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    Clinical Trial Results:
    Global Study to Assess the Addition of Bevacizumab to Carboplatin and Paclitaxel as Front Line Treatment of Epithelial Ovarian Cancer, Fallopian Tube Carcinoma or Primary Peritoneal Carcinoma

    Summary
    EudraCT number
    2010-019525-34
    Trial protocol
    SK   FR   ES   LT   AT   LV   NL   IE   SE   EE   HU   IT   BG   DK   SI   GR   PT   PL  
    Global end of trial date
    18 Mar 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    22 Apr 2016
    First version publication date
    22 Apr 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MO22923
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01239732
    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
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, 41 61 6878333, global.trial_information@roche.com
    Scientific contact
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, 41 61 6878333, 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
    07 Dec 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Mar 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study was to assess the safety profile of bevacizumab when added to carboplatin and paclitaxel chemotherapy as front-line treatment of epithelial ovarian cancer, fallopian tube carcinoma or primary peritoneal carcinoma.
    Protection of trial subjects
    The study was conducted in accordance with the principles of the ‘Declaration of Helsinki’ and Good Clinical Practice (GCP).
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    17 Dec 2010
    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
    Argentina: 7
    Country: Number of subjects enrolled
    Brazil: 34
    Country: Number of subjects enrolled
    Canada: 37
    Country: Number of subjects enrolled
    Denmark: 20
    Country: Number of subjects enrolled
    Egypt: 10
    Country: Number of subjects enrolled
    Estonia: 15
    Country: Number of subjects enrolled
    France: 97
    Country: Number of subjects enrolled
    Greece: 30
    Country: Number of subjects enrolled
    Hong Kong: 21
    Country: Number of subjects enrolled
    Hungary: 33
    Country: Number of subjects enrolled
    India: 29
    Country: Number of subjects enrolled
    Ireland: 1
    Country: Number of subjects enrolled
    Israel: 64
    Country: Number of subjects enrolled
    Italy: 117
    Country: Number of subjects enrolled
    Latvia: 21
    Country: Number of subjects enrolled
    Lithuania: 23
    Country: Number of subjects enrolled
    Macedonia, the former Yugoslav Republic of: 8
    Country: Number of subjects enrolled
    Mexico: 18
    Country: Number of subjects enrolled
    Netherlands: 20
    Country: Number of subjects enrolled
    Poland: 15
    Country: Number of subjects enrolled
    Portugal: 6
    Country: Number of subjects enrolled
    Romania: 20
    Country: Number of subjects enrolled
    Russian Federation: 29
    Country: Number of subjects enrolled
    Saudi Arabia: 1
    Country: Number of subjects enrolled
    Serbia: 10
    Country: Number of subjects enrolled
    Slovakia: 13
    Country: Number of subjects enrolled
    Slovenia: 2
    Country: Number of subjects enrolled
    South Africa: 7
    Country: Number of subjects enrolled
    Spain: 178
    Country: Number of subjects enrolled
    Sweden: 20
    Country: Number of subjects enrolled
    Switzerland: 19
    Country: Number of subjects enrolled
    Taiwan: 29
    Country: Number of subjects enrolled
    Turkey: 15
    Country: Number of subjects enrolled
    Austria: 38
    Country: Number of subjects enrolled
    Bulgaria: 14
    Worldwide total number of subjects
    1021
    EEA total number of subjects
    683
    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)
    763
    From 65 to 84 years
    258
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 1094 participants were screened and of these, 73 participants failed screening and the remaining 1021 were enrolled in the study. This study has been completed. However, the efficacy and safety results up to the clinical database cutoff date of 07 December 2014 are provided.

