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    Clinical Trial Results:
    A Phase 2 Study of Panitumumab Plus Irinotecan Followed by Panitumumab Plus AMG 479 in Subjects With Metastatic Colorectal Carcinoma Expressing Wild-type KRAS and Refractory to Oxaliplatin- or Irinotecan- and Oxaliplatin-containing Regimens to Evaluate Mechanisms of Acquired Resistance to Panitumumab

    Summary
    EudraCT number
    2008-004752-77
    Trial protocol
    DE   FR   ES   IT   BE  
    Global end of trial date
    22 Jul 2013

    Results information
    Results version number
    v2(current)
    This version publication date
    08 Jul 2016
    First version publication date
    01 Aug 2015
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Updates to full data set for consistency with ClinicalTrials.gov posting

    Trial information

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    Trial identification
    Sponsor protocol code
    20070820
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00891930
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Amgen, Inc.
    Sponsor organisation address
    One Amgen Center Drive, Thousand Oaks, CA, United States, 91320
    Public contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
    Scientific contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.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
    Final
    Date of interim/final analysis
    22 Jul 2013
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    22 Jul 2013
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Part 1: To determine if acquired resistance to panitumumab therapy in subjects with KRAS wildtype metastatic colorectal cancer (mCRC) correlates with emergence of mutant KRAS tumors. (Acquired resistance is defined as disease progression on panitumumab and irinotecan that occurs after a period of disease response or stable disease on treatment with this regimen is observed and radiographically-confirmed.) Part 2: To determine if inhibition of the insulin-like growth factor-1 receptor (IGF-1R) pathway with ganitumab can overcome resistance to panitumumab therapy, as demonstrated by the objective response rate (ORR) to panitumumab and ganitumab following disease progression on panitumumab and irinotecan.
    Protection of trial subjects
    This study was conducted in accordance with the International Conference on Harmonisation (ICH) Tripartite Guideline on Good Clinical Practice (GCP) and applicable Food and Drug Administration (FDA) regulations/guidelines. The protocol, amendments, proposed informed consent form (ICF), other written subject information, and any proposed advertising material were reviewed and approved by an Institutional Review Board (IRB) before any subjects were recruited into the study and before investigational product (IP) was shipped to the study site. All subjects provided written informed consent before undergoing any study-related procedures, including protocol-specific screening procedures or administration of study medication.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    05 May 2009
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 33
    Country: Number of subjects enrolled
    Belgium: 7
    Country: Number of subjects enrolled
    France: 8
    Country: Number of subjects enrolled
    Germany: 14
    Country: Number of subjects enrolled
    Italy: 14
    Worldwide total number of subjects
    76
    EEA total number of subjects
    76
    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)
    42
    From 65 to 84 years
    34
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Eligible participants were enrolled into Part 1 of the study to receive panitumumab plus irinotecan. Upon radiographically confirmed disease progression, eligible participants proceeded to Part 2 of the study to receive panitumumab plus ganitumab. A total of 100 subjects were screened, 76 subjects were enrolled in part 1 of the study.

    Period 1
    Period 1 title
    Part 1
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Panitumumab + Irinotecan
    Arm description
    Subjects received panitumumab (6 mg/kg starting dose) with irinotecan (starting dose of 180 mg/m²) every 2 weeks (Q2W).
    Arm type
    Experimental

    Investigational medicinal product name
    Panitumumab
    Investigational medicinal product code
    Other name
    Vectibix
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Panitumumab was administered at a starting dose of 6 mg/kg Q2W administered intravenously (IV) by an infusion pump through a peripheral line or indwelling catheter.

    Investigational medicinal product name
    Irinotecan
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Irinotecan was administered IV at a starting dose of 180 mg/m² on Day 1 of each cycle in Part 1 after completion of the panitumumab infusion.

