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    Clinical Trial Results:
    A randomized phase II study to determine the efficacy and tolerability of two doses of eribulin plus lapatinib in trastuzumab pre-treated patients with HER2-positive metastatic breast cancer

    Summary
    EudraCT number
    2010-023237-37
    Trial protocol
    DE  
    Global end of trial date
    31 Mar 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Dec 2021
    First version publication date
    13 Dec 2021
    Other versions
    Summary report(s)
    EVITA CSR SYNOPSIS

    Trial information

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    Trial identification
    Sponsor protocol code
    GBG64
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01534455
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GBG Forschungs GmbH
    Sponsor organisation address
    Martin Behaim Str. 12, Neu-Isenburg, Germany,
    Public contact
    Medicine and Research, GBG Forschungs GmbH, +49 610274800, publications@gbg.de
    Scientific contact
    Medicine and Research, GBG Forschungs GmbH, +49 610274800, publications@gbg.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    22 Mar 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Mar 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Mar 2015
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    1. To assess the time to progression (TTP) of eribulin at a dose of 1.23 mg/m² IV days 1+8, q 21 and eribulin given at a dose of 1.76 mg/m² IV day 1, q d21 both in combination with lapatinib. 2. To assess the safety and toxicity of both treatment arms.
    Protection of trial subjects
    The trial protocol including amendments, the patient information and the informed consent were reviewed and approved from a properly constituted IRB/IEC for each site prior to the study start. The trial was in compliance with the International Conference on Harmonization (ICH) - Harmonized Tripartite Guideline for Good Clinical Practice (GCP) (E6), and the Commission Directives in the European Community as well as with the applicable German national laws and regulations, and with Declaration of Helsinki and its revisions in all aspects of preparation, monitoring, reporting, auditing, and archiving. IDMC was to ensure the ethical conduct of the trial and to protect patients' safety interests in this study
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    23 Jan 2012
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Scientific research
    Long term follow-up duration
    10 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 41
    Worldwide total number of subjects
    41
    EEA total number of subjects
    41
    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)
    32
    From 65 to 84 years
    9
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Approximately 2.5years (Q-I 2012–Q-III 2014) in 49 sites in Germany. 43 pts were randomized, 41 started treatment (eribulin 1.23mg/m2 d1,8: 21; eribulin 1.76mg/m2 d1: 20). Study was amended in Nov 2013 to prolong recruitment for being behind planned schedule. Despite that, study was stopped on 7th July 2014 due to persistent difficulty in accrual.

    Pre-assignment
    Screening details
    Histologically HER2+ BC; Advanced BC not suitable for surgery or RT alone; Previous systemic treatments eligible: Adjuvant and <=3 CT regimen for advanced BC; Previous trastuzumab as (neo)adjuvant for eBC and/or 1st and/or 2nd line for mBC; Prior max. cum. dose <= 360 mg/m² for A and 720 mg/m² for E; ECOG 0-2, normal cardiac eject. function

    Pre-assignment period milestones
    Number of subjects started
    41
    Number of subjects completed
    41

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Eribulin 1.23
    Arm description
    Eribulin 1.23 mg/m² IV days 1+8, q d21
    Arm type
    Experimental

    Investigational medicinal product name
    Eribulin mesylate (Halaven)
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Eribulin 1.23mg/m² IV as a bolus over 2-5 minutes, days 1+8, q d21

    Arm title
    Eribulin 1.76
    Arm description
    Eribulin 1.76 mg/m² IV day 1 q d21
    Arm type
    Experimental

    Investigational medicinal product name
    Eribulin mesylate (Halaven®)
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Eribulin 1.76 mg/m² IV as a bolus over 2-5 minutes , day 1, q d21

    Number of subjects in period 1
    Eribulin 1.23 Eribulin 1.76
    Started
    21
    20
    Completed
    14
    13
    Not completed
    7
    7
         Physician decision
    2
    -
         Adverse event, non-fatal
    1
    -
         Hematological tox. related to study med
    -
    1
         Other reasons
    2
    3
         Patient wish
    -
    1
         Non-hematol. tox. related to study med
    1
    2
         death (not tumor-related)
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Eribulin 1.23
    Reporting group description
    Eribulin 1.23 mg/m² IV days 1+8, q d21

    Reporting group title
    Eribulin 1.76
    Reporting group description
    Eribulin 1.76 mg/m² IV day 1 q d21

    Reporting group values
    Eribulin 1.23 Eribulin 1.76 Total
    Number of subjects
    21 20 41
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    50 (32 to 84) 60 (39 to 69) -
    Gender categorical
    Units: Subjects
        Female
    21 20 41
        Male
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Eribulin 1.23
    Reporting group description
    Eribulin 1.23 mg/m² IV days 1+8, q d21