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

    Arms
    Arm title
    Bevacizumab + Paclitaxel + Carboplatin
    Arm description
    Participants received bevacizumab 15 milligrams/kilogram (mg/kg) intravenously (IV) on Day 1 every 3 weeks from Cycle 1 (1 cycle = 3 weeks) to Cycle 36 (initially concurrent with chemotherapy, then continued as a single agent following the completion of chemotherapy), or until protocol-defined disease progression or until unacceptable toxicity (whichever occurred first). The 15 mg/kg dose every 3 weeks was the recommended dose; however a dose of IV bevacizumab 7.5 mg/kg every 3 weeks was permissible, but was to be selected prior to the first dosing of bevacizumab. Participants received paclitaxel 175 milligram per square meter (mg/m^2) IV on Day 1 every 3 weeks or 80 mg/m^2 IV every week and carboplatin (area under the plasma concentration-time curve [AUC] 5-6) IV on Day 1 every 3 weeks for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol-defined disease progression, or unacceptable toxicity (whichever occurred first).
    Arm type
    Experimental

    Investigational medicinal product name
    Paclitaxel
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Participants received paclitaxel 175 mg/m^2 IV on Day 1 every 3 weeks or 80 mg/m^2 every week for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol-defined disease progression, or unacceptable toxicity (whichever occurred first).

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Participants received carboplatin (AUC 5-6) IV on Day 1 every 3 weeks for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol-defined disease progression, or unacceptable toxicity (whichever occurred first).

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    Other name
    Avastin
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Participants received bevacizumab 15mg/kg IV on Day 1 every 3 weeks from Cycle 1 to Cycle 36 (initially concurrent with chemotherapy, then continued as a single agent following the completion of chemotherapy), or until protocol-defined disease progression or until unacceptable toxicity (whichever occurred first). The 15 mg/kg dose every 3 weeks was the recommended dose; however a dose of IV bevacizumab 7.5 mg/kg every 3 weeks was permissible, but was to be selected prior to the first dosing of bevacizumab.

    Number of subjects in period 1
    Bevacizumab + Paclitaxel + Carboplatin
    Started
    1021
    Completed
    0
    Not completed
    1021
         Participant non compliance
    5
         Consent withdrawn by subject
    87
         Investigator's decision
    4
         Termination of study per protocol
    667
         Adverse Event
    6
         Treatment failure
    2
         Protocol violation
    3
         Death
    226
         Unspecified
    19
         Study termination by sponsor
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Study (overall period)
    Reporting group description
    Participants received bevacizumab 15 mg/kg IV on Day 1 every 3 weeks from Cycle 1 (1 cycle = 3 weeks) to Cycle 36 (initially concurrent with chemotherapy, then continued as a single agent following the completion of chemotherapy), or until protocol-defined disease progression or until unacceptable toxicity (whichever occurred first). The 15 mg/kg dose every 3 weeks was the recommended dose; however a dose of IV bevacizumab 7.5 mg/kg every 3 weeks was permissible, but was to be selected prior to the first dosing of bevacizumab. Participants received paclitaxel 175 mg/m^2 IV on Day 1 every 3 weeks or 80 mg/m^2 IV every week and carboplatin (AUC 5-6) IV on Day 1 every 3 weeks for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol-defined disease progression, or unacceptable toxicity (whichever occurred first).

    Reporting group values
    Overall Study (overall period) Total
    Number of subjects
    1021 1021
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    56.3 ± 10.98 -
    Gender categorical
    Units: Subjects
        Female
    1021 1021
        Male
    0 0

    End points

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    End points reporting groups
    Reporting group title
    Bevacizumab + Paclitaxel + Carboplatin
    Reporting group description
    Participants received bevacizumab 15 milligrams/kilogram (mg/kg) intravenously (IV) on Day 1 every 3 weeks from Cycle 1 (1 cycle = 3 weeks) to Cycle 36 (initially concurrent with chemotherapy, then continued as a single agent following the completion of chemotherapy), or until protocol-defined disease progression or until unacceptable toxicity (whichever occurred first). The 15 mg/kg dose every 3 weeks was the recommended dose; however a dose of IV bevacizumab 7.5 mg/kg every 3 weeks was permissible, but was to be selected prior to the first dosing of bevacizumab. Participants received paclitaxel 175 milligram per square meter (mg/m^2) IV on Day 1 every 3 weeks or 80 mg/m^2 IV every week and carboplatin (area under the plasma concentration-time curve [AUC] 5-6) IV on Day 1 every 3 weeks for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol-defined disease progression, or unacceptable toxicity (whichever occurred first).

