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    Clinical Trial Results:
    Phase II Evaluating Efficacy of Temsirolimus in 2 Line Therapy for Patients With Advanced Bladder Cancer (VESTOR)

    Summary
    EudraCT number
    2009-011049-15
    Trial protocol
    FR  
    Global end of trial date
    15 Dec 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    05 Feb 2022
    First version publication date
    05 Feb 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    IB 2009–08
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01827943
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Institut Bergonié
    Sponsor organisation address
    229 cours de l'Argonne, Bordeaux, France, 33076
    Public contact
    Regulatory Affairs Management Desk, Institut Bergonié, drci@bordeaux.unicancer.fr
    Scientific contact
    Regulatory Affairs Management Desk, Institut Bergonié, drci@bordeaux.unicancer.fr
    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
    23 Jan 2015
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    15 Dec 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Dec 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate efficacy of Temsirolimus in terms of 2-month non-progression rate (RECIST V1.1)
    Protection of trial subjects
    A supervisory committee is constitued to evaluate the benefit/risk ratio along the study period.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    27 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
    France: 54
    Worldwide total number of subjects
    54
    EEA total number of subjects
    54
    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)
    24
    From 65 to 84 years
    29
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    •Men or women of at least 18 years of age •Histologically proven Bladder cancer •Locally advanced or metastatic disease (stage IV)

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

    Arms
    Arm title
    Temsirolimus
    Arm description
    Temsirolimus was administered intravenously at a dose of 25 mg in a weekly 30 min infusion and was associated to anti-H1 treatment. One cycle corresponded to 4 weeks of treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Torisel
    Investigational medicinal product code
    Temsirolimus
    Other name
    Pharmaceutical forms
    Solution for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Torisel® will be administered at a fixed dose of 25mg, once a week. A cycle will consist of 4 injections: D1, D8, D15, D22. Pre-medication with 25 to 50 mg of diphenhydramine IV (or a comparable anti-H1 antihistamine) should be initiated approximately 30 minutes prior to the Temsirolimus infusion.

    Number of subjects in period 1
    Temsirolimus
    Started
    54
    Completed
    45
    Not completed
    9
         Never treated because of rapid progression
    1
         Protocol deviation
    8

    Baseline characteristics

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

    Reporting group values
    Overall study Total
    Number of subjects
    54 54
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    65 (41 to 87) -
    Gender categorical
    Units: Subjects
        Female
    12 12
        Male
    42 42

    End points

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    End points reporting groups
    Reporting group title
    Temsirolimus
    Reporting group description
    Temsirolimus was administered intravenously at a dose of 25 mg in a weekly 30 min infusion and was associated to anti-H1 treatment. One cycle corresponded to 4 weeks of treatment.

    Primary: Non-progression rate at 2 months

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    End point title
    Non-progression rate at 2 months [1]
    End point description
    Non-progression rate is defined as the rate of participants in complete or partial response or stable disease according to RECIST V1.1. Complete response is defined as the disappearance of all target lesions, partial response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters and stable disease occurs when neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progression, taking as reference the smallest sum diameters while on study.
    End point type
    Primary
    End point timeframe
    2 months
    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: No statistical test has been performed, only the confidence interval calculation
    End point values
    Temsirolimus
    Number of subjects analysed
    45 [2]
    Units: percentage of patients
        number (confidence interval 95%)
    48.9 (33.7 to 64.2)
    Notes
    [2] - 45 eligible patients with at least one treatment administration and tumor assessment at 2 months
    No statistical analyses for this end point