    Reporting group title
    Eribulin 1.76
    Reporting group description
    Eribulin 1.76 mg/m² IV day 1 q d21

    Primary: Time to progression (TTP)

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    End point title
    Time to progression (TTP) [1]
    End point description
    Time to progression (TTP) is defined as the time period between randomization and documented disease progression or disease-related death. Patients with no progression or tumor-related death reported were censored on the date of the last contact (“last tumor assessment”, “last follow up date” or “last date in drug log”).
    End point type
    Primary
    End point timeframe
    time in months between randomization and first event
    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: Kaplan-Meier estimates were presented graphically; median time to progression was reported in each arm together with the 95% confidence interval (CI). No test of significance was planned to compare treatment arms
    End point values
    Eribulin 1.23 Eribulin 1.76
    Number of subjects analysed
    21 [2]
    20 [3]
    Units: month
        number (confidence interval 95%)
    8.1 (4.8 to 9.4)
    6.5 (4.6 to 13.4)
    Notes
    [2] - 19events
    [3] - 17events
    No statistical analyses for this end point

    Secondary: Overall survial

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    End point title
    Overall survial
    End point description
    Overall survival (OS) is defined as the time period between randomization and death due to any cause. Patients with no death reported were censored on the date of the last contact (“last tumor assessment”, “last follow up date” or “last date in drug log“).
    End point type
    Secondary
    End point timeframe
    time in months between randomization and death
    End point values
    Eribulin 1.23 Eribulin 1.76
    Number of subjects analysed
    21 [4]
    20 [5]
    Units: month
        number (confidence interval 95%)
    23.1 (12.5 to 35.0)
    23.2 (13.7 to 30.1)
    Notes
    [4] - 14 events
    [5] - 12 events
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All adverse events occurring during the study treatment period were reported
    Adverse event reporting additional description
    Predefined AEs any grade (1-4) are reported per Patient. Other AEs reported as free-text are given irrespective of preferred terms if occurring in >20% For SAEs relatedness was not tabulated, therefore here we conservatively record all SAEs as related to treatment
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    n.a.
    Reporting groups
    Reporting group title
    Eribulin 1.23
    Reporting group description
    Eribulin 1.23 mg/m² IV days 1+8, q d21

    Reporting group title
    Eribulin 1.76
    Reporting group description
    Eribulin 1.76 mg/m² IV day 1 q d21