    Primary: Percentage of Participants With at Least One Adverse Event (AE)

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    End point title
    Percentage of Participants With at Least One Adverse Event (AE) [1]
    End point description
    An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Analysis was performed on safety population, which included all participants who received at least one dose of study medication.
    End point type
    Primary
    End point timeframe
    Day 1 up to 30 days after last dose of study treatment (until data cutoff 07 December 2014, up to 4 years)
    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 analyses were planned for this endpoint.
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    1021
    Units: percentage of participants
        number (not applicable)
    97.8
    No statistical analyses for this end point

    Secondary: Progression-Free Survival (PFS)

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    End point title
    Progression-Free Survival (PFS)
    End point description
    PFS was defined as the time between the date of first administration of any study treatment and the date of first documented protocol defined disease progression (that is [i.e.], radiologically by Response Evaluation Criteria In Solid Tumors [RECIST], clinical, or symptomatic) or death, whichever occurred first. Participants who had neither progressed nor died at the time of data cut-off (07 December 2014), or participants who were withdrawn from study, or lost to follow-up without documented progression, were censored. Kaplan-Meier estimation was used for median time to PFS. Analysis was performed on intent to treat population (ITT), which included all participants who received at least one dose of study medication.
    End point type
    Secondary
    End point timeframe
    Day 1, at end of Cycles 3 and 6, then every 6 cycles while receiving bevacizumab, and then at bevacizumab cessation, every 26 weeks after cessation of bevacizumab until disease progression or death until data cutoff 07 December 2014, up to 4 years
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    1021
    Units: months
        median (confidence interval 95%)
    25.5 (23.7 to 27.6)
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving Best Overall Response of Complete Response (CR) or Partial Response (PR) According to RECIST Version 1.0

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    End point title
    Percentage of Participants Achieving Best Overall Response of Complete Response (CR) or Partial Response (PR) According to RECIST Version 1.0
    End point description
    Best overall response (BOR) per RECIST version 1.0 was categorized as:CR, PR, progressive disease (PD), stable disease (SD). CR: disappearance of all target lesions and non-target lesions. PR: greater than or equal to (>=) 30 percent (% ) decrease in sum of the longest diameters (LD) of the target lesions taking as a reference the baseline sum LD according to RECIST associated to non-progressive disease response for non-target lesions. PD: Natural progression or deterioration of the malignancy under study (including new sites of metastasis). SD: neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started. Participants with a BOR of CR and PR were defined as responders, while participants with a BOR of SD, PD, or unable to assess were defined as non-responders. Analysis was performed on ITT population. Number of participants analyzed = participants who were evaluable for this outcome.
    End point type
    Secondary
    End point timeframe
    Day 1, at end of Cycles 3 and 6, then every 6 cycles while receiving bevacizumab, and then at bevacizumab cessation, every 26 weeks (Q26W) after cessation of bevacizumab until disease progression or death until data cutoff 07 December 2014, up to 4 years
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    421
    Units: percentage of participants
        number (confidence interval 95%)
    72.7 (68.2 to 76.9)
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an Overall Response by 50% Carcinoma Antigen 125 (CA-125) Response Criteria

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    End point title
    Percentage of Participants Achieving an Overall Response by 50% Carcinoma Antigen 125 (CA-125) Response Criteria
    End point description
    CA-125 responders: Participants with the value of CA-125 reduced by at least 50% and confirmed with a consecutive CA-125 assessment performed at an interval of at least 28 days. Overall response according to CA-125 was only evaluated for participants with a pre-treatment CA-125 within 3 days prior to start of any study treatment of at least twice the upper limit of normal (ULN). Analysis was performed on ITT population. Number of participants analyzed = participants who were evaluable for this outcome.
    End point type
    Secondary
    End point timeframe
    3 days prior to Day 1 of every cycle, then every 6 weeks (Q6W) during the first year, every 3 months (Q3M) in the second and third year, every 6 months (Q6M) in the fourth year of the study (until data cutoff 07 December 2014, up to 4 years)
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    340
    Units: percentage of participants
        number (confidence interval 95%)
    91.8 (88.3 to 94.5)
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an Overall Response by RECIST Version 1.0 and/or 50% CA-125 Response Criteria