    Number of subjects in period 1
    Panitumumab + Irinotecan
    Started
    76
    Received Treatment
    74
    Completed
    36
    Not completed
    40
         Consent withdrawn by subject
    1
         Death
    38
         Lost to follow-up
    1
    Period 2
    Period 2 title
    Part 2
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Panitumumab + Ganitumab
    Arm description
    Subjects who responded (complete or partial response) or had stable disease in Part 1 proceeded to Part 2 of the study and received treatment with panitumumab (6 mg/kg starting dose) and ganitumab (12 mg/kg starting dose) Q2W.
    Arm type
    Experimental

    Investigational medicinal product name
    Panitumumab
    Investigational medicinal product code
    Other name
    Vectibix
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Panitumumab was administered at a starting dose of 6 mg/kg Q2W administered intravenously (IV) by an infusion pump through a peripheral line or indwelling catheter.

    Investigational medicinal product name
    Ganitumab
    Investigational medicinal product code
    AMG 479
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Ganitumab was administered at a starting dose of 12 mg/mL administered IV by an infusion pump through a peripheral line or indwelling catheter.

    Number of subjects in period 2
    Panitumumab + Ganitumab
    Started
    36
    Completed
    5
    Not completed
    31
         Consent withdrawn by subject
    1
         Death
    30

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Panitumumab + Irinotecan
    Reporting group description
    Subjects received panitumumab (6 mg/kg starting dose) with irinotecan (starting dose of 180 mg/m²) every 2 weeks (Q2W).

    Reporting group values
    Panitumumab + Irinotecan Total
    Number of subjects
    76 76
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    62.4 ± 9.9 -
    Gender categorical
    Units: Subjects
        Female
    28 28
        Male
    48 48
    Race
    Units: Subjects
        White or Caucasian
    75 75
        Other
    1 1
    Primary diagnosis
    Units: Subjects
        Colon Cancer
    49 49
        Rectal Cancer
    27 27

    End points

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    End points reporting groups
    Reporting group title
    Panitumumab + Irinotecan
    Reporting group description
    Subjects received panitumumab (6 mg/kg starting dose) with irinotecan (starting dose of 180 mg/m²) every 2 weeks (Q2W).
    Reporting group title
    Panitumumab + Ganitumab
    Reporting group description
    Subjects who responded (complete or partial response) or had stable disease in Part 1 proceeded to Part 2 of the study and received treatment with panitumumab (6 mg/kg starting dose) and ganitumab (12 mg/kg starting dose) Q2W.

    Subject analysis set title
    Panitumumab
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Participants received panitumumab (6 mg/kg starting dose) with irinotecan (starting dose of 180 mg/m²) every 2 weeks (Q2W) during Part 1. Upon radiographically confirmed disease progression, participants proceeded to Part 2 of the study and received treatment with panitumumab (6 mg/kg starting dose) and ganitumab (12 mg/kg starting dose) Q2W.

    Primary: Part 1: Emergence of Mutant KRAS

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    End point title
    Part 1: Emergence of Mutant KRAS [1]
    End point description
    Mutation in Kirsten rat sarcoma-2 virus oncogene (KRAS) status was determined by examining KRAS exons 2, 3, and 4. The emergence of mutant KRAS was defined as a change in KRAS mutation status from wild-type at Baseline in KRAS exons 2, 3, and 4 to mutant in any of KRAS exons 2, 3, and 4 at the time of the second biopsy following the radiographic evidence of acquired resistance to panitumumab when given in combination with irinotecan. This analysis was performed in the KRAS analysis set which includes treated subjects with known KRAS status at both Baseline and at the 2nd biopsy.
    End point type
    Primary
    End point timeframe
    From first dose of study drug until the 2nd biopsy at the time of disease progression/entry into Part 2; median duration of treatment in Part 1 was 16 weeks.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This is a single-arm study; the EudraCT system does not accept statistics for single arm analyses.
    End point values
    Panitumumab + Irinotecan
    Number of subjects analysed
    25 [2]
    Units: percentage of subjects
        number (confidence interval 95%)
    8 (0.98 to 26.03)
    Notes
    [2] - KRAS Analysis Set with wild-type KRAS at Baseline
    No statistical analyses for this end point