    Secondary: Overall survival

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    End point title
    Overall survival
    End point description
    OS was was defined as the time from the treatment initiation to death due to any cause. Participants without documented death were censored at the date of the last follow-up or last patient contact. The OS was calculated using the product-limit (Kaplan-Meier) method for censored data.
    End point type
    Secondary
    End point timeframe
    Through Database Cutoff Date of 23-Jan-2015 (up to approximately 5 years and 7 months - median follow-up time of 14 months)
    End point values
    Temsirolimus
    Number of subjects analysed
    45
    Units: months
        median (confidence interval 95%)
    7.2 (5.2 to 9.5)
    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 (PFS) was defined as the time from the initiation of treatment to the first documented progression (as per RECIST v1.1) or death (due to any cause), whichever occurs first. Per RECIST 1.1, PD was defined as ≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. Patients alive and progression free were censored at the date of last follow-up or last patient contact. The PFS per RECIST 1.1 was calculated using the product-limit (Kaplan-Meier) method for censored data.
    End point type
    Secondary
    End point timeframe
    Through Database Cutoff Date of 23-Jan-2015 (up to approximately 5 years and 7 months - median follow-up time of 14 months)
    End point values
    Temsirolimus
    Number of subjects analysed
    45
    Units: months
        median (confidence interval 95%)
    2.8 (1.8 to 3.7)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    The adverse event are reported from the signature of the informed consent form to 30 days after the last treatment administration.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    3.0
    Reporting groups
    Reporting group title
    Temsirolimus
    Reporting group description
    -