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    End point title
    Percentage of Participants Achieving an Overall Response by RECIST Version 1.0 and/or 50% CA-125 Response Criteria
    End point description
    Overall response was only evaluated for participants who were evaluable according to RECIST version 1.0 with a measurable disease at baseline and/or according to CA-125 with a pre-treatment CA-125 within 3 days prior to start of any study treatment of at least twice the ULN. RECIST responders: Participants achieving an overall response of CR (disappearance of all target lesions and non-target lesions) or PR (>=30% decrease in sum of the LD of the target lesions taking as a reference the baseline sum LD according to RECIST associated to non-progressive disease response for non target lesions). CA-125 responders: Participants with the value of CA-125 reduced by at least 50% and confirmed with a consecutive CA-125 assessment performed at an interval of at least 28 days. Analysis was performed on ITT population. Number of participants analyzed = participants who were evaluable for this outcome.
    End point type
    Secondary
    End point timeframe
    RECIST: Day 1, at end of Cycles 3 and 6, then every 6 cycles, at bevacizumab cessation, Q26W after cessation; CA-125: 3 days before Day 1 of every cycle, then Q6W(1st year), Q3M(2nd-3rd year), Q6M(4th year); until data cutoff 07Dec2014, up to 4 years
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    578
    Units: percentage of participants
        number (confidence interval 95%)
    82.4 (79 to 85.4)
    No statistical analyses for this end point

    Secondary: Duration of Objective Response (DOR)

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    End point title
    Duration of Objective Response (DOR)
    End point description
    DOR was defined as the time from the first documented response (CR or PR per RECIST version 1.0), to the first documented protocol defined disease progression (i.e., radiologically by RECIST, clinical, or symptomatic) or death, whichever occurred first. Participants who had neither progressed nor died at the time of data cut-off (07 December 2014), or participants who were withdrawn from study, or lost to follow-up without documented progression, were censored. RECIST responders: Participants achieving an overall response of CR (disappearance of all target lesions and non-target lesions) or PR (>=30% decrease in sum of the LD of the target lesions taking as a reference the baseline sum LD according to RECIST associated to non-progressive disease response for non target lesions). Disease progression: Natural progression or deterioration of the malignancy under study (including new sites of metastasis). Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Day 1, at end of Cycles 3 and 6, then every 6 cycles while receiving bevacizumab, and then at bevacizumab cessation, every 26 weeks after cessation of bevacizumab until disease progression or death until data cutoff 07 December 2014, up to 4 years
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    1021
    Units: months
        median (confidence interval 95%)
    18.2 (16.6 to 19.6)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    OS was defined as the time from the date of the first administration of any study treatment to the date of death, regardless of the cause of death. Participants without the event of death were censored at the last date in the study, defined as the latest date of the following: the date of first administration of study treatment, date of last study treatment, date of last visit, or date last known to be alive. Kaplan-Meier estimation was used for OS. Analysis was performed on ITT population. "99999" signifies the median and 95% confidence interval were not calculable because less than 50% of participants had the event.
    End point type
    Secondary
    End point timeframe
    First administration of any study treatment until death or data cutoff 07 December 2014, up to 4 years
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    1021
    Units: months
        median (confidence interval 95%)
    99999 (99999 to 99999)
    No statistical analyses for this end point