    Primary: Part 2: Objective Response Rate

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    End point title
    Part 2: Objective Response Rate [3]
    End point description
    Objective response rate (ORR) is defined as the incidence of either a confirmed complete response (CR) or partial response (PR) per modified Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 criteria during the treatment period. This analysis was performed in the Tumor Response Evaluable Analysis Set, defined as all subjects who had radiographically confirmed disease progression on panitumumab and irinotecan in Part 1, who received at least 1 dose of panitumumab and/or ganitumab in Part 2, with at least one Baseline uni-dimensionally measurable lesion per the RECIST version 1.0 based on investigators’ review.
    End point type
    Primary
    End point timeframe
    From the first dose of study drug in Part 2 until the end of treatment in Part 2; median duration of treatment in Part 2 was 8 weeks.
    Notes
    [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This is a single-arm study; the EudraCT system does not accept statistics for single arm analyses.
    End point values
    Panitumumab + Ganitumab
    Number of subjects analysed
    36
    Units: percentage of subjects
        number (confidence interval 95%)
    0 (0 to 9.74)
    No statistical analyses for this end point

    Secondary: Part 1: Objective Response Rate

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    End point title
    Part 1: Objective Response Rate
    End point description
    Objective response rate is defined as the percentage of participants with either a confirmed complete response (CR) or partial response (PR) measured by the investigator per modified RECIST version 1.0 criteria during the treatment period. This endpoint was analyzed in the Tumor Response Evaluable Analysis Set – Part 1: all subjects who had known wild-type KRAS tumors from archival tumor sample and who received at least 1 dose of panitumumab and/or irinotecan in Part 1 and with at least one Baseline uni-dimensionally measurable lesion per the RECIST version 1.0 based on investigators’ review.
    End point type
    Secondary
    End point timeframe
    From first dose of study drug until the end of treatment in Part 1; median duration of treatment was 16 weeks.
    End point values
    Panitumumab + Irinotecan
    Number of subjects analysed
    74
    Units: percentage of subjects
        number (confidence interval 95%)
    21.62 (12.89 to 32.72)
    No statistical analyses for this end point

    Secondary: Progression-free Survival

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    End point title
    Progression-free Survival
    End point description
    Progression-free survival was defined as the interval in days from the first dose of study therapy to the earlier date of disease progression (per modified RECIST version 1.0) or death prior to the analysis data cutoff date, initiating a new line of anti-tumor therapy, and receiving study treatment in part 2 where applicable. Subjects who had not progressed or died during this period were censored at their last evaluable disease assessment date. This endpoint was analyzed in the Primary Analysis Set, for Part 1 defined as all subjects who had known wild-type KRAS tumors from archival tumor sample and who received at least 1 dose of panitumumab and/or irinotecan in Part 1, and for Part 2 as all subjects who had radiographically confirmed disease progression on panitumumab and irinotecan in Part 1 and received at least 1 dose of panitumumab and/or ganitumab in Part 2.
    End point type
    Secondary
    End point timeframe
    From the first dose of study drug until the data cut-off date of 30 July 2013. Median time on study follow-up was 48.5 weeks for Part 1 and 32 weeks in Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    74
    36
    Units: months
        median (confidence interval 95%)
    4.6 (3.7 to 6.9)
    1.7 (1.6 to 1.8)
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    Overall survival was defined as the time from the first dose of study therapy in Part 1 or Part 2 to the date of death. Subjects who had not died by the analysis data cutoff date were censored at their last contact date. This endpoint was analyzed in the Primary Analysis Set.
    End point type
    Secondary
    End point timeframe
    From the first dose of study drug until the data cut-off date of 30 July 2013. Median time on study follow-up was 48.5 weeks for Part 1 and 32 weeks in Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    74
    36
    Units: months
        median (confidence interval 95%)
    11.6 (7.8 to 12.9)
    7.6 (5.6 to 12.3)
    No statistical analyses for this end point

