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    Clinical Trial Results:
    An Open-Label, Multicenter, Phase III Trial of ABI-007 vs Dacarbazine in Previously Untreated Patients with Metastatic Malignant Melanoma

    Summary
    EudraCT number
    2007-004097-32
    Trial protocol
    GB   DE   NL   FR   ES   IT  
    Global end of trial date
    31 Jan 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    14 Jul 2016
    First version publication date
    05 Aug 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CA033
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00864253
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Celgene Corporation
    Sponsor organisation address
    86 Morris Avenue, Summit, United States,
    Public contact
    Clinical Trial Disclosure, Abraxis BioScience, LLC, a wholly owned subsidiary of Celgene Corporation, 1 888-260-1599, clinicaltrialsdisclosure@celgene.com
    Scientific contact
    Ileana Elias, Abraxis BioScience, LLC, a wholly owned subsidiary of Celgene Corporation, 1 6479684300, ielias@celgene.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    30 Jun 2012
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Jun 2012
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Jan 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study is to compare the following regimens with respect to antitumor activity in patients who are previously untreated with cytotoxic chemotherapy for metastatic malignant melanoma: • ABI-007 150 mg/m^2 Days 1, 8, and 15 every 4 weeks • Dacarbazine 1000 mg/m^2 every 3 weeks
    Protection of trial subjects
    Protection of patient confidentiality Protection of biomarker information by a secure database
    Background therapy
    Dacarbazine remains the standard of treatment
    Evidence for comparator
    -
    Actual start date of recruitment
    23 Apr 2009
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    38 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 7
    Country: Number of subjects enrolled
    Spain: 8
    Country: Number of subjects enrolled
    United Kingdom: 30
    Country: Number of subjects enrolled
    France: 45
    Country: Number of subjects enrolled
    Germany: 56
    Country: Number of subjects enrolled
    Italy: 82
    Country: Number of subjects enrolled
    United States: 186
    Country: Number of subjects enrolled
    Australia: 70
    Country: Number of subjects enrolled
    Canada: 45
    Worldwide total number of subjects
    529
    EEA total number of subjects
    228
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    289
    From 65 to 84 years
    234
    85 years and over
    6

    Subject disposition

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    Recruitment
    Recruitment details
    This multicenter study was conducted by investigators in 9 countries: Australia, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom and the United States (US) and treatment was given on an outpatient basis. First participant enrolled 30 April 2011, last participant enrolled June 2011.

    Pre-assignment
    Screening details
    Participants were randomized in a 1:1 ratio. Randomization was stratified based on metastatic stage (M1a, M1b, and M1c), region (North America, Western Europe and Australia), and baseline lactate dehydrogenase (LDH) Upper Limit of Normal (ULN) (< 0.8 x ULN, 0.8-1.1 x ULN, >1.1-2 x ULN).

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    ABI-007
    Arm description
    ABI-007 150mg/m^2 intravenously over approximately 30 minutes on Days 1, 8 and 15 of each 28 day cycle
    Arm type
    Experimental

    Investigational medicinal product name
    ABI-007
    Investigational medicinal product code
    Other name
    Nab-Paclitaxel; Abraxane
    Pharmaceutical forms
    Concentrate and solvent for concentrate for solution for infusion
    Routes of administration
    Intravenous drip use
    Dosage and administration details
    ABI-007 150mg/m^2 intravenously over approximately 30 minutes on Days 1, 8 and 15 of each 28 day cycle

    Arm title
    Dacarbazine
    Arm description
    Dacarbazine 1000mg/m^2 intravenously over approximately 30-60 minutes on Day 1 of each 21 day cycle.
    Arm type
    Active comparator

    Investigational medicinal product name
    Dacarbazine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder and solution for solution for injection
    Routes of administration
    Intravenous drip use
    Dosage and administration details
    Dacarbazine 1000mg/m^2 intravenously over approximately 30-60 minutes on Day 1 of each 21 day cycle.

    Number of subjects in period 1
    ABI-007 Dacarbazine
    Started
    264
    265
    Treated
    257
    258
    Therapy Ongoing
    2
    3
    Therapy Discontinued
    255
    255
    Completed
    2
    3
    Not completed
    262
    262
         Consent withdrawn by subject
    18
    18
         Physician decision
    11
    15
         Adverse event, non-fatal
    3
    11
         Death
    1
    -
         Progressive Disease
    165
    207
         Unrelated Adverse Event
    -
    1
         Untreated
    7
    7
         Unacceptable Toxicity
    56
    -
         Lost to follow-up
    1
    1
         Protocol deviation
    -
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    ABI-007
    Reporting group description
    ABI-007 150mg/m^2 intravenously over approximately 30 minutes on Days 1, 8 and 15 of each 28 day cycle

    Reporting group title
    Dacarbazine
    Reporting group description
    Dacarbazine 1000mg/m^2 intravenously over approximately 30-60 minutes on Day 1 of each 21 day cycle.