    Secondary: Biological Progression-free Interval

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    End point title
    Biological Progression-free Interval
    End point description
    Biological progression-free interval is defined as the interval from the date of the first administration of any study treatment to the date of the first documented serial elevation of the ovarian cancer mucin CA- 125. More precisely, this is defined as the first documented increase in CA-125 levels as follows: 1) CA- 125 >= 2 times (x) the ULN on 2 occasions at least 1 week apart (for participants with CA-125 within normal range pre-treatment) or 2) CA-125 >= 2 x ULN on 2 occasions at least 1 week apart (for participants with elevated CA-125 pre-treatment and initial normalization of CA-125 on-treatment) or 3) CA-125 >= 2 x nadir value, which is the lowest observed CA-125 value per participant on 2 occasions at least 1 week apart (for participants with elevated CA-125 pre-treatment which never normalized). Studies linking CA-125 levels with bevacizumab exposure for PFS did not produce any reliable information. Therefore, biological PFS data were not analyzed.
    End point type
    Secondary
    End point timeframe
    3 days prior to Day 1 of every cycle, then every 6 weeks during the first year, every 3 months in the second and third year, every 6 months in the fourth year of the study (until data cutoff 07 December 2014, up to 4 years)
    End point values
    Bevacizumab + Paclitaxel + Carboplatin
    Number of subjects analysed
    0 [2]
    Units: months
        median (confidence interval 95%)
    ( to )
    Notes
    [2] - The data of biological progression-free interval were not analyzed for this study.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 1 up to 30 days after last dose of study treatment (until data cutoff 07 December 2014, up to 4 years)
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.0
    Reporting groups
    Reporting group title
    Bevacizumab + Paclitaxel + Carboplatin
    Reporting group description
    Participants received bevacizumab 15 mg/kg IV on Day 1 every 3 weeks from Cycle 1 (1 cycle = 3 weeks) to Cycle 36 (initially concurrent with chemotherapy, then continued as a single agent following the completion of chemotherapy), or until protocol defined disease progression or until unacceptable toxicity (whichever occurred first). The 15 mg/kg dose every 3 weeks was the recommended dose; however a dose of IV bevacizumab 7.5 mg/kg every 3 weeks was permissible, but was to be selected prior to the first dosing of bevacizumab. Participants received paclitaxel 175 mg/m^2 IV on Day 1 every 3 weeks or 80 mg/m^2 IV every week and carboplatin (AUC 5-6) IV on Day 1 every 3 weeks for a minimum of 4 and maximum of 8 cycles (including up to 4 pre-surgical cycles), or until protocol defined disease progression, or unacceptable toxicity (whichever occurred first).

