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    Clinical Trial Results:
    BRIM 3: A Randomized, Open-Label, Controlled, Multicenter, Phase III Study in Previously Untreated Patients with Unresectable Stage IIIC or Stage IV Melanoma with V600E BRAF Mutation Receiving Vemurafenib (RO5185426) or Dacarbazine

    Summary
    EudraCT number
    2009-012293-12
    Trial protocol
    NL   DE   FR   SE   IT   GB  
    Global end of trial date
    08 Jul 2015

    Results information
    Results version number
    v2(current)
    This version publication date
    22 Jul 2016
    First version publication date
    15 Mar 2015
    Other versions
    v1 (removed from public view)
    Version creation reason
    Summary report(s)
    NO25026 CTg Receipt

    Trial information

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    Trial identification
    Sponsor protocol code
    NO25026
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01006980
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH-4070
    Public contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, global.trial_information@roche.com
    Scientific contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, global.trial_information@roche.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
    08 Jul 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    08 Jul 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This randomized, open-label study evaluated the efficacy, safety and tolerability of vemurafenib (RO5185426) as compared to dacarbazine in previously untreated subjects with metastatic melanoma. Subjects were randomized to receive either vemurafenib 960 mg orally twice daily or dacarbazine 1000 mg/m2 intravenously every 3 weeks. Anticipated time on study treatment was until occurrence of disease progression or unacceptable toxicity. Subjects in the dacarbazine arm were permitted to cross over to vemurafenib treatment.
    Protection of trial subjects
    All study participants were required to read and sign an Informed Consent Form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    04 Jan 2010
    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
    Australia: 57
    Country: Number of subjects enrolled
    Canada: 33
    Country: Number of subjects enrolled
    France: 103
    Country: Number of subjects enrolled
    Germany: 93
    Country: Number of subjects enrolled
    Israel: 18
    Country: Number of subjects enrolled
    Italy: 70
    Country: Number of subjects enrolled
    Netherlands: 40
    Country: Number of subjects enrolled
    New Zealand: 20
    Country: Number of subjects enrolled
    Sweden: 6
    Country: Number of subjects enrolled
    Switzerland: 22
    Country: Number of subjects enrolled
    United Kingdom: 74
    Country: Number of subjects enrolled
    United States: 139
    Worldwide total number of subjects
    675
    EEA total number of subjects
    386
    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)
    1
    Adults (18-64 years)
    513
    From 65 to 84 years
    157
    85 years and over
    4

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    675 participants were randomized. One participant randomized to dacarbazine was treated in error with vemurafenib throughout the study and is included in the Vemurafenib arm in the table below and for exposure and safety analyses and is included in the dacarbazine arm for efficacy analyses.

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Vemurafenib
    Arm description
    Participants received continuous oral doses of vemurafenib (RO5185426) 960 mg twice a day. Participants took four 240 mg tablets in the morning and four 240 mg tablets in the evening (960 mg twice a day for a total daily dose of 1920 mg).
    Arm type
    Experimental

    Investigational medicinal product name
    Vemurafenib
    Investigational medicinal product code
    Other name
    Zelboraf®, RO5185426
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    960 mg (4 x 240 mg tablets) twice daily

    Arm title
    Dacarbazine
    Arm description
    Dacarbazine was administered intravenously 1000 mg/m˄2 up to 60 minutes on Day 1 of every 3 weeks (3 weeks was one cycle length).
    Arm type
    Active comparator

    Investigational medicinal product name
    Dacarbazine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    1000 mg/m˄2 up to 60 minutes on Day 1 of every 3 weeks

    Number of subjects in period 1
    Vemurafenib Dacarbazine
    Started
    337
    338
    Treated
    336
    293
    Completed
    0
    0
    Not completed
    337
    338
         Withdrawal of Consent
    4
    6
         Protocol violation
    2
    3
         Randomized but not treated
    1
    45
         Adverse event, non-fatal
    25
    5
         Refuse Treatment
    9
    6
         Death
    13
    12
         Reason Not Specified
    26
    43
         Progression
    257
    218

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Vemurafenib
    Reporting group description
    Participants received continuous oral doses of vemurafenib (RO5185426) 960 mg twice a day. Participants took four 240 mg tablets in the morning and four 240 mg tablets in the evening (960 mg twice a day for a total daily dose of 1920 mg).

    Reporting group title
    Dacarbazine
    Reporting group description
    Dacarbazine was administered intravenously 1000 mg/m˄2 up to 60 minutes on Day 1 of every 3 weeks (3 weeks was one cycle length).

