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    Clinical Trial Results:
    An open label, phase II trial of Afatinib with or without Vinorelbine for the treatment of HER2-overexpressing inflammatory breast cancer.

    Due to the EudraCT – Results system being out of service between 31 July 2015 and 12 January 2016, these results have been published in compliance with revised timelines.
    Summary
    EudraCT number
    2010-024454-10
    Trial protocol
    GB  
    Global end of trial date
    18 Nov 2014

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

    Trial information

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    Trial identification
    Sponsor protocol code
    1200.89
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01325428
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Boehringer Ingelheim
    Sponsor organisation address
    Binger Strasse 173, Ingelheim am Rhein, Germany, 55216
    Public contact
    QRPE Processes and Systems Coordination Clinical Trial Information Disclosure, Boehringer Ingelheim Pharma GmbH & Co. KG, +1 +1 800 243 0127, clintriage.rdg@boehringer-ingelheim.com
    Scientific contact
    QRPE Processes and Systems Coordination Clinical Trial Information Disclosure, Boehringer Ingelheim Pharma GmbH & Co. KG, +1 +1 800 243 0127, clintriage.rdg@boehringer-ingelheim.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
    16 Dec 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    18 Nov 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Nov 2014
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The objectives were to investigate the efficacy and safety of Afatinib alone and Afatinib in combination with weekly Vinorelbine upon progression on Afatinib monotherapy in patients with HER2-overexpressing inflammatory breast cancer (IBC).
    Protection of trial subjects
    Only subjects that met all the study inclusion and none of the exclusion criteria were entered in the study. All subjects were free to withdraw from the clinical trial at any time for any reason given. If a subject continued to take trial medication, close monitoring was adhered to and all adverse events recorded. Rules were implemented whereby doses would be reduced if required. In case of treatment-related AEs, the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily. Thereafter, if further events were reported which required dose reductions, the subject would be withdrawn from the trial. Symptomatic treatment of tumour associated symptoms were allowed throughout.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Dec 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Thailand: 12
    Country: Number of subjects enrolled
    Tunisia: 2
    Country: Number of subjects enrolled
    United Kingdom: 5
    Country: Number of subjects enrolled
    United States: 2
    Country: Number of subjects enrolled
    Australia: 2
    Country: Number of subjects enrolled
    Hong Kong: 1
    Country: Number of subjects enrolled
    Korea, Republic of: 5
    Worldwide total number of subjects
    29
    EEA total number of subjects
    5
    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)
    27
    From 65 to 84 years
    2
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This was an open-label single arm study conducted in two sequential parts (Part A in which patients were treated with Afatinib (BIBW 2992) as Monotherapy; Part B in which patients were treated with Afatinib plus Vinorelbine as combination therapy). Patients continued from Part A to Part B upon progression of disease in Part A.

    Pre-assignment
    Screening details
    All subjects were screened for eligibility to participate in the trial. Subjects attended specialist sites which would then ensure that they (the subjects) met all strictly implemented inclusion/exclusion criteria. Subjects were not allocated to trial treatment if any one of the specific entry criteria were violated.

    Period 1
    Period 1 title
    Part A: Treatment Period
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Part A: Afatinib Once Daily (OD).
    Arm description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until Progression of their Disease (PD). In case of treatment-related adverse events (AEs), the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily. Patients were treated until PD in Part A, then they could continue with Afatinib and Vinorelbine in Part B.
    Arm type
    Experimental

    Investigational medicinal product name
    Afatinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD).

    Number of subjects in period 1 [1]
    Part A: Afatinib Once Daily (OD).
    Started
    26
    Completed
    10
    Not completed
    16
         Other reason not defined above
    2
         Refused continue taking trial medication
    2
         Clinical signs, symptoms of progression
    2
         Other adverse event
    1
         Progressive disease according to RECIST
    9
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Baseline characteristics are based on patients who were randomised after successfully completing the screening period and received at least one of the trial medication.
    Period 2
    Period 2 title
    Part B: Treatment Period
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Part B: Afatinib+V (Vinorelbine).
    Arm description
    Part B: Upon first Progression of Disease (PD), patients could enter Part B of the study, during which they continued to be treated with Afatinib at the previously applied dose in Part A and additionally were treated with Vinorelbine 25 mg/m2 per week via intravenous (i.v) infusion. Patients treated with Afatinib and Vinorelbine combination therapy could continue to receive treatment until second progression of disease, intolerable side effects, or withdrawal of consent. A patient was deemed to have completed the trial once they showed progressive disease according to RECIST (1.1) in Part B.
    Arm type
    Experimental

    Investigational medicinal product name
    Vinorelbine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Vinorelbine was administered as 25 mg/m2 per week via intravenous (i.v) infusion.