    Serious adverse events
    Temsirolimus
    Total subjects affected by serious adverse events
         subjects affected / exposed
    35 / 53 (66.04%)
         number of deaths (all causes)
    40
         number of deaths resulting from adverse events
    General disorders and administration site conditions
    Fatigue (asthenia, lethargy, malaise)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fever
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences causally related to treatment / all
    2 / 7
         deaths causally related to treatment / all
    0 / 0
    Constitutional Symptoms - Other (Specify, __)
         subjects affected / exposed
    13 / 53 (24.53%)
         occurrences causally related to treatment / all
    3 / 15
         deaths causally related to treatment / all
    0 / 6
    Respiratory, thoracic and mediastinal disorders
    Adult Respiratory Distress Syndrome (ARDS)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pulmonary/Upper Respiratory - Other (Specify, __)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 1
    Psychiatric disorders
    Confusion
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mood alteration
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Platelet
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Fracture
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Hemorrhage, CNS
    Additional description: Cerebral hemmorhage
         subjects affected / exposed
    2 / 53 (3.77%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    2 / 2
    Blood and lymphatic system disorders
    Hemoglobin
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Ocular/visual - other, specify
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Ileus, GI (functional obstruction of bowel, i.e., neuroconstipation)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mucositis/stomatitis (clinical exam)
         subjects affected / exposed
    2 / 53 (3.77%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Obstruction, GI
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 1
    Vomiting
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Liver dysfunction/failure (clinical)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pain - Other (Specify, __)
         subjects affected / exposed
    5 / 53 (9.43%)
         occurrences causally related to treatment / all
    2 / 7
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    2 / 53 (3.77%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Renal/Genitourinary - Other (Specify, __)
         subjects affected / exposed
    2 / 53 (3.77%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Urinary retention (including neurogenic bladder)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal/Soft Tissue - Other (Specify, __)
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pain
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Infection - Other (Specify, __)
    Additional description: 1 grade 5 septic shock
         subjects affected / exposed
    9 / 53 (16.98%)
         occurrences causally related to treatment / all
    4 / 10
         deaths causally related to treatment / all
    1 / 1
    Infection with unknown ANC
    Additional description: Vaginal infection
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Glucose, serum-high (hyperglycemia)
    Additional description: DISRUPTION OF HIS DIABETES
         subjects affected / exposed
    1 / 53 (1.89%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Temsirolimus
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    53 / 53 (100.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences all number
    4
    General disorders and administration site conditions
    Constitutional Symptoms - Other (Specify, __)
         subjects affected / exposed
    20 / 53 (37.74%)
         occurrences all number
    21
    Fatigue (asthenia, lethargy, malaise)
         subjects affected / exposed
    39 / 53 (73.58%)
         occurrences all number
    43
    Fever (in the absence of neutropenia, where neutropenia is defined as ANC <1.0 x 10e9/L)
         subjects affected / exposed
    26 / 53 (49.06%)
         occurrences all number
    21
    Edema:limb
         subjects affected / exposed
    14 / 53 (26.42%)
         occurrences all number
    14
    Pain
         subjects affected / exposed
    29 / 53 (54.72%)
         occurrences all number
    61
    Pain - Other (Specify, __)
         subjects affected / exposed
    5 / 53 (9.43%)
         occurrences all number
    6
    Respiratory, thoracic and mediastinal disorders
    Hemorrhage, pulmonary/upper respiratory
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    6
    Cough
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    6
    Dyspnea (shortness of breath)
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    7
    Pulmonary/Upper Respiratory - Other (Specify, __)
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences all number
    4
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    5 / 53 (9.43%)
         occurrences all number
    5
    Mood alteration
         subjects affected / exposed
    13 / 53 (24.53%)
         occurrences all number
    15
    Investigations
    Leukocytes (total WBC)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    4
    Platelets
         subjects affected / exposed
    16 / 53 (30.19%)
         occurrences all number
    24
    Weight loss
         subjects affected / exposed
    11 / 53 (20.75%)
         occurrences all number
    12
    Cholesterol, serum-high (hypercholesteremia)
         subjects affected / exposed
    7 / 53 (13.21%)
         occurrences all number
    7
    Injury, poisoning and procedural complications
    Rash/desquamation
         subjects affected / exposed
    8 / 53 (15.09%)
         occurrences all number
    10
    Nervous system disorders
    Taste alteration (dysgeusia)
         subjects affected / exposed
    10 / 53 (18.87%)
         occurrences all number
    10
    Dizziness
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Neuropathy: sensory
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    8
    Blood and lymphatic system disorders
    Hemoglobin
         subjects affected / exposed
    26 / 53 (49.06%)
         occurrences all number
    40
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    13 / 53 (24.53%)
         occurrences all number
    13
    Diarrhea
         subjects affected / exposed
    15 / 53 (28.30%)
         occurrences all number
    20
    Dry mouth/salivary gland (xerostomia)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Gastritis (including bile reflux gastritis)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Gastrointestinal - Other (Specify, __)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Hemorrhoids
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    5
    Mucositis/stomatitis (clinical exam)
         subjects affected / exposed
    19 / 53 (35.85%)
         occurrences all number
    23
    Mucositis/stomatitis (functional/symptomatic)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    4
    Nausea
         subjects affected / exposed
    23 / 53 (43.40%)
         occurrences all number
    24
    Obstruction, GI
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    7
    Vomiting
         subjects affected / exposed
    15 / 53 (28.30%)
         occurrences all number
    19
    Skin and subcutaneous tissue disorders
    Dermatology/Skin - Other (Specify, __)
         subjects affected / exposed
    13 / 53 (24.53%)
         occurrences all number
    20
    Dry skin
         subjects affected / exposed
    14 / 53 (26.42%)
         occurrences all number
    14
    Pruritus/itching
         subjects affected / exposed
    8 / 53 (15.09%)
         occurrences all number
    11
    Renal and urinary disorders
    Hemorrhage, GU
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    5
    Renal failure
         subjects affected / exposed
    9 / 53 (16.98%)
         occurrences all number
    10
    Renal/Genitourinary - Other (Specify, __)
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences all number
    4
    Musculoskeletal and connective tissue disorders
    Metabolic/Laboratory - Other (Specify, __)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Musculoskeletal/Soft Tissue - Other (Specify, __)
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    6
    Infections and infestations
    Infection - Other (Specify, __)
         subjects affected / exposed
    31 / 53 (58.49%)
         occurrences all number
    45
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    23 / 53 (43.40%)
         occurrences all number
    26
    Dehydration
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Albumin, serum-low (hypoalbuminemia)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Calcium, serum-low (hypocalcemia)
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences all number
    4
    Glucose, serum-high (hyperglycemia)
         subjects affected / exposed
    6 / 53 (11.32%)
         occurrences all number
    6
    Potassium, serum-high (hyperkalemia)
         subjects affected / exposed
    3 / 53 (5.66%)
         occurrences all number
    3
    Potassium, serum-low (hypokalemia)
         subjects affected / exposed
    4 / 53 (7.55%)
         occurrences all number
    6
    Triglyceride, serum-high (hypertriglyceridemia)
         subjects affected / exposed
    13 / 53 (24.53%)
         occurrences all number
    16

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    07 Jan 2011
    Protocol V3 dated 16-jun-2010
    25 Jul 2012
    Protocol V4 dated 20-oct-2011
    30 Apr 2014
    Protocol V5 dated 09-apr-2013
    28 Jan 2015
    Protocol V6 dated 08-oct-2014

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/29454321
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