    Serious adverse events
    Bevacizumab + Paclitaxel + Carboplatin
    Total subjects affected by serious adverse events
         subjects affected / exposed
    285 / 1021 (27.91%)
         number of deaths (all causes)
    235
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast cancer recurrent
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Chronic lymphocytic leukaemia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thyroid cancer recurrent
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    16 / 1021 (1.57%)
         occurrences causally related to treatment / all
    14 / 16
         deaths causally related to treatment / all
    0 / 0
    Embolism venous
         subjects affected / exposed
    9 / 1021 (0.88%)
         occurrences causally related to treatment / all
    9 / 9
         deaths causally related to treatment / all
    1 / 1
    Lymphocele
         subjects affected / exposed
    8 / 1021 (0.78%)
         occurrences causally related to treatment / all
    0 / 8
         deaths causally related to treatment / all
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Embolism arterial
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Lymphoedema
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Arterial thrombosis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypovolaemic shock
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Malignant hypertension
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombophlebitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Venous thrombosis limb
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Intestinal operation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    6 / 1021 (0.59%)
         occurrences causally related to treatment / all
    1 / 6
         deaths causally related to treatment / all
    0 / 0
    Asthenia
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    4 / 1021 (0.39%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    Impaired healing
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Chest pain
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Death
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Fatigue
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mucosal inflammation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Performance status decreased
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Female genital tract fistula
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Pelvic pain
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    8 / 1021 (0.78%)
         occurrences causally related to treatment / all
    5 / 8
         deaths causally related to treatment / all
    0 / 0
    Pneumothorax
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemoptysis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Psychiatric disorders
    Suicide attempt
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Bruxism
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Major depression
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Alanine aminotransferase abnormal
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Aspartate aminotransferase abnormal
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood alkaline phosphatase abnormal
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical condition abnormal
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Weight decreased
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Hand fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infusion related reaction
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hip fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Joint dislocation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Procedural pain
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower limb fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Radius fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pubis fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Seroma
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transfusion reaction
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 1
    Myocardial infarction
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    1 / 1
    Angina pectoris
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tachycardia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Headache
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Generalised tonic-clonic seizure
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Presyncope
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral ischaemia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebrovascular disorder
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Lacunar infarction
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Leukoencephalopathy
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Peripheral sensorimotor neuropathy
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Posterior reversible encephalopathy syndrome
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    25 / 1021 (2.45%)
         occurrences causally related to treatment / all
    6 / 28
         deaths causally related to treatment / all
    0 / 1
    Neutropenia
         subjects affected / exposed
    21 / 1021 (2.06%)
         occurrences causally related to treatment / all
    7 / 23
         deaths causally related to treatment / all
    0 / 0
    Anaemia
         subjects affected / exposed
    16 / 1021 (1.57%)
         occurrences causally related to treatment / all
    3 / 20
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    13 / 1021 (1.27%)
         occurrences causally related to treatment / all
    3 / 14
         deaths causally related to treatment / all
    0 / 0
    Leukopenia
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Thrombotic microangiopathy
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Disseminated intravascular coagulation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pancytopenia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    13 / 1021 (1.27%)
         occurrences causally related to treatment / all
    4 / 14
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    11 / 1021 (1.08%)
         occurrences causally related to treatment / all
    1 / 11
         deaths causally related to treatment / all
    0 / 0
    Ileus
         subjects affected / exposed
    9 / 1021 (0.88%)
         occurrences causally related to treatment / all
    1 / 11
         deaths causally related to treatment / all
    0 / 1
    Subileus
         subjects affected / exposed
    9 / 1021 (0.88%)
         occurrences causally related to treatment / all
    0 / 9
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    8 / 1021 (0.78%)
         occurrences causally related to treatment / all
    3 / 8
         deaths causally related to treatment / all
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    8 / 1021 (0.78%)
         occurrences causally related to treatment / all
    2 / 8
         deaths causally related to treatment / all
    0 / 0
    Constipation
         subjects affected / exposed
    6 / 1021 (0.59%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    5 / 1021 (0.49%)
         occurrences causally related to treatment / all
    2 / 6
         deaths causally related to treatment / all
    0 / 0
    Nausea
         subjects affected / exposed
    4 / 1021 (0.39%)
         occurrences causally related to treatment / all
    2 / 4
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal perforation
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Ascites
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Umbilical hernia
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Abdominal hernia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Abdominal incarcerated hernia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Anal fistula
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Dysphagia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterocolitis haemorrhagic
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Faecaloma
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastric stenosis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastric ulcer
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastriointestinal inflammation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal toxicity
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemorrhoids
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemorrhoids thrombosed
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal perforation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Jejunal perforation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Large intestinal obstruction
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Large intestine perforation
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mallory-Weiss syndrome
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Mechanical ileus
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mouth haemorrhage
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Oesophagitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholecystitis acute
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Jaundice cholestatic
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Urticaria