    Reporting group values
    ABI-007 Dacarbazine Total
    Number of subjects
    264 265 529
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Adults (18-64 years)
    154 135 289
        From 65-84 years
    107 127 234
        85 years and over
    3 3 6
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
    Age continuous
    Units: years
        median (full range (min-max))
    62 (21 to 85) 64 (28 to 87) -
    Gender categorical
    Units: Subjects
        Female
    91 91 182
        Male
    173 174 347
    Eastern Cooperative Oncology Group Performance Status (ECOG)
    ECOG-Eastern Cooperative Oncology Group (ECOG) Performance Status is used by doctors and researchers to assess how a participant's disease is progressing, assess how the disease affects the daily living activities of the participant and determine appropriate treatment and prognosis. 0 = Fully Active (Most Favorable Activity); 1 = Restricted activity but ambulatory; 2 = Ambulatory but unable to carry out work activities; 3 = Limited Self-Care; 4 = Completely Disabled, No self-care (Least Favorable Activity)
    Units: Subjects
        0 = Fully Active
    195 181 376
        1= Restrictive but Ambulatory
    68 82 150
        2 = Ambulatory but Unable to Work
    1 2 3
        3 = Limited Self-Care
    0 0 0
        4 = Completely Disabled
    0 0 0
    Baseline Lactate Dehydrogenase value
    The serum level of Lactate Dehydrogenase (LDH) is considered a risk factor for overall survival in participants with metastatic melanoma. LDH is a blood test used as a general indicator of the existence and severity of acute or chronic tissue damage and used to monitor cancers such as metastatic melanoma. The baseline LDH value was considered to be the last central laboratory LDH value before randomization. If the central laboratory data was not available, the last non-missing local laboratory value before randomization was used.
    Units: Subjects
        <0.8 * Upper Limit of Normal (ULN)
    138 139 277
        0.8-1.1 * ULN
    72 69 141
        >1.1-2 * ULN
    51 56 107
        >2 * ULN
    3 1 4
    Metastatic Stage of Disease
    Distant Metastatic (M) Stages: MX: Distant metastasis cannot be assessed; M0: No distant metastasis; M1= Distant metastasis; M1a: Metastasis to skin, subcutaneous tissues or distant lymph nodes; M1b: metastasis to lung; M1c: metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactic dehyrogenase.
    Units: Subjects
        M1a
    27 21 48
        M1b
    66 69 135
        M1c
    171 175 346
    BRAF Mutation Status
    BRAF is a mutation biomarker for melanoma, a human gene that makes the protein B-Raf. The gene is referred to as a protoco-oncogene B Raf and vRaf murine sarcoma viral oncogene homolog B1, while the protein is known as serine/threonine-protein kinase B-Raf. The protein is involved in sending signals inside cells and in directing cell growth. These BRAF mutations were associated with features of high risk melanoma, including truncal primary, earlier age of onset, lack of chronic skin damage and shortened survival. The BRAF statuses included: Wild type and V600E mutation
    Units: Subjects
        Wild Type (mutation negative)
    116 108 224
        Unknown
    83 90 173
        V 600 E Mutation
    65 67 132

    End points

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    End points reporting groups
    Reporting group title
    ABI-007
    Reporting group description
    ABI-007 150mg/m^2 intravenously over approximately 30 minutes on Days 1, 8 and 15 of each 28 day cycle

    Reporting group title
    Dacarbazine
    Reporting group description
    Dacarbazine 1000mg/m^2 intravenously over approximately 30-60 minutes on Day 1 of each 21 day cycle.

    Primary: Primary: Progression Free Survival (PFS) Based on a Blinded Radiology Assessment of Response Using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0 Guidelines

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    End point title
    Primary: Progression Free Survival (PFS) Based on a Blinded Radiology Assessment of Response Using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0 Guidelines
    End point description
    PFS was defined as the time from the randomization date to the start of disease progression or patient death, whichever occurred first. Participants who did not have disease progression or had not died were censored at the last known time that the patient was progression free. In the event of palliative radiotherapy or surgery, they were censored at the last assessment where they were documented to be progression-free prior to the date of radiotherapy or surgery. In follow up, participants who began new anticancer therapy prior to documented progression were censored at the last assessment where they were documented as progression free. Those with two or more missing response assessments prior to a visit with documented disease progression (or death) were censored at the last visit where they were documented to be progression free. RECIST defines progressive disease as a ≥ 20% increase taking as reference the smallest sum of the longest diameters recorded since the treatment began.
    End point type
    Primary
    End point timeframe
    Response assessment completed every 8 weeks until disease progression for up to 106 weeks; data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    264
    265
    Units: Months
        median (confidence interval 95%)
    4.8 (3.7 to 5.5)
    2.5 (2 to 3.6)
    Statistical analysis title
    Progression Free Survival
    Statistical analysis description
    Two hundred fifty-seven (257) patients were to be randomized to each treatment group for a total of 514 patients. This sample size was chosen to provide at least 80% power for the final analysis (with a two-sided type I error of 0.049) to reject the null hypothesis that the ABI 007/dacarbazine hazard ratio (HR) for PFS is equal to 1.0. This sample size calculation was based on estimates of HR = 0.750.
    Comparison groups
    ABI-007 v Dacarbazine
    Number of subjects included in analysis
    529
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    = 0.044 [2]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.792
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.631
         upper limit
    0.992
    Notes
    [1] - An interim safety review was performed by DMC. An alpha spending function was utilized to preserve the overall Type 1 error at 0.050. The spending function allocated alpha of 0.001 and 0.049 to the interim and final analyses of PFS, respectively.
    [2] - P-value is based on a stratified log-rank test stratified by geographic region, metastatic stage, and LDH category.