    Secondary: Time to Objective Response

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    End point title
    Time to Objective Response
    End point description
    Time to objective reponse was defined as time from first dose of study drug to the first confirmed objective response. An objective response is defined as a confirmed complete response or partial response per modified RECIST v1.0 criteria during the treatment period. This endpoint was analyzed in the Tumor Response Evaluable Analysis Set - Part 1 and Part 2 participants with an objective response.
    End point type
    Secondary
    End point timeframe
    From the first dose of study drug until the end of treatment in each part; median duration of treatment was 16 weeks in Part 1 and 8 weeks in Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    16 [4]
    0 [5]
    Units: Months
        median (full range (min-max))
    1.8 (1.6 to 3)
    ( to )
    Notes
    [4] - Subjects with an objective response in Part 1
    [5] - Subjects with an objective response In Part 2
    No statistical analyses for this end point

    Secondary: Duration of response

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    End point title
    Duration of response
    End point description
    Duration of response is defined as the time from the first confirmed objective response to the earlier date of disease progression or death. An objective response is defined as a confirmed complete response or partial response per modified RECIST v1.0 criteria during the treatment period. This endpoint was analyzed in the Tumor Response Evaluable Analysis Set - Part 1 and Part 2 participants with an objective response
    End point type
    Secondary
    End point timeframe
    From the first dose of study drug until the data cut-off date of 30 July 2013. Median time on study follow-up was 48.5 weeks for Part 1 and 32 weeks in Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    16 [6]
    0 [7]
    Units: months
        median (confidence interval 95%)
    7.7 (6.7 to 9.1)
    ( to )
    Notes
    [6] - Subjects with an objective response in Part 1
    [7] - Subjects with an objective response in Part 2
    No statistical analyses for this end point

    Secondary: Number of Subjects Who Developed Antibodies to Panitumumab

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    End point title
    Number of Subjects Who Developed Antibodies to Panitumumab
    End point description
    Two screening immunoassays, an acid-dissociation enzyme-linked immunosorbent assay (ELISA) and a Biacore-based biosensor assay, were used to detect antibodies capable of binding to panitumumab. Positive samples were further tested for neutralizing antibodies in a cell-based epidermal growth factor receptor (EGFR) phosphorylation bioassay.
    End point type
    Secondary
    End point timeframe
    From first dose date to 30 days since the last dose date. The median time frame is 4.2 months for Part 1 and 2.4 months for Part 2.
    End point values
    Panitumumab
    Number of subjects analysed
    25 [8]
    Units: subjects
        Binding antibody positive
    0
        Neutralizing antibody positive
    0
    Notes
    [8] - Subjects with at least 1 post-baseline immunoassay result
    No statistical analyses for this end point

    Secondary: Number of Subjects Who Developed Antibodies to Ganitumab

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    End point title
    Number of Subjects Who Developed Antibodies to Ganitumab
    End point description
    Two validated assays were used to detect the presence of anti-ganitumab antibodies. First, an electrochemiluminescent bridging immunoassay was used to detect binding antibodies (screening assay) and confirm antibodies (confirmatory assay) capable of binding ganitumab. Second, a cell-based bioassay was used to test positive binding antibody samples for neutralizing activity against ganitumab.
    End point type
    Secondary
    End point timeframe
    From first dose of ganitumab until 30 days after last dose; median time frame was 2.4 months.
    End point values
    Panitumumab + Ganitumab
    Number of subjects analysed
    15 [9]
    Units: subjects
        Binding antibody positive
    0
        Neutralizing antibody positive
    0
    Notes
    [9] - Subjects with at least 1 immunoassay result in Part 2
    No statistical analyses for this end point