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Erythema
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Paraneoplastic dermatomyositis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psoriasis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal failure
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Calculus ureteric
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Glomerulonephritis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hydronephrosis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nephrotic syndrome
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal infarct
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Tubulointerstitial nephritis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ureteric obstruction
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthropathy
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Back pain
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Neck pain
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pain in extremity
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Rheumatic disorder
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    5 / 1021 (0.49%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 1
    Urinary tract infection
         subjects affected / exposed
    5 / 1021 (0.49%)
         occurrences causally related to treatment / all
    1 / 5
         deaths causally related to treatment / all
    0 / 0
    Infected lymphocele
         subjects affected / exposed
    4 / 1021 (0.39%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    Cellulitis
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    3 / 1021 (0.29%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Nasopharyngitis
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Abdominal wall abscess
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Anal abscess
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Lung infection
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pelvic abscess
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pharyngitis
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Abdominal infection
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Abdominal sepsis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute hepatitis C
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Arthritis infective
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Catheter site infection
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cholecystitis infective
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Clostridium difficile infection
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Colonic abscess
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cystitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterocolitis infectious
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastroenteritis viral
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gingivitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Groin abscess
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infected cyst
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Parotid abscess
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Peritoneal abscess
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Staphylococcal infection
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Subdiaphragmatic abscess
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vulval cellulitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Proctitis infectious
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    2 / 1021 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Decreased appetite
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperkalaemia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nicotinic acid deficiency
         subjects affected / exposed
    1 / 1021 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Bevacizumab + Paclitaxel + Carboplatin
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    980 / 1021 (95.98%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    552 / 1021 (54.06%)
         occurrences all number
    1429
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    372 / 1021 (36.43%)
         occurrences all number
    637
    Asthenia
         subjects affected / exposed
    135 / 1021 (13.22%)
         occurrences all number
    243
    Mucosal inflammation
         subjects affected / exposed
    110 / 1021 (10.77%)
         occurrences all number
    140
    Pyrexia
         subjects affected / exposed
    86 / 1021 (8.42%)
         occurrences all number
    109
    Oedema peripheral
         subjects affected / exposed
    63 / 1021 (6.17%)
         occurrences all number
    72
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
         subjects affected / exposed
    301 / 1021 (29.48%)
         occurrences all number
    461
    Cough
         subjects affected / exposed
    94 / 1021 (9.21%)
         occurrences all number
    125
    Dyspnoea
         subjects affected / exposed
    66 / 1021 (6.46%)
         occurrences all number
    83
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    66 / 1021 (6.46%)
         occurrences all number
    79
    Investigations
    Weight increased
         subjects affected / exposed
    77 / 1021 (7.54%)
         occurrences all number
    81
    Platelet count decreased
         subjects affected / exposed
    93 / 1021 (9.11%)
         occurrences all number
    164
    Nervous system disorders
    Headache
         subjects affected / exposed
    241 / 1021 (23.60%)
         occurrences all number
    449
    Neuropathy peripheral
         subjects affected / exposed
    201 / 1021 (19.69%)
         occurrences all number
    268
    Peripheral sensory neuropathy
         subjects affected / exposed
    161 / 1021 (15.77%)
         occurrences all number
    205
    Paraesthesia
         subjects affected / exposed
    134 / 1021 (13.12%)
         occurrences all number
    195
    Dizziness
         subjects affected / exposed
    75 / 1021 (7.35%)
         occurrences all number
    88
    Dysgeusia
         subjects affected / exposed
    68 / 1021 (6.66%)
         occurrences all number
    94
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    485 / 1021 (47.50%)
         occurrences all number
    1046
    Anaemia
         subjects affected / exposed
    333 / 1021 (32.62%)
         occurrences all number
    471
    Thrombocytopenia
         subjects affected / exposed
    279 / 1021 (27.33%)
         occurrences all number
    560
    Leukopenia
         subjects affected / exposed
    109 / 1021 (10.68%)
         occurrences all number
    245
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    393 / 1021 (38.49%)
         occurrences all number
    863
    Diarrhoea
         subjects affected / exposed
    258 / 1021 (25.27%)
         occurrences all number
    480
    Constipation
         subjects affected / exposed
    255 / 1021 (24.98%)
         occurrences all number
    441
    Vomiting
         subjects affected / exposed
    230 / 1021 (22.53%)
         occurrences all number
    370
    Abdominal pain
         subjects affected / exposed
    221 / 1021 (21.65%)
         occurrences all number
    341
    Stomatitis
         subjects affected / exposed
    110 / 1021 (10.77%)
         occurrences all number
    165
    Abdominal pain upper
         subjects affected / exposed
    104 / 1021 (10.19%)
         occurrences all number
    143
    Gingival bleeding
         subjects affected / exposed
    75 / 1021 (7.35%)
         occurrences all number
    107
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    442 / 1021 (43.29%)
         occurrences all number
    450
    Rash
         subjects affected / exposed
    76 / 1021 (7.44%)
         occurrences all number
    101
    Pruritus
         subjects affected / exposed
    71 / 1021 (6.95%)
         occurrences all number
    101
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    317 / 1021 (31.05%)
         occurrences all number
    681
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    261 / 1021 (25.56%)
         occurrences all number
    439
    Myalgia
         subjects affected / exposed
    185 / 1021 (18.12%)
         occurrences all number
    304
    Pain in extremity
         subjects affected / exposed
    138 / 1021 (13.52%)
         occurrences all number
    198
    Back pain
         subjects affected / exposed
    133 / 1021 (13.03%)
         occurrences all number
    163
    Musculoskeletal pain
         subjects affected / exposed
    132 / 1021 (12.93%)
         occurrences all number
    189
    Bone pain
         subjects affected / exposed
    52 / 1021 (5.09%)
         occurrences all number
    67
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    122 / 1021 (11.95%)
         occurrences all number
    181
    Nasopharyngitis
         subjects affected / exposed
    83 / 1021 (8.13%)
         occurrences all number
    114
    Upper respiratory tract infection
         subjects affected / exposed
    60 / 1021 (5.88%)
         occurrences all number
    92
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    94 / 1021 (9.21%)
         occurrences all number
    123