    Secondary: Participant Survival

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    End point title
    Participant Survival
    End point description
    Survival was defined as the time from the date of randomization to the date of death (any cause). Participants were censored at the last known time that they were alive.
    End point type
    Secondary
    End point timeframe
    Up to 38 months; Up to data cut off of 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    264
    265
    Units: months
        median (confidence interval 95%)
    12.8 (11.3 to 14.6)
    10.7 (9.6 to 12.5)
    Statistical analysis title
    Participant Survival
    Statistical analysis description
    For the participant survival, at the time at least 417 events are recorded, this sample size provides at least 80% power with a two-sided Type 1 error of 0.049 to reject the null hypothesis that the ABI-007/dacarbazine hazard ratio is equal to 1.0. This was based on a HR = 0.760. Proportional hazards were assumed.
    Comparison groups
    ABI-007 v Dacarbazine
    Number of subjects included in analysis
    529
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.094 [3]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.831
    Confidence interval
         level
    99.9%
         sides
    2-sided
         lower limit
    0.578
         upper limit
    1.196
    Notes
    [3] - The treatment difference was tested using the stratified log-rank test, stratified by metastatic stage, region, and baseline LDH.

    Secondary: Summary of Treatment-emergent Adverse Events (AEs)

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    End point title
    Summary of Treatment-emergent Adverse Events (AEs)
    End point description
    A Treatment Emergent AE (TEAE) was any AE that began or worsened after the start of the study drug through 30 days after the last dose of study drug or end of study whichever is later. A treatment related toxicity was one considered by the investigator to be possibly, probably or definitely related to study drug. AE's were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) V 3.0 criteria and the following scale: Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life threatening, and Grade 5 = Death A SAE is any untoward medical occurrence at any dose that is fatal or life threatening, results in persistent or significant disability or incapacity; requires prolonged hospitalizations; is a congenital anomaly birth defect in the offspring of a patient, and conditions not included in the above that may jeopardize the patient or may require intervention to prevent one of the outcomes listed above.
    End point type
    Secondary
    End point timeframe
    Maximum exposure to study drug was 106 weeks; up to data cut off of 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    257
    258
    Units: participants
        ≥1 TEAE
    255
    239
        ≥1 TEAE related to study drug
    250
    212
        ≥1 NCI CTCAE Grade (GR) 3 or above
    167
    117
        ≥1 NCI CTCAE GR 3 or above TEAE to study drug
    129
    71
        ≥1 TEAE with outcome of death
    8
    1
        ≥1 drug related TEAE with outcome of death
    2
    1
        ≥1 serious TEAE
    62
    54
        ≥1 serious TEAE related to study drug
    23
    17
        ≥1 TEAE leading to a dose reduction of study
    81
    51
        ≥1 related TEAE leading to dose reduction
    80
    49
        ≥1 TEAE leading to drug interruption
    4
    16
        ≥1 drug related TEAE leading to drug interrup
    3
    15
        ≥1 TEAE leading to dose delay of study drug
    124
    84
        ≥1 drug related TEAE leading to dose delay
    106
    77
        ≥1 TEAE leading to drug discontinuation
    59
    12
        ≥1 drug related TEAE leading to drug disconti
    56
    11
    No statistical analyses for this end point

    Secondary: Number of Participants Experiencing Dose Reductions, or Dose Interruptions, or Dose Delays of Study Drug

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    End point title
    Number of Participants Experiencing Dose Reductions, or Dose Interruptions, or Dose Delays of Study Drug
    End point description
    The number of participants with dose reductions, dose interruptions and dose delays that occurred during the treatment period. Dose reductions, interruptions and delays are typically caused by clinically significant laboratory abnormalities and /or treatment emergent adverse events/toxicities
    End point type
    Secondary
    End point timeframe
    Maximum study drug exposure 106 weeks; data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    257
    258
    Units: participants
        Dose Reductions
    81
    51
        Dose Interruptions
    6
    17
        Dose Delay
    145
    105
    No statistical analyses for this end point

    Secondary: Nadir for the Absolute Neutrophil Count (ANC) Measurements

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    End point title
    Nadir for the Absolute Neutrophil Count (ANC) Measurements
    End point description
    Maximal degree of myelosuppression during study drug dosing was represented by the nadir in ANC measurements over all treatment cycles. Treated Population = consisted of all randomized participants who received at least one dose of study drug and with at least one post-baseline central laboratory result were included.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 106 weeks; up to data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    253
    246
    Units: 10^9/L
        median (full range (min-max))
    1.5 (0.1 to 20)
    2.4 (0 to 13.2)
    No statistical analyses for this end point

    Secondary: Nadir for White Blood Cells (WBCs) Measurements

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    End point title
    Nadir for White Blood Cells (WBCs) Measurements
    End point description
    Maximal degree of myelosuppression was represented by the nadir in white blood cells (WBCs) count measurements over all treatment cycles. Treated population = consisted of all randomized participants who received at least one dose of study drug and with at least one post-baseline central laboratory result were included
    End point type
    Secondary
    End point timeframe
    Day 1 up to 106 weeks; up to data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    253
    246
    Units: 10^9/L
        median (full range (min-max))
    3 (0.6 to 22.8)
    4.1 (0.5 to 14.7)
    No statistical analyses for this end point

    Secondary: Nadir for Platelet Count Measurements.