    Secondary: Number of Subjects With Adverse Events

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    End point title
    Number of Subjects With Adverse Events
    End point description
    The severity of each adverse event (AE) was graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 (where 1 = Mild [aware of sign or symptom, but easily tolerated]; 2 = Moderate [discomfort enough to cause interference with usual activity]; 3 = severe [incapacitating with inability to work or do usual activity]; 4 = life-threatening; 5 = fatal), with the exception of selected skin toxicities that were graded using a modified version of CTC. Treatment-related adverse events were those events for which the investigator considered there to be a reasonable possibility that the event may have been caused by panitumumab (Part 1) and by panitumumab and/or ganitumab (Part 2). Discontinuation includes AEs leading to discontinuation of panitumumab (Part 1) and panitumumab, ganitumab (Part 2) or removal from the study.
    End point type
    Secondary
    End point timeframe
    From first dose date to 30 days since the last dose date in each part of the study. The median time frame is 4.2 months for Part 1 and 2.4 months for Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    74
    36
    Units: subjects
        Any adverse event (AE)
    74
    35
        Worst grade of 3
    43
    17
        Worst grade of 4
    6
    1
        Worst grade of 5
    6
    2
        Worst grade of 5 excluding progressive disease
    1
    0
        Serious adverse event (SAE)
    26
    8
        AE leading to discontinuation
    3
    1
        SAE leading to discontinuation
    8
    1
        Any treatment-related adverse event (TRAE)
    70
    33
        TRAE worst grade of 3
    34
    7
        TRAE worst grade of 4
    3
    1
        TRAE worst grade of 5
    0
    0
        TRAE worst grade 5 excluding progressive disease
    0
    0
        Treatment-related SAE
    7
    1
        TRAE leading to discontinuation
    0
    1
        Serious TRAE leading to discontinuation
    1
    0
    No statistical analyses for this end point

    Secondary: Number of Subjects With Worst Post-baseline Grade 3 or Higher Laboratory Toxicities

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    End point title
    Number of Subjects With Worst Post-baseline Grade 3 or Higher Laboratory Toxicities
    End point description
    The severity of laboratory toxicities was graded using CTCAE v3.0.
    End point type
    Secondary
    End point timeframe
    From first dose date to 30 days since the last dose date in each part of the study. The median time frame is 4.2 months for Part 1 and 2.4 months for Part 2.
    End point values
    Panitumumab + Irinotecan Panitumumab + Ganitumab
    Number of subjects analysed
    74
    36
    Units: subjects
        Decreased absolute neutrophil count
    3
    0
        Decreased hemoglobin
    3
    0
        Decreased lymphocytes
    3
    0
        Decreased total neutrophils
    2
    0
        Decreased white blood cells
    2
    0
        Decreased albumin
    1
    0
        Increased alkaline phosphatase
    5
    2
        Increased aspartate aminotransferase
    1
    1
        Decreased calcium
    4
    1
        Increased creatinine
    1
    0
        Decreased glucose
    2
    0
        Increased glucose
    1
    2
        Decreased magnesium
    9
    2
        Increased magnesium
    2
    2
        Decreased phosphorus
    2
    1
        Decreased potassium
    7
    0
        Increased potassium
    3
    0
        Decreased sodium
    7
    0
        Increased total bilirubin
    3
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose date to 30 days since the last dose date in each part of the study. The median time frame is 4.2 months for Part 1 and 2.4 months for Part 2.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.0
    Reporting groups
    Reporting group title
    Part2: Panitumumab + Ganitumab
    Reporting group description
    Subjects who responded (complete or partial response) or had stable disease in Part 1 proceeded to Part 2 of the study and received treatment with panitumumab (6 mg/kg starting dose) and ganitumab (12 mg/kg starting dose) Q2W.

    Reporting group title
    Part1: Panitumumab + Irinotecan
    Reporting group description
    Subjects received panitumumab (6 mg/kg starting dose) with irinotecan (starting dose of 180 mg/m²) every 2 weeks (Q2W).