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 May 2011
    - The recommended dose of bevacizumab remained as 15 mg/kg; however; the investigator was permitted to use a bevacizumab dose of 7.5 mg/kg instead. - Guidance on the assessment of glomerular filtration rate and thus carboplatin dose was provided, after a change in the standards of the laboratory testing of creatinine; which could have impacted the dose of carboplatin given. - Clarification of what concomitant medication is required to be documented in the electronic case report forms (eCRF). - Clarification of the maximum number of bevacizumab monotherapy cycles to be received and that there was no stipulated minimum. - Clarification that the participant must remain on the commenced paclitaxel regimen (every 3 weeks or weekly) for the duration of paclitaxel therapy.
    21 Feb 2012
    - Regarding thromboembolic events: The exclusion criteria were updated to specify that participants who had recent (within 6 months) Grade >1 arterial or Grade >3 venous thromboembolic events were excluded. This aligned the MO22923 study with other bevacizumab study protocols which excluded participants with recent thromboses. The guidance of when to stop bevacizumab therapy following thromboembolic events was further clarified so that pulmonary emboli were specified as venous events and that dose adjustment for asymptomatic venous thromboembolic events found on routine scans were done on a case-by-case basis according to the judgment of the investigator. - Regarding hematology lab value requirements for paclitaxel administration: During amendment Version 2.0 the absolute neutrophil count (ANC) levels to withhold paclitaxel dose were incorrectly changed from 1.0 × 10^9/L to 1.5 × 10^9/L. Feedback from investigators revealed that this was not in accordance with common practice and led to many doses being unnecessarily missed or numerous protocol violations. The ANC level for withholding paclitaxel was re-set to 1.0 × 10^9/L. The entry level ANC for the study remained at 1.5 × 10^9/L. In addition, the minimum platelets level on Days 8 and 15, used to determine paclitaxel administration was changed from 100 × 10^9/L to 80 × 10^9/L. - The exploratory biomarker analyses were supplemented with additional samples to be taken during bevacizumab monotherapy for those participants who consented to be in the biomarker study.
    25 Feb 2014
    Greater clarity was provided regarding the End of Study - The protocol was aligned with the updated biomarker plan which no longer included immunohistochemistry analyses (e.g., vascular endothelial growth factor [VEGF], VEGF receptor 1/2 [VEGFR1/2], neuropilin-1, cluster of differentiation 31 [CD31]) from tissue samples. The updated biomarker plan focused on ribonucleic acid (RNA) extraction. The planned analysis of tissue-derived deoxyribonucleic acid (DNA) was removed. - The post-study provision of care with bevacizumab was clarified. - Definition of the per protocol (PP) population was clarified. - Text regarding the reporting and follow up of AEs was updated in line with the latest Roche protocol template wording.

    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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