    Serious adverse events
    Eribulin 1.23 Eribulin 1.76
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 21 (28.57%)
    8 / 20 (40.00%)
         number of deaths (all causes)
    1
    1
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Gastric cancer
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Vascular disorders
    Pulmonary embolism
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Arrhythmia
         subjects affected / exposed
    0 / 21 (0.00%)
    2 / 20 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Confusional state
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    3 / 21 (14.29%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    3 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 21 (0.00%)
    2 / 20 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 21 (9.52%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fever
         subjects affected / exposed
    0 / 21 (0.00%)
    4 / 20 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    4 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Flu like symptoms
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chills
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Macular edema
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Retinal haemorrhage
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Pulmonary mass
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Pain in lumbar spine
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    2 / 21 (9.52%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Eribulin 1.23 Eribulin 1.76
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    21 / 21 (100.00%)
    20 / 20 (100.00%)
    Investigations
    Increased bilirubin
         subjects affected / exposed
    1 / 21 (4.76%)
    3 / 20 (15.00%)
         occurrences all number
    1
    3
    Increased alkaline phosphatase
         subjects affected / exposed
    7 / 21 (33.33%)
    7 / 20 (35.00%)
         occurrences all number
    7
    7
    Increased ASAT
         subjects affected / exposed
    13 / 21 (61.90%)
    15 / 20 (75.00%)
         occurrences all number
    13
    15
    Increased ALAT
         subjects affected / exposed
    15 / 21 (71.43%)
    12 / 20 (60.00%)
         occurrences all number
    15
    12
    Increased creatinine
         subjects affected / exposed
    1 / 21 (4.76%)
    1 / 20 (5.00%)
         occurrences all number
    1
    1
    Vascular disorders
    Vascular disorders
         subjects affected / exposed
    4 / 21 (19.05%)
    8 / 20 (40.00%)
         occurrences all number
    4
    8
    Nervous system disorders
    Headache
         subjects affected / exposed
    4 / 21 (19.05%)
    6 / 20 (30.00%)
         occurrences all number
    4
    6
    Sensory neuropathy
         subjects affected / exposed
    13 / 21 (61.90%)
    14 / 20 (70.00%)
         occurrences all number
    13
    14
    Nervous system disorder
         subjects affected / exposed
    5 / 21 (23.81%)
    5 / 20 (25.00%)
         occurrences all number
    5
    5
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    18 / 21 (85.71%)
    15 / 20 (75.00%)
         occurrences all number
    18
    15
    Leukopenia
         subjects affected / exposed
    19 / 21 (90.48%)
    17 / 20 (85.00%)
         occurrences all number
    19
    17
    Neutropenia
         subjects affected / exposed
    16 / 21 (76.19%)
    16 / 20 (80.00%)
         occurrences all number
    16
    16
    Febrile neutropenia
         subjects affected / exposed
    1 / 21 (4.76%)
    2 / 20 (10.00%)
         occurrences all number
    1
    2
    Thrombopenia
         subjects affected / exposed
    6 / 21 (28.57%)
    2 / 20 (10.00%)
         occurrences all number
    6
    2
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    16 / 21 (76.19%)
    16 / 20 (80.00%)
         occurrences all number
    16
    16
    Mucositis/esophagitis
         subjects affected / exposed
    9 / 21 (42.86%)
    10 / 20 (50.00%)
         occurrences all number
    9
    10
    Fever without neutropenia
         subjects affected / exposed
    5 / 21 (23.81%)
    6 / 20 (30.00%)
         occurrences all number
    5
    6
    General disorders and administration site conditions
         subjects affected / exposed
    3 / 21 (14.29%)
    11 / 20 (55.00%)
         occurrences all number
    3
    11
    Immune system disorders
    Allergic reactions
         subjects affected / exposed
    5 / 21 (23.81%)
    6 / 20 (30.00%)
         occurrences all number
    5
    6
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    10 / 21 (47.62%)
    9 / 20 (45.00%)
         occurrences all number
    10
    9
    Vomiting
         subjects affected / exposed
    6 / 21 (28.57%)
    4 / 20 (20.00%)
         occurrences all number
    6
    4
    Diarrhoea
         subjects affected / exposed
    12 / 21 (57.14%)
    12 / 20 (60.00%)
         occurrences all number
    12
    12
    Constipation
         subjects affected / exposed
    3 / 21 (14.29%)
    4 / 20 (20.00%)
         occurrences all number
    3
    4
    Gastrointestinal disorders
         subjects affected / exposed
    10 / 21 (47.62%)
    9 / 20 (45.00%)
         occurrences all number
    10
    9
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
         subjects affected / exposed
    5 / 21 (23.81%)
    14 / 20 (70.00%)
         occurrences all number
    5
    14
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    20 / 21 (95.24%)
    18 / 20 (90.00%)
         occurrences all number
    20
    18
    PPE (hand-foot syndrome)
         subjects affected / exposed
    7 / 21 (33.33%)
    5 / 20 (25.00%)
         occurrences all number
    7
    5
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    13 / 21 (61.90%)
    14 / 20 (70.00%)
         occurrences all number
    13
    14
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    10 / 21 (47.62%)
    12 / 20 (60.00%)
         occurrences all number
    10
    12
    Myalgia
         subjects affected / exposed
    6 / 21 (28.57%)
    7 / 20 (35.00%)
         occurrences all number
    6
    7
    Musculoskeletal, connective tissue and bone disorders
         subjects affected / exposed
    5 / 21 (23.81%)
    9 / 20 (45.00%)
         occurrences all number
    5
    9
    Infections and infestations
    Infection
         subjects affected / exposed
    11 / 21 (52.38%)
    10 / 20 (50.00%)
         occurrences all number
    11
    10
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    5 / 21 (23.81%)
    7 / 20 (35.00%)
         occurrences all number
    5
    7

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Sep 2013
    There was one substantial Amendment to the protocol of E-Vita. In November 2013, given that the study recruitment was behind the planned schedule, the study was amended in order to prolong the recruitment period, as well as to allow the use of new Anti-HER2 treatment options as TDM1. Despite that the study was stopped in July 2014 due to the persistent difficulty in accrual. Amendment 1 protocol changes: Title: A randomized phase II study to determine the efficacy and tolerability of two doses of eribulin plus lapatinib in patients pre-treated with anti-HER2- therapy with HER2-positive metastatic breast cancer. Stratification factors for randomization will be: • previous line of chemotherapy for metastatic disease (0-1 vs. 2-3). Inclusion criterion no.6: The following previous systemic treatments are eligible: • Previous treatment with anti HER2 therapy either as (neo)adjuvant treatment for early breast cancer and/or first, second and/or third line treatment for metastatic breast cancer, • adjuvant and up to 3 chemotherapy regimen for metastatic breast cancer, … • radiotherapy with full recovery from clinical relevant side effects. The measurable disease must be completely outside the radiation field or there must be pathologic proof of progressive disease. Exclusion criterion no.2: Patients who have received eribulin or who have received lapatinib as part of the last therapy before entering this Trial. Enrollment period: 36 months (Q-I 2012 – Q-I 2015). Regular End of Study: The end of this study is defined as 4 years after the 1st patient entered the trial. Planned end of study is Q-I 2016.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/30875348
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