    Serious adverse events
    Part2: Panitumumab + Ganitumab Part1: Panitumumab + Irinotecan
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 36 (22.22%)
    26 / 74 (35.14%)
         number of deaths (all causes)
    2
    6
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Colorectal cancer
         subjects affected / exposed
    2 / 36 (5.56%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    Metastases to peritoneum
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         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
    Fatigue
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 36 (0.00%)
    3 / 74 (4.05%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    2 / 36 (5.56%)
    5 / 74 (6.76%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 8
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    Performance status decreased
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Pyrexia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 74 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    1 / 36 (2.78%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Atelectasis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Weight decreased
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Nervous system disorders
    Paresis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 36 (0.00%)
    6 / 74 (8.11%)
         occurrences causally related to treatment / all
    0 / 0
    3 / 6
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oesophagitis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    1 / 36 (2.78%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Stomatitis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 36 (0.00%)
    3 / 74 (4.05%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholangitis
         subjects affected / exposed
    1 / 36 (2.78%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholestasis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure acute
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         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
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bone pain
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Muscle contracture
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myalgia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Anal abscess
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         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
    0 / 36 (0.00%)
    2 / 74 (2.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypomagnesaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 74 (1.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Part2: Panitumumab + Ganitumab Part1: Panitumumab + Irinotecan
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    35 / 36 (97.22%)
    74 / 74 (100.00%)
    Vascular disorders
    Haematoma
         subjects affected / exposed
    1 / 36 (2.78%)
    4 / 74 (5.41%)
         occurrences all number
    1
    5
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    12 / 36 (33.33%)
    39 / 74 (52.70%)
         occurrences all number
    22
    109
    Chest pain
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    5
    Chills
         subjects affected / exposed
    3 / 36 (8.33%)
    2 / 74 (2.70%)
         occurrences all number
    3
    2
    Fatigue
         subjects affected / exposed
    5 / 36 (13.89%)
    12 / 74 (16.22%)
         occurrences all number
    8
    26
    General physical health deterioration
         subjects affected / exposed
    1 / 36 (2.78%)
    6 / 74 (8.11%)
         occurrences all number
    1
    6
    Mucosal inflammation
         subjects affected / exposed
    4 / 36 (11.11%)
    25 / 74 (33.78%)
         occurrences all number
    5
    71
    Oedema peripheral
         subjects affected / exposed
    4 / 36 (11.11%)
    5 / 74 (6.76%)
         occurrences all number
    5
    7
    Pyrexia
         subjects affected / exposed
    4 / 36 (11.11%)
    12 / 74 (16.22%)
         occurrences all number
    5
    15
    Xerosis
         subjects affected / exposed
    2 / 36 (5.56%)
    7 / 74 (9.46%)
         occurrences all number
    2
    9
    Respiratory, thoracic and mediastinal disorders
    Dysphonia
         subjects affected / exposed
    1 / 36 (2.78%)
    4 / 74 (5.41%)
         occurrences all number
    1
    4
    Cough
         subjects affected / exposed
    2 / 36 (5.56%)
    8 / 74 (10.81%)
         occurrences all number
    2
    10
    Dyspnoea
         subjects affected / exposed
    2 / 36 (5.56%)
    7 / 74 (9.46%)
         occurrences all number
    2
    9
    Epistaxis
         subjects affected / exposed
    3 / 36 (8.33%)
    2 / 74 (2.70%)
         occurrences all number
    3
    2
    Oropharyngeal pain
         subjects affected / exposed
    1 / 36 (2.78%)
    5 / 74 (6.76%)
         occurrences all number
    1
    5
    Productive cough
         subjects affected / exposed
    0 / 36 (0.00%)
    5 / 74 (6.76%)
         occurrences all number
    0
    5
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    0 / 36 (0.00%)
    8 / 74 (10.81%)
         occurrences all number
    0
    9
    Investigations
    Weight decreased
         subjects affected / exposed
    1 / 36 (2.78%)
    8 / 74 (10.81%)
         occurrences all number
    1
    9
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    3 / 36 (8.33%)
    2 / 74 (2.70%)
         occurrences all number
    3
    2
    Congenital, familial and genetic disorders
    Trichomegaly
         subjects affected / exposed
    0 / 36 (0.00%)
    5 / 74 (6.76%)
         occurrences all number
    0
    7
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    4
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    2 / 36 (5.56%)
    5 / 74 (6.76%)
         occurrences all number
    3
    5
    Headache
         subjects affected / exposed
    0 / 36 (0.00%)
    6 / 74 (8.11%)