    Reporting group values
    Vemurafenib Dacarbazine Total
    Number of subjects
    337 338 675
    Age categorical
    Units: Subjects
        < 65 years
    244 270 514
        >=65 years
    93 68 161
    Gender, Male/Female
    Units: participants
        Female
    137 157 294
        Male
    200 181 381

    End points

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    End points reporting groups
    Reporting group title
    Vemurafenib
    Reporting group description
    Participants received continuous oral doses of vemurafenib (RO5185426) 960 mg twice a day. Participants took four 240 mg tablets in the morning and four 240 mg tablets in the evening (960 mg twice a day for a total daily dose of 1920 mg).

    Reporting group title
    Dacarbazine
    Reporting group description
    Dacarbazine was administered intravenously 1000 mg/m˄2 up to 60 minutes on Day 1 of every 3 weeks (3 weeks was one cycle length).

    Primary: Overall Survival

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    End point title
    Overall Survival
    End point description
    An Overall survival event was defined as death due to any cause. The number of participants with overall survival events is reported. The intent-to-treat (ITT) population was defined as all randomized participants, whether or not study treatment was received. The ITT population was analyzed according to the treatment assigned at randomization. Overall survival was assessed on participants randomized at least 15 days prior to the clinical cutoff date of December 30, 2010.
    End point type
    Primary
    End point timeframe
    From randomization (initiated January 2010) to December 30 2010. Median follow-up time in the vemurafenib group was 3.75 months (range 0.3 to 10.8) and in the dacarbazine group was 2.33 months (range <0.1 to 10.3).
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    336
    336
    Units: participants
    number (not applicable)
        Participants with events
    43
    75
        Participants without events
    293
    261
    Statistical analysis title
    Statistical analysis - Overall Survival
    Statistical analysis description
    The trial had a power of 80% to detect a hazard ratio of 0.65 for overall survival with an alpha level of 0.045 (an increase in median survival from 8 months for dacarbazine to 12.3 months for vemurafenib), one interim analysis for overall survival at 50% information. The hazard ratio for death for vemurafenib relative to dacarbazine and the associated 95% confidence interval were computed using an unstratified Cox regression model.
    Comparison groups
    Vemurafenib v Dacarbazine
    Number of subjects included in analysis
    672
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    < 0.0001
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.37
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.26
         upper limit
    0.55

    Primary: Progression-free Survival

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    End point title
    Progression-free Survival
    End point description
    A progression-free survival (PFS) event was defined as disease progression or death due to any cause. Tumor response (progression) was assessed according to the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 criteria using computed tomography (CT) scans or magnetic resonance imaging (MRI). The analysis population for PFS consisted of all ITT participants randomized by October 27, 2010 (at least 9 weeks prior to the clinical cutoff date of December 30, 2010). The 9-week interval was chosen to allow time for participants to have had their first scheduled post baseline tumor assessment CT scan.
    End point type
    Primary
    End point timeframe
    From randomization (initiated January 2010) to December 30 2010.
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    275
    274
    Units: participants
    number (not applicable)
        Participants with events
    104
    182
        Participants without events
    171
    92
    Statistical analysis title
    Statistical analysis - PFS
    Statistical analysis description
    The trial had a power of 90% to detect a hazard ratio of 0.55 for progression-free survival with an alpha level of 0.005 (an increase in median survival from 2.5 months for dacarbazine to 4.5 months for vemurafenib). Hazard ratios for treatment with vemurafenib, as compared with dacarbazine, were estimated with the use of unstratified Cox regression.
    Comparison groups
    Vemurafenib v Dacarbazine
    Number of subjects included in analysis
    549
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.0001
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.26
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.2
         upper limit
    0.33

    Secondary: Participants with a Best Overall Response (BOR) of complete response or partial response

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    End point title
    Participants with a Best Overall Response (BOR) of complete response or partial response
    End point description
    BOR was defined as a complete response (CR) or partial response (PR) confirmed per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. Participants who never received study treatment and treated participants without any post-baseline tumor assessments were considered as non-responders. CR: Disappearance of all target lesions, all non-target lesions and no new lesion. Any pathological lymph nodes must have had reduction in the short axis to <10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, no progression in non-target lesion and no new lesion. The analysis population consisted of all ITT participants randomized by September 22, 2010 (at least 14 weeks prior to the clinical cutoff date of December 30, 2010). The 14-week interval was chosen as it was the minimum time needed to observe a confirmed overall response according to protocol-specified schedule for the first two tumor assessments.
    End point type
    Secondary
    End point timeframe
    From randomization (initiated January 2010) until December 30, 2010
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    219
    220
    Units: participants
    number (not applicable)
        Responders
    106
    12
        Non-responders
    113
    208
    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 was defined as the time between the date of the earliest qualifying response and the date of disease progression or death due to any cause. Duration of response was calculated only for participants who had a best overall response of Complete Response or Partial Response and was estimated using the Kaplan–Meier method. The analysis population included all participants randomized by September 22, 2010 and with a best overall confirmed response of complete response or partial response. 999 = Median duration of response was not reached as only 2 of the 12 participants with a qualifying response had subsequent disease progression or death due to any cause at the time of the analysis.
    End point type
    Secondary
    End point timeframe
    From randomization (initiated in January 2010) until December 30, 2010.
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    106
    12
    Units: months
        median (confidence interval 95%)
    5.49 (3.98 to 5.72)
    999 (4.6 to 999)
    No statistical analyses for this end point