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    End point title
    Nadir for Platelet Count Measurements.
    End point description
    Maximal degree of myelosuppression was represented by the nadir in platelet count measurements over all treatment cycles. Treated population = consisted of all randomized participants who received at least one dose of study drug and with at least one post-baseline central laboratory result were included
    End point type
    Secondary
    End point timeframe
    Day 1 up to 106 weeks; up to data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    252
    246
    Units: 10^9/L
        median (full range (min-max))
    228.5 (112 to 437)
    153 (9 to 723)
    No statistical analyses for this end point

    Secondary: Nadir for the Hemoglobin Count Measurements

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    End point title
    Nadir for the Hemoglobin Count Measurements
    End point description
    Maximal degree of myelosuppression during study drug dosing was represented by the nadir in hemoglobin count measurements over all treatment cycles. Treated population = consisted of all randomized participants who received at least one dose of study drug and with at least one post-baseline central laboratory result were included.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 106 weeks; up to data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    253
    246
    Units: g/L
        median (full range (min-max))
    109 (65 to 137)
    122 (65 to 161)
    No statistical analyses for this end point

    Secondary: Pharmacokinetic Parameters

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    End point title
    Pharmacokinetic Parameters
    End point description
    Patients randomized to receive ABI-007 treatment in Australia, Canada, Europe, United Kingdom and United States had the option to participate in sparse PK sampling in this study. Only 44 participants consented to participate, an insufficient number to support the planned population PK analysis hence these analyses were not performed
    End point type
    Secondary
    End point timeframe
    On Cycle 1, Day 1 blood samples were taken at 0.25, 3.5, and 24 hr post-infusion end of the initial dose
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    0 [4]
    0 [5]
    Units: ng*hr/mL
        geometric mean (geometric coefficient of variation)
    ( )
    ( )
    Notes
    [4] - PK Analyses was not performed as the PK portion was optional. Insufficient numbers of subject sample
    [5] - PK Analysis was not performed on participants in the dacarbazine treatment arm.
    No statistical analyses for this end point

    Other pre-specified: Progression-free Survival (PFS) Based on Investigator Assessment Using RECIST Response Guidelines

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    End point title
    Progression-free Survival (PFS) Based on Investigator Assessment Using RECIST Response Guidelines
    End point description
    PFS was defined as the time from the randomization date to the start of disease progression or patient death, whichever occurred first. Participants who did not have disease progression or had not died were censored at the last known time that the patient was progression free. In the event of palliative radiotherapy or surgery, they were censored at the last assessment where they were documented to be progression-free prior to the date of radiotherapy or surgery. In follow up, patients who began new anticancer therapy prior to documented progression were censored at the last assessment where they were documented as progression free. Those with two or more missing response assessments prior to a visit with documented disease progression (or death) were censored at the last visit where they were documented to be progression free.
    End point type
    Other pre-specified
    End point timeframe
    Response assessments completed every 8 weeks until disease progression; up to data cut off 30 June 2012; 38 months
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    264
    265
    Units: months
        median (confidence interval 95%)
    3.7 (3.1 to 3.9)
    2.1 (1.9 to 2.5)
    Statistical analysis title
    PFS Based on Investigator Assessment Using RECIST
    Comparison groups
    ABI-007 v Dacarbazine
    Number of subjects included in analysis
    529
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.086 [6]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.845
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.696
         upper limit
    1.025
    Notes
    [6] - P-value is based on a stratified log-rank test stratified by geographic region, metastatic stage, and LDH category

    Other pre-specified: Percent of Participants Who Achieve an Objective Confirmed Complete or Partial Response Based on Blinded Radiology Assessment of Response by Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0

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    End point title
    Percent of Participants Who Achieve an Objective Confirmed Complete or Partial Response Based on Blinded Radiology Assessment of Response by Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0
    End point description
    RECIST defines complete response (CR): The disappearance of all known disease and no new sites or disease related symptoms confirmed at least 4 weeks after initial documentation. All sites must be assessed, including non-measurable sites, such as effusions, or markers. Disappearance of all non-target lesions. The normalization of tumor marker level confirmed at least 4 weeks after initial documentation. Partial response (PR): At least a 30% decrease in the sum of the longest diameters of target lesions, taking as a reference the baseline sum of the longest diameters confirmed at least 4 weeks after initial documentation. PR is also recorded when all measurable disease has completely disappeared, but a non-measurable component (i.e., ascites) is still present but not progressing. As well as persistence of one or more non-target lesion(s) and/or the maintenance of tumor marker level above the normal limits.
    End point type
    Other pre-specified
    End point timeframe
    every 8 weeks; up to data cut off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    264
    265
    Units: percentage of participants
    number (not applicable)
        Complete Response (CR)
    0
    0
        Partial Response (PR)
    15
    11
    Statistical analysis title
    Confirmed Complete or Partial Response
    Comparison groups
    ABI-007 v Dacarbazine
    Number of subjects included in analysis
    529
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.239
    Method
    Chi-squared
    Parameter type
    Response Rate Ratio
    Point estimate
    1.305
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.837
         upper limit
    2.035