    Investigational medicinal product name
    Afatinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD).

    Number of subjects in period 2
    Part B: Afatinib+V (Vinorelbine).
    Started
    10
    Completed
    7
    Not completed
    3
         Refused continue taking trial medication
    2
         Other reason not defined above
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Part A: Treatment Period
    Reporting group description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until Progression of their Disease (PD). In case of treatment-related AEs, the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily.

    Reporting group values
    Part A: Treatment Period Total
    Number of subjects
    26
    Age categorical
    Units: Subjects
    Age continuous
    TRT A Treated set - TS (Part A): All patients who were documented to have taken at least one dose of Afatinib in Part A. TRT B Treated set (Part B): All patients who received at least one dose each of Afatinib and Vinorelbine in Part B.
    Units: years
        arithmetic mean (standard deviation)
    51.5 ( 8.8 ) -
    Gender categorical
    Units: Subjects
        Female
    26 26
        Male
    0 0
    Subject analysis sets

    Subject analysis set title
    Afatinib Once Daily (OD). Afatinib+V (Vinorelbine).
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until Progression of their Disease (PD). In case of treatment-related AEs, the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily. Part B: Upon first Progression of Disease (PD), patients could enter Part B of the study, during which they continued to be treated with Afatinib and additionally were treated with Vinorelbine 25 mg/m2 per week via intravenous (i.v) infusion. Patients treated with Afatinib and Vinorelbine combination therapy could continue to receive treatment until second progression of disease, intolerable side effects, or withdrawal of consent.

    Subject analysis sets values
    Afatinib Once Daily (OD). Afatinib+V (Vinorelbine).
    Number of subjects
    26
    Age categorical
    Units: Subjects
    Age continuous
    TRT A Treated set - TS (Part A): All patients who were documented to have taken at least one dose of Afatinib in Part A. TRT B Treated set (Part B): All patients who received at least one dose each of Afatinib and Vinorelbine in Part B.
    Units: years
        arithmetic mean (standard deviation)
    51.5 ( 8.8 )
    Gender categorical
    Units: Subjects
        Female
    26
        Male
    0

    End points

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    End points reporting groups
    Reporting group title
    Part A: Afatinib Once Daily (OD).
    Reporting group description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until Progression of their Disease (PD). In case of treatment-related adverse events (AEs), the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily. Patients were treated until PD in Part A, then they could continue with Afatinib and Vinorelbine in Part B.
    Reporting group title
    Part B: Afatinib+V (Vinorelbine).
    Reporting group description
    Part B: Upon first Progression of Disease (PD), patients could enter Part B of the study, during which they continued to be treated with Afatinib at the previously applied dose in Part A and additionally were treated with Vinorelbine 25 mg/m2 per week via intravenous (i.v) infusion. Patients treated with Afatinib and Vinorelbine combination therapy could continue to receive treatment until second progression of disease, intolerable side effects, or withdrawal of consent. A patient was deemed to have completed the trial once they showed progressive disease according to RECIST (1.1) in Part B.

    Subject analysis set title
    Afatinib Once Daily (OD). Afatinib+V (Vinorelbine).
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until Progression of their Disease (PD). In case of treatment-related AEs, the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily. Part B: Upon first Progression of Disease (PD), patients could enter Part B of the study, during which they continued to be treated with Afatinib and additionally were treated with Vinorelbine 25 mg/m2 per week via intravenous (i.v) infusion. Patients treated with Afatinib and Vinorelbine combination therapy could continue to receive treatment until second progression of disease, intolerable side effects, or withdrawal of consent.

    Primary: Part A: Clinical Benefit (CB) Assessed by Complete Response (CR), Partial Response (PR) or Stable Disease (SD) for at least 6 Months Using the Response Evaluation Criteria in Solid Tumours (RECIST 1.1).