    Secondary: Time to confirmed response

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    End point title
    Time to confirmed response
    End point description
    Time to response was defined as the time from randomization to confirmed response (complete response or partial response). The analysis population included all participants randomized by September 22, 2010 and with a best overall confirmed response of complete response or partial response.
    End point type
    Secondary
    End point timeframe
    From randomization (initiated January 2010) until December 30, 2010.
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    106
    12
    Units: months
        median (full range (min-max))
    1.45 (1 to 5.5)
    2.72 (1.6 to 5.8)
    No statistical analyses for this end point

    Secondary: Time to treatment failure

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    End point title
    Time to treatment failure
    End point description
    Treatment failure was defined as a secondary endpoint in the protocol, defined as death, disease progression or premature withdrawal of study treatment. This endpoint was not included in the Statistical analysis plan; therefore no analyses of time to treatment failure were performed.
    End point type
    Secondary
    End point timeframe
    approximately 3 years
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    0 [1]
    0 [2]
    Units: months
        median (confidence interval 95%)
    ( to )
    ( to )
    Notes
    [1] - Data not analyzed; no subjects achieved clinical remission during the study.
    [2] - Data not analyzed; no subjects achieved clinical remission during the study.
    No statistical analyses for this end point

    Secondary: Number of participants with adverse events (AEs)

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    End point title
    Number of participants with adverse events (AEs)
    End point description
    The intensity of AEs was graded according to the NCI Common Terminology Criteria for Adverse Events v 4.0 (CTCAE) on a five-point scale (Grade 1 to 5: Mild, Moderate, Severe, Life-threatening and Death). A serious adverse event is any experience that suggests a significant hazard, contraindication, side effect or precaution, for example is life-threatening, requires hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or requires intervention to prevent one or other of the outcomes listed above. The safety population was defined as all treated participants who had at least one on-study assessment. The safety population was analyzed according to the treatment received.
    End point type
    Secondary
    End point timeframe
    From randomization (initiated January 2010) until December 30, 2010.
    End point values
    Vemurafenib Dacarbazine
    Number of subjects analysed
    336
    282
    Units: participants
    number (not applicable)
        Any adverse event
    326
    253
        Serious adverse event
    110
    45
    No statistical analyses for this end point

    Secondary: Pre and Post-dose Plasma vemurafenib Concentration by Study Day

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    End point title
    Pre and Post-dose Plasma vemurafenib Concentration by Study Day [3]
    End point description
    The pharmacokinetics of vemurafenib were assessed at the beginning of each 21-day cycle using predose and 2-4 hours post-dose sampling. The pharmacokinetic (PK) analysis population included all participants who received vemurafenib and provided valid PK assessments. The PK population at specific time points varied depending on the availability of confirmed dosing and PK assessment times. "n" indicates the number of participants with available PK data at each time point.
    End point type
    Secondary
    End point timeframe
    Plasma samples were collected before the morning dose (troughs) and 2-4 hours after the morning dose at the beginning of each cycle (Days 1, 22, 43, 64, 106, 148 and 190).
    Notes
    [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Descriptive analysis was performed.
    End point values
    Vemurafenib
    Number of subjects analysed
    260
    Units: μg/mL
    arithmetic mean (standard deviation)
        Pre-Dose Day 1 (n = 260)
    0 ( 0 )
        Post-Dose Day 1 (n = 255)
    4.3 ( 4.35 )
        Pre-Dose Day 22 (n = 204)
    53 ( 26.66 )
        Post-Dose Day 22 (n = 221)
    54 ( 25.67 )
        Pre-Dose Day 43 (n = 166)
    54.4 ( 24.13 )
        Post-Dose Day 43 (n = 170)
    54.4 ( 23.28 )
        Pre-Dose Day 64 (n = 141)
    57.4 ( 23.79 )
        Post-Dose Day 64 (n = 138)
    57.7 ( 22.29 )
        Pre-Dose Day 106 (n = 77)
    55 ( 17.62 )
        Post-Dose Day 106 (n = 75)
    56.3 ( 20.36 )
        Pre-Dose Day 148 (n = 38)
    51.8 ( 24.13 )
        Post-Dose Day 148 (n = 39)
    53.3 ( 21.55 )
        Pre-Dose Day 190 (n = 9)
    53.6 ( 12.6 )
        Post-Dose Day 190 (n = 9)
    50.5 ( 20.16 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline through the end of study (maximum exposure: 57.07 months)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.0
    Reporting groups
    Reporting group title
    Vemurafenib
    Reporting group description
    Adverse events reported for this group include those occurring in participants receiving vemurafenib starting at their baseline visit. Participants received continuous oral doses of vemurafenib (RO5185426) 960 mg twice a day. Participants took four 240 mg tablets in the morning and four 240 mg tablets in the evening (960 mg twice a day for a total daily dose of 1920 mg).

