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    Clinical Trial Results:
    Dynamic contrast enhanced MRI (DCE-MRI) assessment of the vascular changes induced with bevacizumab alone and in combination with interferon-α in patients with advanced renal cell carcinoma.

    Summary
    EudraCT number
    2008-006414-19
    Trial protocol
    GB  
    Global end of trial date

    Results information
    Results version number
    v1(current)
    This version publication date
    26 Jun 2019
    First version publication date
    26 Jun 2019
    Other versions
    Summary report(s)
    Interim analysis early termination

    Trial information

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    Trial identification
    Sponsor protocol code
    RD2007-114
    Additional study identifiers
    ISRCTN number
    ISRCTN08193901
    US NCT number
    NCT00873236
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    East and North Hertfordshire NHS Trust
    Sponsor organisation address
    Coreys Mill Lane, Stevenage, United Kingdom, SG14AB
    Public contact
    Phillip Smith, Associate Director of Research and Development, East and North Hertfordshire NHS Trust , 0203 826 2075, phillip.smith5@nhs.net
    Scientific contact
    Dr Paul Nathan, Consultant Oncologist, East and North Hertfordshire NHS Trust , 0203 826 2444, p.nathan@nhs.net
    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
    22 Mar 2013
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    To establish whether bevacizumab induced changes in DCE MRI vascular parameters are significantly enhanced by interferon-α And if so: To establish whether there is an IFN dose response in potentiating bevacizumab induced changes in DCE-MRI vascular parameters.
    Protection of trial subjects
    Patients had the potential benefit of accessing the trial treatment with proven activity for advanced renal cell carcinoma. An independent Advisor unrelated to the investigators and sponsors reviewed the safety data once 8 weeks of data had been accrued for 15 patients.
    Background therapy
    N/A
    Evidence for comparator
    N/A
    Actual start date of recruitment
    19 Nov 2009
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 21
    Worldwide total number of subjects
    21
    EEA total number of subjects
    21
    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)
    18
    From 65 to 84 years
    3
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    25 patients were screened for the study between December 2009 and February 2012. The steering committee performed an un-planned interim analysis after 24 months of recruitment to assess for any trends to justify continued recruitment in the trial. At this point, excluding the 4 screen failures, 21 patients were randomised into the three arms

    Pre-assignment
    Screening details
    Metastatic (stage IV) or locally advanced (inoperable stage III) RCC Male or female patients aged ≥ 18 years with good or intermediate prognosis by Motzer score who were systemic treatment naïve in metastatic setting formed the subjects of this trial.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    n/a

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A
    Arm description
    Bevacizumab 10mg/kg every 2 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    EU/1/04/300/001
    Other name
    Avastin
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    10mg/kg/2 weeks

    Arm title
    Arm B
    Arm description
    Bevacizumab 10mg/kg every 2 weeks plus low-dose IFN-α2a 3MU Three times in a week (t.i.w), commencing on Day 0
    Arm type
    Experimental

    Investigational medicinal product name
    Roferon-A
    Investigational medicinal product code
    PL 0031/0485
    Other name
    IFN-α
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Patients in Arm B had a maximum of 3MU of interferon subcutaneously three times a week, commencing on day 0.

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    EU/1/04/300/001
    Other name
    Avastin
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    10mg/kg/2 weeks

    Arm title
    Arm C
    Arm description
    Bevacizumab 10mg/kg every 2 weeks plus standard dose IFN-α2a 9 MU t.i.w. Patients will commence on IFN-α 3MU t.i.w on Day 0, and escalate dose to 9MU t.i.w on Day 14.
    Arm type
    Experimental

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    EU/1/04/300/001
    Other name
    Avastin
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    10mg/kg/2 weeks

    Investigational medicinal product name
    Roferon-A
    Investigational medicinal product code
    PL 0031/0485
    Other name
    IFN-α
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Patients in Arm C had a maximum of 9MU of interferon subcutaneously three times a week.