    Other pre-specified: Percent of Participants With Stable Disease (SD) for ≥ 16 Weeks, or Confirmed Complete or Partial Response (i.e., Disease Control) Based on a Blinded Radiology Assessment of Response

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    End point title
    Percent of Participants With Stable Disease (SD) for ≥ 16 Weeks, or Confirmed Complete or Partial Response (i.e., Disease Control) Based on a Blinded Radiology Assessment of Response
    End point description
    Disease control is stable disease (SD) for >=16 weeks + complete response (CR) + partial response (PR). See Outcome #4 for definitions of CR and PR. RECIST defines SD for target lesions as neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease, no occurrence of progression disease for non-target lesions, and no new lesions.
    End point type
    Other pre-specified
    End point timeframe
    Response assessment completed every 8 weeks until disease progression; up to data cut-off 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    264
    265
    Units: percent of participants
        number (not applicable)
    39
    27
    Statistical analysis title
    Those With Stable Disease (SD) for ≥ 16 Weeks
    Comparison groups
    ABI-007 v Dacarbazine
    Number of subjects included in analysis
    529
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.004
    Method
    Chi-squared
    Parameter type
    Response Rate Ratio
    Point estimate
    1.442
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.123
         upper limit
    1.852

    Other pre-specified: Duration of Response (DOR) in Responding Participants

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    End point title
    Duration of Response (DOR) in Responding Participants
    End point description
    Duration of response (DOR) as measured by PFS based on radiological review for those who achieved an objective confirmed response of CR or PR. DOR was defined as PFS in responders, i.e. as the time between the start of a complete response (CR) or partial response (PR) and the start of progressive disease (PD) or participants death from any cause, whichever occurred first. Those that did not have progression or had not died were censored at the last known time the participant was progression free. Participants that had initiated other anticancer therapy prior to progression were censored at the time when new anticancer therapy was initiated. Complete response (CR) and partial response (PR) are defined in outcome #4. PD was defined as at least a 20% increase in the sum of the longest diameters of target lesions; or the appearance of one or more new lesions; or the unequivocal progression of a non-target lesion. Includes ITT with a confirmed complete or partial overall response
    End point type
    Other pre-specified
    End point timeframe
    Up to the data cut off of 30 June 2012
    End point values
    ABI-007 Dacarbazine
    Number of subjects analysed
    39 [7]
    30 [8]
    Units: months
        median (confidence interval 95%)
    11.1 (7.3 to 9999)
    16.4 (11 to 21.8)
    Notes
    [7] - ITT of participants with a confirmed complete or partial overall response
    [8] - ITT of participants with a confirmed complete or partial overall response
    Statistical analysis title
    DOR in Responding Participants
    Comparison groups
    Dacarbazine v ABI-007
    Number of subjects included in analysis
    69
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.057
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    2.201
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.959
         upper limit
    5.053

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Any adverse event (AE) that started at any time from the time the signing of the informed consent to 30 days after the last dose of study drug or End of Study was followed and reported; maximum drug exposure 106 weeks
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    12.1
    Reporting groups
    Reporting group title
    ABI-007
    Reporting group description
    ABI-007 150mg/m^2 intravenously over approximately 30 minutes on Days 1, 8 and 15 of each 28 day cycle

    Reporting group title
    Dacarbazine
    Reporting group description
    Dacarbazine 1000mg/m^2 intravenously over approximately 30-60 minutes on Day 1 of each 21 day cycle.