    Reporting group title
    Dacarbazine
    Reporting group description
    Adverse events reported for this group include those occurring in participants receiving dacarbazine starting at their baseline visit until study discontinuation or treatment switch. Dacarbazine was administered intravenously 1000 mg/m˄2 up to 60 minutes on Day 1 of every 3 weeks (3 weeks was one cycle length).

    Reporting group title
    Vemurafenib After Crossover
    Reporting group description
    Adverse events reported for this group include those occurring following switch to vemurafenib in those participants who switched from dacarbazine to vemurafenib during the study.

    Serious adverse events
    Vemurafenib Dacarbazine Vemurafenib After Crossover
    Total subjects affected by serious adverse events
         subjects affected / exposed
    165 / 336 (49.11%)
    52 / 293 (17.75%)
    44 / 84 (52.38%)
         number of deaths (all causes)
    271
    170
    71
         number of deaths resulting from adverse events
    1
    1
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Basal cell carcinoma
         subjects affected / exposed
    10 / 336 (2.98%)
    2 / 293 (0.68%)
    3 / 84 (3.57%)
         occurrences causally related to treatment / all
    16 / 18
    0 / 4
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bowen's disease
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intracranial tumour haemorrhage
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Keratoacanthoma
         subjects affected / exposed
    36 / 336 (10.71%)
    3 / 293 (1.02%)
    6 / 84 (7.14%)
         occurrences causally related to treatment / all
    47 / 47
    1 / 3
    7 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malignant melanoma
         subjects affected / exposed
    7 / 336 (2.08%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    6 / 8
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malignant melanoma in situ
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin papilloma
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Squamous cell carcinoma of skin
         subjects affected / exposed
    66 / 336 (19.64%)
    2 / 293 (0.68%)
    12 / 84 (14.29%)
         occurrences causally related to treatment / all
    129 / 129
    0 / 2
    15 / 15
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tonsil cancer
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haematoma
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Hypertension
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypertensive crisis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Shock
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    Subclavian vein thrombosis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Thrombosis
         subjects affected / exposed
    0 / 336 (0.00%)
    2 / 293 (0.68%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vasculitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chest pain
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Device occlusion
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    2 / 336 (0.60%)
    1 / 293 (0.34%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gait disturbance
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    5 / 336 (1.49%)
    4 / 293 (1.37%)
    3 / 84 (3.57%)
         occurrences causally related to treatment / all
    2 / 5
    3 / 6
    2 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Cervical dysplasia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Dyspnoea
         subjects affected / exposed
    3 / 336 (0.89%)
    2 / 293 (0.68%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 4
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Epistaxis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Haemoptysis
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pleuritic pain
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    4 / 336 (1.19%)
    2 / 293 (0.68%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 4
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Completed suicide
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Confusional state
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood alkaline phosphatase increased
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood bilirubin increased
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    2 / 84 (2.38%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    International normalised ratio decreased
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Liver function test abnormal
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femoral neck fracture
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Hip fracture
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Multiple injuries
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrial tachycardia
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Cardiac arrest
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Cardiac tamponade
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Cardiopulmonary failure
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pericarditis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Nervous system disorders
    Aphasia
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Headache
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Intraventricular haemorrhage
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Loss of consciousness
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peripheral sensorimotor neuropathy
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Seizure
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sensorimotor disorder
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    VIIth nerve paralysis
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    2 / 84 (2.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bone marrow failure