    Number of subjects in period 1
    Arm A Arm B Arm C
    Started
    6
    9
    6
    Completed
    6
    9
    6

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    21 21
    Age categorical
    Male and Female subjects ≥ 18 years with previously untreated metastatic (stage IV) or locally advanced (inoperable stage III) renal cell carcinoma were recruited. 21 patients were randomised in the following age groups: - 40-50 years - 5 patients -50-60 years - 5 patients -60-70 years - 8 patients -70-75 years - 2 patients - Over 75 years - 1 patient
    Units: Subjects
        40-50 years
    5 5
        50 - 60 years
    5 5
        60-70 years
    8 8
        70-75 years
    2 2
        Over 75
    1 1
    Gender categorical
    Units: Subjects
        Female
    2 2
        Male
    19 19

    End points

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    End points reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks

    Reporting group title
    Arm B
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks plus low-dose IFN-α2a 3MU Three times in a week (t.i.w), commencing on Day 0

    Reporting group title
    Arm C
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks plus standard dose IFN-α2a 9 MU t.i.w. Patients will commence on IFN-α 3MU t.i.w on Day 0, and escalate dose to 9MU t.i.w on Day 14.

    Primary: Primary

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    End point title
    Primary [1]
    End point description
    Primary objective: To establish whether bevacizumab induced changes in DCE MRI vascular parameters are significantly enhanced by interferon-α And if so: To establish whether there is an IFN dose response in potentiating bevacizumab induced changes in DCE-MRI vascular parameters. Primary endpoint: DCE-MRI defined changes in Ktrans after 6 weeks of bevacizumab monotherapy or bevacizumab and low or standard dose IFN-α
    End point type
    Primary
    End point timeframe
    After 6 weeks of bevacizumab monotherapy or bevacizumab and low or standard dose IFN-α
    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: Statistical analyses available in attached publication
    End point values
    Arm A Arm B Arm C
    Number of subjects analysed
    4
    7
    4
    Units: Changes in Ktrans
    4
    7
    4
    Attachments
    Interim analysis
    No statistical analyses for this end point

    Secondary: Secondary

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    End point title
    Secondary
    End point description
    Secondary objectives: 1. To correlate changes in DCE-MRI vascular parameters for each treatment group with the following: • progression free survival • tumour response and changes in tumour size • other surrogate biomarkers 2. To assess the degree of change in baseline Ktrans within each arm of treatment 3.To investigate changes in Diffusion and BOLD MRI and their correlation with other pharmacodynamic endpoints. 4. To assess the efficacy and safety profile of bevacizumab monotherapy or in combination with low or standard doses of IFN
    End point type
    Secondary
    End point timeframe
    Secondary endpoints: Change in vascular permeability (Ktrans), Response, Treatment duration, withdrawal, dose modification, incidence of AEs and biomarker correlations
    End point values
    Arm A Arm B Arm C
    Number of subjects analysed
    4
    7
    4
    Units: Various
    4
    7
    4
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Serious and non-serious adverse events were collected up to 28 days after the last bevacizumab infusion.
    Adverse event reporting additional description
    Serious adverse events (SAEs) related to bevacizumab were reported for the duration of the study. Intensity of all adverse events were graded according to the NCI Common Terminology Criteria for Adverse Events v 3.0 (CTCAE) on a five-point scale (Grade 1 to 5).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    3.0
    Reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks

    Reporting group title
    Arm B
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks plus low-dose IFN-α2a 3MU Three times in a week (t.i.w), commencing on Day 0

    Reporting group title
    Arm C
    Reporting group description
    Bevacizumab 10mg/kg every 2 weeks plus standard dose IFN-α2a 9 MU t.i.w. Patients will commence on IFN-α 3MU t.i.w on Day 0, and escalate dose to 9MU t.i.w on Day 14.