    Serious adverse events
    ABI-007 Dacarbazine
    Total subjects affected by serious adverse events
         subjects affected / exposed
    62 / 257 (24.12%)
    54 / 258 (20.93%)
         number of deaths (all causes)
    160
    175
         number of deaths resulting from adverse events
    8
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Haemorrhagic tumour necrosis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour pain
         subjects affected / exposed
    0 / 257 (0.00%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypotension
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Venous thrombosis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Extravasation
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Implant site thrombosis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oedema
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    2 / 257 (0.78%)
    5 / 258 (1.94%)
         occurrences causally related to treatment / all
    1 / 2
    3 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    0 / 257 (0.00%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemoptysis
         subjects affected / exposed
    0 / 257 (0.00%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Completed suicide
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Muscle strain
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Traumatic brain injury
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    0 / 257 (0.00%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    1 / 257 (0.39%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 257 (0.39%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial flutter
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardio-respiratory arrest
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Palpitations
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Aphasia
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ataxia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebral haematoma
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Cerebrovascular stenosis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dizziness
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Haemorrhagic stroke
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Hemiparesis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Monoplegia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neuropathy peripheral
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral motor neuropathy
         subjects affected / exposed
    2 / 257 (0.78%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral sensory neuropathy
         subjects affected / exposed
    2 / 257 (0.78%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spinal cord compression
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subarachnoid haemorrhage
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 257 (0.39%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    3 / 257 (1.17%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    3 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Diplopia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Maculopathy
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain lower
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ascites
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Nausea
         subjects affected / exposed
    2 / 257 (0.78%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    3 / 257 (1.17%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    2 / 257 (0.78%)
    2 / 258 (0.78%)
         occurrences causally related to treatment / all
    2 / 3
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Bile duct obstruction
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic function abnormal
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Urticaria
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal failure acute
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal pain
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary retention
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lumbar spinal stenosis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteoporotic fracture
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pathological fracture
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Anal abscess
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Catheter related infection
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    3 / 257 (1.17%)
    4 / 258 (1.55%)
         occurrences causally related to treatment / all
    3 / 3
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Device related infection
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    3 / 257 (1.17%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Escherichia bacteraemia
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infected skin ulcer
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    0 / 257 (0.00%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    4 / 257 (1.56%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    1 / 4
    0 / 1
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 257 (0.39%)
    1 / 258 (0.39%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin infection
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Streptococcal bacteraemia
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Swine influenza
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    3 / 257 (1.17%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypocalcaemia
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypomagnesaemia
         subjects affected / exposed
    1 / 257 (0.39%)
    0 / 258 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    ABI-007 Dacarbazine
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    255 / 257 (99.22%)
    239 / 258 (92.64%)
    Vascular disorders
    Flushing
         subjects affected / exposed
    8 / 257 (3.11%)
    16 / 258 (6.20%)
         occurrences all number
    8
    20
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    39 / 257 (15.18%)
    28 / 258 (10.85%)
         occurrences all number
    64
    49
    Chills
         subjects affected / exposed
    12 / 257 (4.67%)
    15 / 258 (5.81%)
         occurrences all number
    18
    19
    Fatigue
         subjects affected / exposed
    134 / 257 (52.14%)
    110 / 258 (42.64%)
         occurrences all number
    237
    187
    Infusion site pain
         subjects affected / exposed
    2 / 257 (0.78%)
    13 / 258 (5.04%)
         occurrences all number
    3
    21
    Mucosal inflammation
         subjects affected / exposed
    20 / 257 (7.78%)
    13 / 258 (5.04%)
         occurrences all number
    24
    15
    Oedema peripheral