         occurrences all number
    0
    6
    Neurotoxicity
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    4
    Paraesthesia
         subjects affected / exposed
    0 / 36 (0.00%)
    5 / 74 (6.76%)
         occurrences all number
    0
    6
    Polyneuropathy
         subjects affected / exposed
    0 / 36 (0.00%)
    5 / 74 (6.76%)
         occurrences all number
    0
    6
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    3 / 36 (8.33%)
    11 / 74 (14.86%)
         occurrences all number
    4
    24
    Neutropenia
         subjects affected / exposed
    2 / 36 (5.56%)
    9 / 74 (12.16%)
         occurrences all number
    3
    22
    Eye disorders
    Conjunctivitis
         subjects affected / exposed
    3 / 36 (8.33%)
    9 / 74 (12.16%)
         occurrences all number
    3
    12
    Dry eye
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    6
    Gastrointestinal disorders
    Abdominal distension
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    4
    Abdominal pain
         subjects affected / exposed
    8 / 36 (22.22%)
    17 / 74 (22.97%)
         occurrences all number
    8
    25
    Constipation
         subjects affected / exposed
    8 / 36 (22.22%)
    20 / 74 (27.03%)
         occurrences all number
    11
    29
    Abdominal pain upper
         subjects affected / exposed
    7 / 36 (19.44%)
    8 / 74 (10.81%)
         occurrences all number
    10
    9
    Diarrhoea
         subjects affected / exposed
    8 / 36 (22.22%)
    54 / 74 (72.97%)
         occurrences all number
    10
    241
    Dyspepsia
         subjects affected / exposed
    2 / 36 (5.56%)
    6 / 74 (8.11%)
         occurrences all number
    2
    6
    Haemorrhoids
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    6
    Nausea
         subjects affected / exposed
    10 / 36 (27.78%)
    38 / 74 (51.35%)
         occurrences all number
    14
    91
    Stomatitis
         subjects affected / exposed
    2 / 36 (5.56%)
    5 / 74 (6.76%)
         occurrences all number
    2
    11
    Vomiting
         subjects affected / exposed
    4 / 36 (11.11%)
    28 / 74 (37.84%)
         occurrences all number
    7
    49
    Hepatobiliary disorders
    Hepatic pain
         subjects affected / exposed
    2 / 36 (5.56%)
    2 / 74 (2.70%)
         occurrences all number
    2
    3
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    2 / 36 (5.56%)
    10 / 74 (13.51%)
         occurrences all number
    4
    25
    Alopecia
         subjects affected / exposed
    1 / 36 (2.78%)
    23 / 74 (31.08%)
         occurrences all number
    1
    38
    Dermatitis acneiform
         subjects affected / exposed
    3 / 36 (8.33%)
    8 / 74 (10.81%)
         occurrences all number
    3
    21
    Dry skin
         subjects affected / exposed
    5 / 36 (13.89%)
    24 / 74 (32.43%)
         occurrences all number
    6
    42
    Erythema
         subjects affected / exposed
    1 / 36 (2.78%)
    5 / 74 (6.76%)
         occurrences all number
    1
    9
    Eczema
         subjects affected / exposed
    2 / 36 (5.56%)
    1 / 74 (1.35%)
         occurrences all number
    2
    1
    Nail bed inflammation
         subjects affected / exposed
    3 / 36 (8.33%)
    0 / 74 (0.00%)
         occurrences all number
    4
    0
    Nail toxicity
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    12
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    3 / 36 (8.33%)
    1 / 74 (1.35%)
         occurrences all number
    3
    1
    Pruritus
         subjects affected / exposed
    2 / 36 (5.56%)
    13 / 74 (17.57%)
         occurrences all number
    2
    20
    Skin fissures
         subjects affected / exposed
    3 / 36 (8.33%)
    19 / 74 (25.68%)
         occurrences all number
    5
    37
    Rash
         subjects affected / exposed
    15 / 36 (41.67%)
    39 / 74 (52.70%)
         occurrences all number
    38
    145
    Skin toxicity
         subjects affected / exposed
    3 / 36 (8.33%)
    14 / 74 (18.92%)
         occurrences all number
    6
    55
    Renal and urinary disorders
    Dysuria
         subjects affected / exposed
    2 / 36 (5.56%)
    4 / 74 (5.41%)
         occurrences all number
    2
    5
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 36 (0.00%)
    4 / 74 (5.41%)
         occurrences all number
    0
    5
    Back pain
         subjects affected / exposed
    3 / 36 (8.33%)
    9 / 74 (12.16%)
         occurrences all number
    3
    11
    Musculoskeletal chest pain
         subjects affected / exposed
    2 / 36 (5.56%)
    1 / 74 (1.35%)
         occurrences all number
    2
    1
    Musculoskeletal pain
         subjects affected / exposed
    4 / 36 (11.11%)
    6 / 74 (8.11%)
         occurrences all number
    4
    7
    Infections and infestations
    Infection
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 74 (0.00%)
         occurrences all number
    2
    0
    Folliculitis
         subjects affected / exposed
    2 / 36 (5.56%)
    6 / 74 (8.11%)
         occurrences all number
    4
    12
    Nasopharyngitis
         subjects affected / exposed
    1 / 36 (2.78%)
    4 / 74 (5.41%)
         occurrences all number
    1
    4
    Paronychia
         subjects affected / exposed
    7 / 36 (19.44%)
    18 / 74 (24.32%)
         occurrences all number
    10
    40
    Urinary tract infection
         subjects affected / exposed
    3 / 36 (8.33%)
    5 / 74 (6.76%)
         occurrences all number
    3
    5
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    5 / 36 (13.89%)
    28 / 74 (37.84%)
         occurrences all number
    6
    40
    Hypokalaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    6 / 74 (8.11%)
         occurrences all number
    0
    8
    Hypomagnesaemia
         subjects affected / exposed
    5 / 36 (13.89%)
    22 / 74 (29.73%)
         occurrences all number
    6
    59