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lymphadenitis
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Diplopia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Orbital oedema
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uveitis
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    2 / 336 (0.60%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain lower
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Abdominal pain upper
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea haemorrhagic
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Gastric ulcer
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal haemorrhagee
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal ulcer
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Gastrooesophageal reflux disease
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Intussusception
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Large intestinal obstruction
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Pancreatitis
         subjects affected / exposed
    2 / 336 (0.60%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Vomiting
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatitis acute
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Skin and subcutaneous tissue disorders
    Photosensitivity reaction
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    3 / 336 (0.89%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    6 / 6
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin lesion
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Stevens-Johnson syndrome
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Toxic epidermal necrolysis
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         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
    Acute kidney injury
         subjects affected / exposed
    3 / 336 (0.89%)
    1 / 293 (0.34%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhage urinary tract
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Renal failure
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Renal impairment
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    3 / 336 (0.89%)
    2 / 293 (0.68%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bone pain
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Groin pain
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Hypercreatinaemia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Joint effusion
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal chest pain
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Musculoskeletal pain
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myalgia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neck pain
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Pain in extremity
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Pathological fracture
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Spinal pain
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Anal abscess
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diverticulitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Encephalitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes virus infection
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Intervertebral discitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lung infection
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Osteomyelitis
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    5 / 336 (1.49%)
    2 / 293 (0.68%)
    2 / 84 (2.38%)
         occurrences causally related to treatment / all
    0 / 5
    1 / 2
    0 / 3
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Sepsis
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin infection
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Soft tissue infection
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Urinary tract infection
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Wound infection staphylococcal
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    2 / 336 (0.60%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diabetes mellitus
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Failure to thrive
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypercalcaemia
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyperkalaemia
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 293 (0.00%)
    0 / 84 (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
    Hyperuricaemia
         subjects affected / exposed
    0 / 336 (0.00%)
    1 / 293 (0.34%)
    0 / 84 (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
    Hypoglycaemia
         subjects affected / exposed
    0 / 336 (0.00%)
    0 / 293 (0.00%)
    1 / 84 (1.19%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Vemurafenib Dacarbazine Vemurafenib After Crossover
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    333 / 336 (99.11%)
    247 / 293 (84.30%)
    83 / 84 (98.81%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Melanocytic naevus
         subjects affected / exposed
    39 / 336 (11.61%)
    3 / 293 (1.02%)
    9 / 84 (10.71%)
         occurrences all number
    56
    3
    11
    Seborrhoeic keratosis
         subjects affected / exposed
    46 / 336 (13.69%)
    2 / 293 (0.68%)
    8 / 84 (9.52%)
         occurrences all number
    61
    2
    11
    Skin papilloma
         subjects affected / exposed
    96 / 336 (28.57%)
    1 / 293 (0.34%)
    17 / 84 (20.24%)
         occurrences all number
    162
    1
    24
    Vascular disorders
    Flushing
         subjects affected / exposed
    17 / 336 (5.06%)
    6 / 293 (2.05%)
    2 / 84 (2.38%)
         occurrences all number
    19
    11
    2