         subjects affected / exposed
    54 / 257 (21.01%)
    24 / 258 (9.30%)
         occurrences all number
    78
    29
    Pain
         subjects affected / exposed
    20 / 257 (7.78%)
    10 / 258 (3.88%)
         occurrences all number
    22
    10
    Pyrexia
         subjects affected / exposed
    32 / 257 (12.45%)
    30 / 258 (11.63%)
         occurrences all number
    43
    46
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    59 / 257 (22.96%)
    33 / 258 (12.79%)
         occurrences all number
    68
    41
    Dyspnoea
         subjects affected / exposed
    39 / 257 (15.18%)
    38 / 258 (14.73%)
         occurrences all number
    49
    46
    Epistaxis
         subjects affected / exposed
    34 / 257 (13.23%)
    5 / 258 (1.94%)
         occurrences all number
    39
    5
    Oropharyngeal pain
         subjects affected / exposed
    17 / 257 (6.61%)
    9 / 258 (3.49%)
         occurrences all number
    20
    11
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    16 / 257 (6.23%)
    19 / 258 (7.36%)
         occurrences all number
    19
    21
    Insomnia
         subjects affected / exposed
    42 / 257 (16.34%)
    31 / 258 (12.02%)
         occurrences all number
    51
    42
    Investigations
    Weight decreased
         subjects affected / exposed
    16 / 257 (6.23%)
    10 / 258 (3.88%)
         occurrences all number
    22
    13
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    32 / 257 (12.45%)
    30 / 258 (11.63%)
         occurrences all number
    41
    43
    Dysgeusia
         subjects affected / exposed
    62 / 257 (24.12%)
    24 / 258 (9.30%)
         occurrences all number
    76
    28
    Headache
         subjects affected / exposed
    42 / 257 (16.34%)
    38 / 258 (14.73%)
         occurrences all number
    53
    52
    Neuropathy peripheral
         subjects affected / exposed
    98 / 257 (38.13%)
    6 / 258 (2.33%)
         occurrences all number
    236
    8
    Paraesthesia
         subjects affected / exposed
    41 / 257 (15.95%)
    8 / 258 (3.10%)
         occurrences all number
    61
    10
    Peripheral sensory neuropathy
         subjects affected / exposed
    52 / 257 (20.23%)
    9 / 258 (3.49%)
         occurrences all number
    108
    11
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    39 / 257 (15.18%)
    28 / 258 (10.85%)
         occurrences all number
    64
    47
    Leukopenia
         subjects affected / exposed
    31 / 257 (12.06%)
    23 / 258 (8.91%)
         occurrences all number
    49
    69
    Neutropenia
         subjects affected / exposed
    66 / 257 (25.68%)
    63 / 258 (24.42%)
         occurrences all number
    130
    138
    Thrombocytopenia
         subjects affected / exposed
    1 / 257 (0.39%)
    43 / 258 (16.67%)
         occurrences all number
    1
    99
    Eye disorders
    Lacrimation increased
         subjects affected / exposed
    17 / 257 (6.61%)
    4 / 258 (1.55%)
         occurrences all number
    17
    4
    Vision blurred
         subjects affected / exposed
    19 / 257 (7.39%)
    6 / 258 (2.33%)
         occurrences all number
    23
    6
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    34 / 257 (13.23%)
    28 / 258 (10.85%)
         occurrences all number
    45
    31
    Abdominal pain upper
         subjects affected / exposed
    17 / 257 (6.61%)
    14 / 258 (5.43%)
         occurrences all number
    19
    19
    Constipation
         subjects affected / exposed
    83 / 257 (32.30%)
    89 / 258 (34.50%)
         occurrences all number
    104
    130
    Diarrhoea
         subjects affected / exposed
    103 / 257 (40.08%)
    45 / 258 (17.44%)
         occurrences all number
    156
    67
    Dyspepsia
         subjects affected / exposed
    24 / 257 (9.34%)
    20 / 258 (7.75%)
         occurrences all number
    30
    29
    Nausea
         subjects affected / exposed
    104 / 257 (40.47%)
    130 / 258 (50.39%)
         occurrences all number
    154
    244
    Stomatitis
         subjects affected / exposed
    18 / 257 (7.00%)
    8 / 258 (3.10%)
         occurrences all number
    22
    9
    Vomiting
         subjects affected / exposed
    53 / 257 (20.62%)
    56 / 258 (21.71%)
         occurrences all number
    79
    89
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    177 / 257 (68.87%)
    9 / 258 (3.49%)
         occurrences all number
    235
    9
    Dry skin
         subjects affected / exposed
    24 / 257 (9.34%)
    5 / 258 (1.94%)
         occurrences all number
    25
    6
    Erythema
         subjects affected / exposed
    16 / 257 (6.23%)
    5 / 258 (1.94%)
         occurrences all number
    19
    5
    Nail disorder
         subjects affected / exposed
    52 / 257 (20.23%)
    2 / 258 (0.78%)
         occurrences all number
    72
    2
    Photosensitivity reaction
         subjects affected / exposed
    3 / 257 (1.17%)
    13 / 258 (5.04%)
         occurrences all number
    3
    17
    Pruritus
         subjects affected / exposed
    31 / 257 (12.06%)
    17 / 258 (6.59%)
         occurrences all number
    37
    22
    Rash
         subjects affected / exposed
    72 / 257 (28.02%)
    18 / 258 (6.98%)
         occurrences all number
    110
    26
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    48 / 257 (18.68%)
    24 / 258 (9.30%)
         occurrences all number
    81
    36
    Back pain
         subjects affected / exposed
    24 / 257 (9.34%)
    26 / 258 (10.08%)
         occurrences all number
    30
    35
    Musculoskeletal pain
         subjects affected / exposed
    16 / 257 (6.23%)
    16 / 258 (6.20%)
         occurrences all number
    21
    22
    Myalgia
         subjects affected / exposed
    44 / 257 (17.12%)
    10 / 258 (3.88%)
         occurrences all number
    69
    12
    Pain in extremity
         subjects affected / exposed
    33 / 257 (12.84%)
    20 / 258 (7.75%)
         occurrences all number
    47
    21
    Muscular weakness
         subjects affected / exposed
    16 / 257 (6.23%)
    5 / 258 (1.94%)
         occurrences all number
    24
    6
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    14 / 257 (5.45%)
    10 / 258 (3.88%)
         occurrences all number
    17
    12
    Upper respiratory tract infection
         subjects affected / exposed
    18 / 257 (7.00%)
    13 / 258 (5.04%)
         occurrences all number
    21
    17
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    68 / 257 (26.46%)
    52 / 258 (20.16%)
         occurrences all number
    85
    56
    Hypokalaemia
         subjects affected / exposed
    13 / 257 (5.06%)
    10 / 258 (3.88%)
         occurrences all number
    22
    11