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    01 Oct 2009
    - Inclusion criteria were updated to allow the use of other experienced laboratories to confirm wild-type KRAS tumor status of archival tumor tissue using a validated test method per local regulatory guidelines, in addition to Amgen approved central laboratory. - Screening procedures were updated to include various methods of obtaining KRAS tumor status determination by an Amgen approved central laboratory or an experienced laboratory (local laboratory) per local regulatory guidelines using a validated test method. - Inclusion/exclusion criteria, dose adjustment, and discontinuation criteria were updated based on new requirements for ganitumab. - The section on long-term follow-up was updated to include the procedure for assessment of anti-panitumumab and antiganitumab antibodies. - Reporting procedures for all adverse events were updated with specific timelines to report any adverse event. - The version of Response Evaluation Criteria in Solid Tumors (RECIST) utilized in this study was updated to 1.0. - The drug storage and handling information for panitumumab and ganitumab was updated in the pharmacy guide.
    27 May 2011
    - To address a potential risk of formation of particles in vials of ganitumab that has been exposed to temperatures < - 30°C, a requirement was added to use an in-line, nonpyrogenic, low-protein-binding 0.2- or 0.22-micron filter when administering ganitumab. - Reporting procedures for all adverse events were updated to clarify the reporting procedures for non-serious adverse events. Additionally, serious adverse event reporting procedures were updated to include reporting methods other than fax, eg, electronic reporting. - Secondary endpoints were updated in line with the statistical analysis plan.
    14 Nov 2012
    - The duration of the long term follow-up for survival was shortened and the primary analysis and final analysis were combined into a single analysis because the majority of enrolled subjects (75 out of the 76 [99%]) had already ended the study treatment and safety follow-up, and it was expected that at least 66 out of the 76 enrolled subjects [87%] would end the long term follow-up and the study due to death by the time of the analysis data cut-off date. - The period of long term follow-up for survival was modified to end approximately 2 years (± 2 months) after the last subject is enrolled in part 1. - The definition of the end of study for a subject was updated to include the date the subject completes the 30-day safety follow-up visit. - The criterion for end of study was revised to include flexibility of ± 2 months at 2 years after the last subject is enrolled in part 1. - A new section was added to limit data collection from subjects who remained on treatment after all planned study analyses were completed to investigational product administration and serious adverse event reporting through 30 days after the last dose of study treatment. - The serious adverse event reporting timeline was changed from 1 working day to 24 hours. - A new section was added on pregnancy and lactation reporting procedures. - The timing of the final analysis was updated to occur after a minimum potential follow-up of 2 years (± 2 months) after the last subject is enrolled in part 1. - Pregnancy Notification Worksheet was updated and the Lactation Notification Worksheet was included.

    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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