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    50 / 336 (14.88%)
    29 / 293 (9.90%)
    7 / 84 (8.33%)
         occurrences all number
    70
    47
    13
    Chest pain
         subjects affected / exposed
    26 / 336 (7.74%)
    5 / 293 (1.71%)
    4 / 84 (4.76%)
         occurrences all number
    30
    5
    4
    Chills
         subjects affected / exposed
    23 / 336 (6.85%)
    3 / 293 (1.02%)
    2 / 84 (2.38%)
         occurrences all number
    30
    5
    3
    Fatigue
         subjects affected / exposed
    158 / 336 (47.02%)
    101 / 293 (34.47%)
    32 / 84 (38.10%)
         occurrences all number
    245
    128
    54
    Influenza like illness
         subjects affected / exposed
    29 / 336 (8.63%)
    5 / 293 (1.71%)
    3 / 84 (3.57%)
         occurrences all number
    33
    5
    7
    Oedema peripheral
         subjects affected / exposed
    49 / 336 (14.58%)
    15 / 293 (5.12%)
    8 / 84 (9.52%)
         occurrences all number
    73
    17
    10
    Pain
         subjects affected / exposed
    30 / 336 (8.93%)
    14 / 293 (4.78%)
    2 / 84 (2.38%)
         occurrences all number
    48
    22
    2
    Peripheral swelling
         subjects affected / exposed
    26 / 336 (7.74%)
    0 / 293 (0.00%)
    5 / 84 (5.95%)
         occurrences all number
    42
    0
    5
    Pyrexia
         subjects affected / exposed
    71 / 336 (21.13%)
    26 / 293 (8.87%)
    18 / 84 (21.43%)
         occurrences all number
    110
    31
    24
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    52 / 336 (15.48%)
    24 / 293 (8.19%)
    6 / 84 (7.14%)
         occurrences all number
    63
    28
    10
    Dyspnoea
         subjects affected / exposed
    33 / 336 (9.82%)
    24 / 293 (8.19%)
    8 / 84 (9.52%)
         occurrences all number
    40
    27
    9
    Oropharyngeal pain
         subjects affected / exposed
    27 / 336 (8.04%)
    5 / 293 (1.71%)
    3 / 84 (3.57%)
         occurrences all number
    36
    5
    4
    Psychiatric disorders
    Depression
         subjects affected / exposed
    21 / 336 (6.25%)
    7 / 293 (2.39%)
    3 / 84 (3.57%)
         occurrences all number
    24
    7
    3
    Insomnia
         subjects affected / exposed
    37 / 336 (11.01%)
    16 / 293 (5.46%)
    7 / 84 (8.33%)
         occurrences all number
    40
    18
    7
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    28 / 336 (8.33%)
    4 / 293 (1.37%)
    6 / 84 (7.14%)
         occurrences all number
    35
    6
    8
    Aspartate aminotransferase increased
         subjects affected / exposed
    25 / 336 (7.44%)
    3 / 293 (1.02%)
    8 / 84 (9.52%)
         occurrences all number
    32
    3
    9
    Blood alkaline phosphatase increased
         subjects affected / exposed
    33 / 336 (9.82%)
    0 / 293 (0.00%)
    9 / 84 (10.71%)
         occurrences all number
    57
    0
    14
    Blood bilirubin increased
         subjects affected / exposed
    31 / 336 (9.23%)
    1 / 293 (0.34%)
    2 / 84 (2.38%)
         occurrences all number
    65
    2
    3
    Blood creatine increased
         subjects affected / exposed
    28 / 336 (8.33%)
    1 / 293 (0.34%)
    7 / 84 (8.33%)
         occurrences all number
    42
    1
    13
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    24 / 336 (7.14%)
    4 / 293 (1.37%)
    7 / 84 (8.33%)
         occurrences all number
    42
    5
    15
    Weight decreased
         subjects affected / exposed
    32 / 336 (9.52%)
    8 / 293 (2.73%)
    4 / 84 (4.76%)
         occurrences all number
    39
    10
    5
    Injury, poisoning and procedural complications
    Sunburn
         subjects affected / exposed
    57 / 336 (16.96%)
    0 / 293 (0.00%)
    15 / 84 (17.86%)
         occurrences all number
    117
    0
    24
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    41 / 336 (12.20%)
    14 / 293 (4.78%)
    3 / 84 (3.57%)
         occurrences all number
    51
    15
    3
    Dysgeusia
         subjects affected / exposed
    55 / 336 (16.37%)
    10 / 293 (3.41%)
    9 / 84 (10.71%)
         occurrences all number
    63
    11
    12
    Headache
         subjects affected / exposed
    113 / 336 (33.63%)
    29 / 293 (9.90%)
    23 / 84 (27.38%)
         occurrences all number
    165
    57
    37
    Hyperaesthesia
         subjects affected / exposed
    17 / 336 (5.06%)
    1 / 293 (0.34%)
    0 / 84 (0.00%)
         occurrences all number
    18
    1
    0
    Paraesthesia
         subjects affected / exposed
    30 / 336 (8.93%)
    16 / 293 (5.46%)
    6 / 84 (7.14%)
         occurrences all number
    40
    28
    8
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    32 / 336 (9.52%)
    22 / 293 (7.51%)
    13 / 84 (15.48%)
         occurrences all number
    41
    46
    21
    Neutropenia
         subjects affected / exposed
    1 / 336 (0.30%)
    34 / 293 (11.60%)
    0 / 84 (0.00%)
         occurrences all number
    1
    64
    0
    Thrombocytopenia
         subjects affected / exposed
    5 / 336 (1.49%)
    20 / 293 (6.83%)
    1 / 84 (1.19%)
         occurrences all number
    7
    56
    1
    Gastrointestinal disorders
    Abdominal distension
         subjects affected / exposed
    18 / 336 (5.36%)
    5 / 293 (1.71%)
    2 / 84 (2.38%)
         occurrences all number
    21
    5
    2
    Abdominal pain
         subjects affected / exposed
    35 / 336 (10.42%)
    12 / 293 (4.10%)
    3 / 84 (3.57%)
         occurrences all number
    49
    22
    3
    Abdominal pain upper
         subjects affected / exposed
    37 / 336 (11.01%)
    8 / 293 (2.73%)
    5 / 84 (5.95%)
         occurrences all number
    52
    12
    6
    Constipation
         subjects affected / exposed
    52 / 336 (15.48%)
    72 / 293 (24.57%)
    8 / 84 (9.52%)
         occurrences all number