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 Aug 2008
    1. Added optional biomarker analysis as additional efficacy endpoint, including SPARC testing, of tumor tissue and blood has in order to further study the correlation between expression of molecular biomarkers and clinical outcome. 2. In response to the FDA Clinical Pharmacology Reviewer’s recommendation, added sparse PK sampling and sampling rationale.
    13 Mar 2009
    1. References to dacarbazine brand names have been removed throughout the document. 2. Language added to clarify that participation in PK sampling is optional. 3. Added clarification that patients who stopped treatment prior to developing disease progression were to be followed without further treatment until progressive disease was documented or until the treating physician felt that additional treatment was required (in which case documentation was to be made in the Case Report Form as to the compelling reason(s) for starting a new treatment in the absence of progressive disease). 4. Added procedures for collection and preparation of specimens for biomarker analyses. 5. Updated storage and preparation information for dacarbazine. 6. The Every-8-Weeks assessment of CBC, differential and platelet count has been removed from both arms as it was erroneous. 7. Added clarification that PK was an optional procedure. 8. The list of tests to be included in the clinical chemistry panel was detailed. 9. Sponsor Signatories page has been updated.
    15 Apr 2009
    1.Change of Medical Monitor 2. Clarified that pharmacokinetic evaluations are for the ABI-007 arm only. 3. Added clarification that patients should have cutaneous malignant melanoma for entry into the study. 4. Updated language to reflect expression of SPARC in metastatic melanoma and its association with a poor prognosis. 5. Added details regarding premedication for dacarbazine arm (Arm B). 6. Deleted paragraph regarding patients who received chemotherapy or an investigational drug 3 weeks prior to first dose since prior cytotoxic chemotherapy and prior adjuvant cytotoxic chemotherapy were not permitted for patients in this study. 7. CT scan or MRI of head assessment added for consistency. 8. Added outline of planned interim safety review. 9. Added a section to outline the establishment of a Data Monitoring Committee
    02 Sep 2009
    1. Changed time window for dacarbazine infusion from 15 – 60 minutes to 30 – 60 minutes. 2. The following changes were made to inclusion criteria: - Inclusion Criterion 2 was updated to clarify the timeframe by which sites should allow a patient to enter the study upon completing prior treatment. - Inclusion Criterion 3 was updated to clarify the guidelines regarding contraception during and after treatment in the protocol, and to be consistent with the Summary of Product Characteristics and Prescribing Information. - Inclusion Criterion 4 was updated to clarify the length of time and types of previous malignancies that are and are not acceptable for entry into the study. - Inclusion Criterion 5 was modified with language to reinforce that any patients who enrolled into the trial were healthy enough to complete the study. The following changes were made to exclusion criteria: - Exclusion 8 was added to ensure that patients with hypersensitivity reactions to any of the investigational products or comparators were not enrolled. 3. Text for blood collection for biomarkers was modified to ensure that sites were allowed to minimize any extra stress put on the patient by having multiple blood draws in a compressed time frame. 4. Clarification was added regarding participation in other investigational trials while participating in the current study, and also regarding radiotherapy with reference to Treatment for Brain Metastases section. 5. Language was updated to allow sites to use their standard practice for study drug administration while ensuring that any major changes in body weight were accounted for in the BSA calculations for dosing the patient. 6. Added BSA calculation at Baseline. 7. Added guidance for abnormal lymph nodes identified as target lesions, for target lesions documented via digital photography and for the assessment of progressive disease for pleural fluid, ascites, pericardial effusions, and other fluid collections.
    25 Mar 2011
    1. Changes were made throughout the protocol to reflect the acquisition of Abraxis BioScience by Celgene Corporation. 2. Added text to clarify the acceptable window for ABI-007 infusion time (30 – 40 minutes). 3. Added language to clarify that because pharmacokinetic information was not being collected for the dacarbazine treatment arm in this study, the infusion time window for dacarbazine could be determined by guidelines followed at the clinical site. 4. Removed text specific to United States and Canada from the PK sections to allow study sites from additional regions to participate. 5. Added clarification that PK sampling participation was to be determined by the patient. 6. Inclusion criteria were modified to allow enrollment of patients with other malignancies if they were cured by surgery with radiotherapy. 7. Text modified to clarify that the biomarker assays were part of a sub-study involving a subset of patients and that the assays performed were for exploratory purposes and were not validated. 8. Added clarification that follow-up of non-serious AEs will not continue if patient initiates another anti-cancer therapy.
    12 Jun 2012
    1. Updated the IND number on the protocol to IND 115025. IND 115025 administratively split the malignant melanoma indication from the existing IND 055974 for ABI-007 at the request of FDA as a result of the reorganization at the FDA Office of Oncology Drug Products in September 2011. 2. Updated Contact Information to reflect the acquisition of Abraxis BioScience by Celgene Corporation. 3. Added a final patient contact for follow-up OS status. 4. Clarified that lack of efficacy (disease progression) is not considered an AE or SAE. 5. An administrative change to update the safety reporting contact information and the methods for reporting to Celgene Drug Safety instead of Abraxis. 6. Updated the Study Design, Randomization, Sample Size, Power, and Interim Safety Review section (Section 8.1) to reflect the change in timing (and rationale) for the final analysis of the primary endpoint of independently assessed PFS as a result of independent statistical review. 7. Independent review of pooled PFS events revealed that the final event total would be lower than originally planned 379. Thus the final analysis of PFS was performed one year after the last patient was randomized (data cutoff date of 30 Jun 2012). Based on a projected 320 total PFS events, the power to reject the null hypothesis that the ABI-007/dacarbazine HR for PFS is equal to 1.0 will be approximately 72% for HR = 0.750 utilizing the remaining two-sided alpha of 0.049 for the final analysis instead of at least 80% (with a two-sided type I error of 0.049). 
    12 Dec 2012
    1. An administrative change to reflect approval of study drug for the indication of non-small cell lung cancer patients in the US since last protocol revision. 2. Updated OS follow-up to continue to collect survival status beyond 24 months from treatment discontinuation, until death or study termination in all patients. 3. Safety reporting procedures have been broadened to reflect the extended overall survival follow-up period. 4. Administrative change to update signature page with personnel at Celgene Corporation.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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