and erythroid growth factors.
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安慰剂比较:Placebo
Participants receive injection for intravenous infusion every 2 weeks plus BSC as determined appropriate by the investigator(s).
Because investigators and ancillary medical personnel will be blinded as to assignment to active therapy versus placebo, the volume of placebo to be administered will be calculated as if it were active product with a dose of 8 mg/kg.
Treatment will continue until there is evidence of PD, the development of unacceptable toxicity, protocol noncompliance, or withdrawal of consent.
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BSC as determined appropriate by the investigator(s).
BSC may include but are not limited to antiemetic agents, opiate and nonopiate analgesic agents, appetite stimulants, and granulocyte and erythroid growth factors.
Placebo comparator for ramucirumab 8 mg/kg as intravenous infusion every 2 weeks
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Overall Survival (OS)
大体时间:Randomization up to 28 months post-randomization
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Overall survival is defined as the time from the date of randomization to the date of death from any cause.
Participants who were alive at the date of data cut-off or who were lost to follow-up were censored on the last date the participant was known to be alive
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Randomization up to 28 months post-randomization
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Progression-Free Survival (PFS)
大体时间:Randomization up to 17 months
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PFS is defined as the time from date of randomization until date of objectively determined progressive disease (PD) or death due to any cause, whichever is first.
Participants alive and without PD were censored at the time of last adequate objective tumor assessment (that is, response other than unevaluable).
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Randomization up to 17 months
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Percentage of Participants Who Are Progression-Free at Week 12 (PFS Rate)
大体时间:Week 12 post-randomization
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The percentage of participants alive and progression-free 12 weeks after randomization.
Progression-free survival (PFS) is defined as the time from the date of randomization until the date of objectively determined progressive disease (PD) or death due to any cause whichever comes first.
Participants alive and without PD were censored at the time of the last adequate objective tumor assessment.
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Week 12 post-randomization
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Percentage of Participants With Objective Response (Objective Response Rate [ORR])
大体时间:Randomization up to 17 months post-randomization
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ORR is equal to the percentage of participants achieving a best overall response of complete response (CR) or partial response (PR).
CR and PR were defined using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0).
CR is defined as the disappearance of all target and non-target lesions, no appearance of new lesions and confirmed at the consecutive tumor assessment.
PR is defined as at least a 30% decrease in the sum of the longest diameters (LD) of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, no appearance of new lesions and confirmed at a subsequent tumor assessment.
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Randomization up to 17 months post-randomization
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Duration of Response (DOR)
大体时间:Randomization up to 17 months post-randomization
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DOR is the interval from date of initial documented response (complete response [CR] or partial response [PR]) to first documented date of disease progression (PD) or death as a result of any cause.
CR and PR were defined using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0).
CR is defined as the disappearance of all target and non-target lesions, no appearance of new lesions and confirmed at the consecutive tumor assessment.
PR is defined as at least a 30% decrease in the sum of the longest diameters (LD) of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, no appearance of new lesions and confirmed at a subsequent tumor assessment.
Participants who did not relapse or die were censored at the time of the last adequate objective tumor assessment.
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Randomization up to 17 months post-randomization
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Change From Baseline in Quality of Life (QoL) as Measured by the European Organisation for Research and Treatment of Cancer Questionnaire (EORTC-QLQ-C30)
大体时间:Baseline up to Cycle 10 (18 weeks [1 cycle=2 weeks])
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EORTC QLQ-C30 v3.0 is a self-administered questionnaire with multidimensional scales that measures 5 functional domains (physical, role, cognitive, emotional, and social), global health status, and symptom scales of fatigue, pain, nausea and vomiting, dyspnea, loss of appetite, insomnia, constipation and diarrhea, and financial difficulties.
A linear transformation is applied to standardize the raw scores to range between 0 and 100 per developer guidelines.
For functional domains and global health status, higher scores represent a better level of functioning.
For symptoms scales, higher scores represented a greater degree of symptoms.
Best change from baseline results determined by Least Square (LS) mean estimated with randomization stratification factors and baseline value as continuous covariate.
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Baseline up to Cycle 10 (18 weeks [1 cycle=2 weeks])
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Number of Participants With Adverse Events
大体时间:Randomization up to 18 months
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Clinically significant events were defined as serious adverse events (SAE) and other treatment-emergent non-serious adverse events (NSAE).
A summary of SAEs and all other NSAEs is located in the Reported Adverse Event module.
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Randomization up to 18 months
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Maximum Concentration (Cmax) of IMC-1121B
大体时间:6 weeks post-randomization
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Cmax was not analyzed as only pre-dose samples were collected.
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6 weeks post-randomization
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Number of Participants Who Developed Antibodies Against IMC-1121B
大体时间:Baseline, 12 Weeks
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The number of participants who developed treatment emergent antibody responses to IMC-1121B after baseline.
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Baseline, 12 Weeks
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合作者和调查者
出版物和有用的链接
一般刊物
- Chau I, Fuchs CS, Ohtsu A, Barzi A, Liepa AM, Cui ZL, Hsu Y, Al-Batran SE. Association of quality of life with disease characteristics and treatment outcomes in patients with advanced gastric cancer: Exploratory analysis of RAINBOW and REGARD phase III trials. Eur J Cancer. 2019 Jan;107:115-123. doi: 10.1016/j.ejca.2018.11.013. Epub 2018 Dec 14.
- Tabernero J, Ohtsu A, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Ajani JA, Tomasek J, Safran H, Chandrawansa K, Hsu Y, Heathman M, Khan A, Ni L, Melemed AS, Gao L, Ferry D, Fuchs CS. Exposure-Response Analyses of Ramucirumab from Two Randomized, Phase III Trials of Second-line Treatment for Advanced Gastric or Gastroesophageal Junction Cancer. Mol Cancer Ther. 2017 Oct;16(10):2215-2222. doi: 10.1158/1535-7163.MCT-16-0895. Epub 2017 Jul 17.
- Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, Safran H, Dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Zalcberg JR, Chau I, Campbell W, Sivanandan C, Pikiel J, Koshiji M, Hsu Y, Liepa AM, Gao L, Schwartz JD, Tabernero J; REGARD Trial Investigators. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014 Jan 4;383(9911):31-39. doi: 10.1016/S0140-6736(13)61719-5. Epub 2013 Oct 3.
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他研究编号
- 13893
- 2008-005964-15 (注册表标识符:MHRA)
- CP12-0715 (其他标识符:ImClone Systems)
- I4T-IE-JVBD (其他标识符:Eli Lilly and Company)
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
IPD 计划说明
IPD 共享时间框架
IPD 共享访问标准
IPD 共享支持信息类型
- 研究方案
- 树液
- 企业社会责任
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