    67
    94
    11
    Diarrhoea
         subjects affected / exposed
    124 / 336 (36.90%)
    36 / 293 (12.29%)
    24 / 84 (28.57%)
         occurrences all number
    226
    70
    47
    Dyspepsia
         subjects affected / exposed
    20 / 336 (5.95%)
    2 / 293 (0.68%)
    2 / 84 (2.38%)
         occurrences all number
    36
    3
    2
    Nausea
         subjects affected / exposed
    132 / 336 (39.29%)
    128 / 293 (43.69%)
    33 / 84 (39.29%)
         occurrences all number
    229
    258
    41
    Vomiting
         subjects affected / exposed
    73 / 336 (21.73%)
    77 / 293 (26.28%)
    20 / 84 (23.81%)
         occurrences all number
    123
    109
    22
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    15 / 336 (4.46%)
    0 / 293 (0.00%)
    5 / 84 (5.95%)
         occurrences all number
    23
    0
    5
    Actinic keratosis
         subjects affected / exposed
    44 / 336 (13.10%)
    12 / 293 (4.10%)
    13 / 84 (15.48%)
         occurrences all number
    71
    14
    16
    Alopecia
         subjects affected / exposed
    162 / 336 (48.21%)
    7 / 293 (2.39%)
    25 / 84 (29.76%)
         occurrences all number
    199
    8
    27
    Dermal cyst
         subjects affected / exposed
    26 / 336 (7.74%)
    1 / 293 (0.34%)
    3 / 84 (3.57%)
         occurrences all number
    29
    2
    3
    Dermatitis acneiform
         subjects affected / exposed
    18 / 336 (5.36%)
    1 / 293 (0.34%)
    4 / 84 (4.76%)
         occurrences all number
    22
    1
    6
    Dry skin
         subjects affected / exposed
    80 / 336 (23.81%)
    2 / 293 (0.68%)
    16 / 84 (19.05%)
         occurrences all number
    98
    2
    16
    Erythema
         subjects affected / exposed
    61 / 336 (18.15%)
    4 / 293 (1.37%)
    12 / 84 (14.29%)
         occurrences all number
    137
    6
    18
    Hyperkeratosis
         subjects affected / exposed
    99 / 336 (29.46%)
    1 / 293 (0.34%)
    15 / 84 (17.86%)
         occurrences all number
    175
    1
    21
    Keratosis pilaris
         subjects affected / exposed
    32 / 336 (9.52%)
    1 / 293 (0.34%)
    7 / 84 (8.33%)
         occurrences all number
    37
    1
    9
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    34 / 336 (10.12%)
    2 / 293 (0.68%)
    11 / 84 (13.10%)
         occurrences all number
    49
    2
    19
    Photosensitivity reaction
         subjects affected / exposed
    136 / 336 (40.48%)
    13 / 293 (4.44%)
    26 / 84 (30.95%)
         occurrences all number
    204
    14
    31
    Pruritus
         subjects affected / exposed
    86 / 336 (25.60%)
    5 / 293 (1.71%)
    14 / 84 (16.67%)
         occurrences all number
    125
    5
    15
    Rash
         subjects affected / exposed
    143 / 336 (42.56%)
    6 / 293 (2.05%)
    28 / 84 (33.33%)
         occurrences all number
    270
    6
    44
    Rash erythematous
         subjects affected / exposed
    9 / 336 (2.68%)
    0 / 293 (0.00%)
    5 / 84 (5.95%)
         occurrences all number
    12
    0
    7
    Rash maculo-papular
         subjects affected / exposed
    34 / 336 (10.12%)
    1 / 293 (0.34%)
    10 / 84 (11.90%)
         occurrences all number
    51
    1
    13
    Skin exfoliation
         subjects affected / exposed
    18 / 336 (5.36%)
    0 / 293 (0.00%)
    2 / 84 (2.38%)
         occurrences all number
    20
    0
    3
    Skin lesion
         subjects affected / exposed
    40 / 336 (11.90%)
    4 / 293 (1.37%)
    4 / 84 (4.76%)
         occurrences all number
    59
    4
    4
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    189 / 336 (56.25%)
    9 / 293 (3.07%)
    48 / 84 (57.14%)
         occurrences all number
    452
    11
    120
    Back pain
         subjects affected / exposed
    53 / 336 (15.77%)
    20 / 293 (6.83%)
    11 / 84 (13.10%)
         occurrences all number
    72
    27
    17
    Musculoskeletal pain
         subjects affected / exposed
    44 / 336 (13.10%)
    11 / 293 (3.75%)
    12 / 84 (14.29%)
         occurrences all number
    56
    15
    16
    Myalgia
         subjects affected / exposed
    50 / 336 (14.88%)
    5 / 293 (1.71%)
    15 / 84 (17.86%)
         occurrences all number
    82
    7
    17
    Pain in extremity
         subjects affected / exposed
    76 / 336 (22.62%)
    18 / 293 (6.14%)
    14 / 84 (16.67%)
         occurrences all number
    116
    19
    20
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    20 / 336 (5.95%)
    1 / 293 (0.34%)
    2 / 84 (2.38%)
         occurrences all number
    24
    2
    2
    Folliculitis
         subjects affected / exposed
    28 / 336 (8.33%)
    3 / 293 (1.02%)
    2 / 84 (2.38%)
         occurrences all number
    37
    3
    2
    Influenza
         subjects affected / exposed
    18 / 336 (5.36%)
    4 / 293 (1.37%)
    3 / 84 (3.57%)
         occurrences all number
    22
    5
    3
    Lower respiratory tract infection
         subjects affected / exposed
    8 / 336 (2.38%)
    2 / 293 (0.68%)
    6 / 84 (7.14%)
         occurrences all number
    11
    2
    9
    Nasopharyngitis
         subjects affected / exposed
    36 / 336 (10.71%)
    10 / 293 (3.41%)
    4 / 84 (4.76%)
         occurrences all number
    57
    14
    6
    Upper respiratory tract infection
         subjects affected / exposed
    19 / 336 (5.65%)
    5 / 293 (1.71%)
    4 / 84 (4.76%)
         occurrences all number
    23
    5
    7
    Urinary tract infection
         subjects affected / exposed
    9 / 336 (2.68%)
    9 / 293 (3.07%)
    5 / 84 (5.95%)
         occurrences all number
    10
    11
    7
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    76 / 336 (22.62%)
    24 / 293 (8.19%)
    20 / 84 (23.81%)
         occurrences all number
    112
    31
    30