    Serious adverse events
    Arm A Arm B Arm C
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    3 / 5 (60.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Gastrointestinal disorders
    Proctitis
    Additional description: Rectal Bleed assessed as not related to Avastin although Avastin permanently discontinued.
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Pregnancy of partner
    Additional description: Patient's partner conceived while patient was taking Avastin + INFa
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Infection
    Additional description: Chest Infection not related to study drugs
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epistaxis
    Additional description: Epistaxis Grade 2 Related to Avastin required cauterization.
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Bladder obstruction
    Additional description: Bladder obstruction caused by clot retention unrelated to study drugs
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Viral infection
    Additional description: Viral Illness with hospitalisation not related to study drugs
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Arm A Arm B Arm C
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 5 (80.00%)
    5 / 5 (100.00%)
    5 / 5 (100.00%)
    Vascular disorders
    Hot flush
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Hypertension
         subjects affected / exposed
    2 / 5 (40.00%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
         occurrences all number
    3
    0
    2
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 5 (20.00%)
    1 / 5 (20.00%)
         occurrences all number
    1
    2
    1
    General disorders and administration site conditions
    Chills
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Fatigue
         subjects affected / exposed
    2 / 5 (40.00%)
    5 / 5 (100.00%)
    4 / 5 (80.00%)
         occurrences all number
    2
    16
    6
    Influenza
    Additional description: Fevers, rigors and/or shivers/flu-like symptoms.
         subjects affected / exposed
    2 / 5 (40.00%)
    1 / 5 (20.00%)
    1 / 5 (20.00%)
         occurrences all number
    2
    1
    1
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Diarrhoea
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 5 (60.00%)
    3 / 5 (60.00%)
         occurrences all number
    0
    4
    5
    Mucositis management
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Nausea
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    3
    2
    Vomiting
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    1
    0
    Epistaxis
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    0
    3
    Throat irritation
    Additional description: Hoarse voice
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    0
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 5 (60.00%)
    0 / 5 (0.00%)
         occurrences all number
    0
    3
    0
    Dry skin
    Additional description: Dry lips
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    0
    1
    Palmar-plantar erythrodysaesthesia syndrome
    Additional description: Dry lips and/or stomatitis
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 5 (20.00%)
    4 / 5 (80.00%)
         occurrences all number
    2
    2
    5
    Rash maculo-papular
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    3
    1
    Hyperhidrosis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    2
    1
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    1
    2
    Insomnia
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
         occurrences all number
    0
    1
    0
    Proteinuria
         subjects affected / exposed
    1 / 5 (20.00%)
    3 / 5 (60.00%)
    3 / 5 (60.00%)
         occurrences all number
    1
    15
    3
    Musculoskeletal and connective tissue disorders
    Myalgia
    Additional description: Muscle aches
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 5 (20.00%)
    1 / 5 (20.00%)
         occurrences all number
    1
    1
    1
    Metabolism and nutrition disorders
    Appetite disorder
    Additional description: Anorexia No. of patients with grad 1 or 2 AE: 6 No. of patients with grad 3 or 4 AE: 2
         subjects affected / exposed
    1 / 5 (20.00%)
    3 / 5 (60.00%)
    3 / 5 (60.00%)
         occurrences all number
    1
    6
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Mar 2010
    1. Inclusion criteria - Calculated creatinine clearance > 50ml/min to be used in place of serum creatinine < 1.5 ULN. 2. To include prior adjuvant antiangiogenic treatment in the last 6 months as an exclusion criteria
    05 Jan 2011
    Update to the safety information regarding the use of AVASTIN (bevacizumab).

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    20 Sep 2012
    Temporary halt to recruitment to perform an interim futility analysis with current dataset.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    5 patients were excluded from the primary DCE-MRI analysis due to technical reasons. 5 patients had to be excluded from the primary DCE-MRI analysis due to technical reasons. Slow recruitment due to inclusion/exclusion criteria.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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