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jun 2010
    • Clarified information on the BRAF analysis and the process for the BRAF mutation analysis. • Clarified the timing of clinical assessments and procedures and reorganized them to match the new schedule of assessments. • For patients for whom a computerized tomography (CT) scan was contraindicated, a clarification was added that a magnetic resonance imaging (MRI) scan could be used for assessment of non-cutaneous squamous cell carcinoma (SCC) surveillance. • Added information about the length of acceptable delay/interruption in vemurafenib dosing to clarify when interruptions/delays occur depending on the grade of adverse events (AEs). • Clarified that all SCC events should be reported as SAEs.
    01 Nov 2010
    • Changed the estimated treatment effect of vemurafenib as measured by the hazard ratio for death from 0.75 to 0.65 due to emerging results from Phase 1 and 2 studies; with the change in the type 1 error rate, this resulted in a reduction in the number of deaths required for final analysis from 468 to approximately 196. • Changed the number of interim analyses for OS from two (at 50% and 75%) to one (at 50% information). • Added PFS as a co-primary endpoint and as part of the study’s primary objective. • Changed the type 1 error rate for the study from 0.025 (two-sided) to 0.05 (two-sided). • Added allowance for crossover from the dacarbazine arm to the vemurafenib arm if recommended by the DSMB based on their review of efficacy data at the time of the interim analysis of OS.
    16 Feb 2011
    • Added allowance for crossover from the dacarbazine group to the vemurafenib group for all patients on dacarbazine with a wash-out period of 14 days. Crossover from the vemurafenib group to the dacarbazine group was disallowed. • Added cautions for concomitant medications: for potential drug-drug interactions with any concomitant medications that are primarily metabolized by the CYP450 1A2, 3A4 and 2C9, those that strongly inhibit or induce CYP3A4, and for medications and supplements that may affect QT interval prolongation. • Increased monitoring of ECG and electrolytes before initiating treatment with vemurafenib and during treatment, as well as recommendations to manage potential QTc prolongation. • Added evaluation and assessment of molecular characteristics of suspicious lesions in addition to the evaluation of cuSCC.
    19 Jun 2012
    • Risk Management Plan was revised with new timelines for SCC (both cutaneous and noncutaneous) follow-up, which was to occur during the treatment period and up to a maximum of 6 months after last dose during follow-up. • Tissue samples of any new primary neoplasm or SCC (cutaneous or noncutaneous) were to be submitted a central pathology laboratory for molecular characterization. • Serious AEs (SAEs) section was updated as follows: Keratoacanthoma, basal cell carcinoma, and any occurrence of a new primary malignancy were added as reportable SAEs. SAE reporting requirements were changed from reporting them within 1 working day to reporting them within 24 hours of knowledge of the event. • Gamma-glutamyltransferase (GGT) was added to Laboratory Assessments. The assessment had been ongoing in the study but was not documented in previous versions of the protocol. • Safety monitoring intervals for the DSMB changed and were outlined in the DSMB Charter.
    01 Dec 2012
    • Timing of PK sampling was clarified (patients receiving vemurafenib in Arm A only). Plasma and serum biomarker samples were to be obtained at disease progression or on the same day as the final dose of study treatment, whichever occurred first. • Timing of the optional biopsy at disease progression was clarified. • Dermatological evaluation was updated to include secondary primary melanoma consistently throughout the protocol.
    21 Apr 2014
    • The Sponsor was permitted to end the current study and permit eligible patients still receiving vemurafenib treatment to be offered enrollment in the extension study (Study GO28399). • Safety information was updated for cutaneous SCC (cuSCC), liver function abnormalities and liver-related AEs, and neutropenia in patients treated with vemurafenib. • Safety information was included for cases of adenomatous colonic polyps, NRAS-mutated chronic myelomonocyte leukemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reactions with eosinophilia and systemic symptoms syndrome. • Information on the effects of vemurafenib on QT interval from Study NP22657 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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