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    End point title
    Part A: Clinical Benefit (CB) Assessed by Complete Response (CR), Partial Response (PR) or Stable Disease (SD) for at least 6 Months Using the Response Evaluation Criteria in Solid Tumours (RECIST 1.1). [1]
    End point description
    Tumour response was assessed separately for Part A and Part B according to the Response Evaluation Criteria in SolidTumors (RECIST) version 1.1. The primary endpoint of this study was confirmed clinical benefit, as assessed by stable disease for at least 6 months (defined as >182 days), partial response (PR), or complete response (CR) according to RECIST version 1.1 (only confirmed responses were considered). The Confidence Interval (CI) is Exact CI.
    End point type
    Primary
    End point timeframe
    This endpoint was assessed between the from first administration of trial medication in Part A and the earliest of PD, death or start of next treatment (either Part B combination therapy or new anti-cancer therapy) up to 929 days.
    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: This endpoint was evaluated only descriptively. Thus, no statistical hypothesis was tested.
    End point values
    Part A: Afatinib Once Daily (OD).
    Number of subjects analysed
    26 [2]
    Units: Percentage of participants
        number (confidence interval 95%)
    35 (17 to 56)
    Notes
    [2] - Part A: TS
    No statistical analyses for this end point

    Primary: Part B: Clinical Benefit (CB) Assessed by Complete Response (CR), Partial Response (PR) or Stable Disease (SD) for at least 6 Months Using the Response Evaluation Criteria in Solid Tumours (RECIST 1.1).

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    End point title
    Part B: Clinical Benefit (CB) Assessed by Complete Response (CR), Partial Response (PR) or Stable Disease (SD) for at least 6 Months Using the Response Evaluation Criteria in Solid Tumours (RECIST 1.1). [3]
    End point description
    Tumour response was assessed separately for Part A and Part B according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The primary endpoint of this study was confirmed clinical benefit, as assessed by stable disease for at least 6 months (defined as >182 days), partial response (PR), or complete response (CR) according to RECIST version 1.1 (only confirmed responses were considered). The Confidence Interval (CI) is Exact CI.
    End point type
    Primary
    End point timeframe
    This endpoint was recorded from first administration of trial medication in Part B until the earliest of PD, death or start of new anti-cancer therapy up to 929 days.
    Notes
    [3] - 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: This endpoint was evaluated only descriptively. Thus, no statistical hypothesis was tested.
    End point values
    Part B: Afatinib+V (Vinorelbine).
    Number of subjects analysed
    10 [4]
    Units: Percentage of participants
        number (confidence interval 95%)
    20 (3 to 56)
    Notes
    [4] - Part B: TS
    No statistical analyses for this end point

    Secondary: Part A: Confirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).

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    End point title
    Part A: Confirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).
    End point description
    Objective response was defined on a patient level as a best response of CR or PR. The Confidence Interval (CI) is Exact CI.
    End point type
    Secondary
    End point timeframe
    This endpoint was recorded from first administration of trial medication until the earliest of disease progression, death or start of next treatment (either Part B combination therapy or new anti-cancer therapy) up to 929 days.
    End point values
    Part A: Afatinib Once Daily (OD).
    Number of subjects analysed
    26 [5]
    Units: Percentage of participants
        number (confidence interval 95%)
    31 (14 to 52)
    Notes
    [5] - Part A: TS
    No statistical analyses for this end point

    Secondary: Part B: Confirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).

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    End point title
    Part B: Confirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).
    End point description
    Objective response was defined on a patient level as a best response of CR or PR. The Confidence Interval (CI) is Exact CI.
    End point type
    Secondary
    End point timeframe
    This endpoint was recorded from first administration of trial medication in Part B and until the earliest of disease progression, death or start of new anti-cancer therapy up to 929 days.
    End point values
    Part B: Afatinib+V (Vinorelbine).
    Number of subjects analysed
    10 [6]
    Units: Percentage of participants
        number (confidence interval 95%)
    10 (0 to 45)
    Notes
    [6] - Part B: TS
    No statistical analyses for this end point

    Secondary: Part A: Unconfirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).

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    End point title
    Part A: Unconfirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).
    End point description
    Objective response was defined on a patient level as a best response of CR or PR. The Confidence Interval (CI) is Exact CI.
    End point type
    Secondary
    End point timeframe
    This endpoint was recorded from first administration of trial medication until the earliest of PD, death or start of next treatment (either Part B combination therapy or new anti-cancer therapy) up to 929 days.
    End point values
    Part A: Afatinib Once Daily (OD).
    Number of subjects analysed
    26 [7]
    Units: Percentage of participants
        number (confidence interval 95%)
    42 (23 to 63)
    Notes
    [7] - Part A: TS
    No statistical analyses for this end point

    Secondary: Part B: Unconfirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).

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    End point title
    Part B: Unconfirmed Objective Response (OR) Assessed by RECIST 1.1 (Response Evaluation Criteria in Solid Tumours Version 1.1).
    End point description
    Objective response was defined on a patient level as a best response of CR or PR. The Confidence Interval (CI) is Exact CI.
    End point type
    Secondary
    End point timeframe
    This endpoint was recorded from first administration of trial medication in Part B and until the earliest of PD, death or start of new anti-cancer therapy up to 929 days.
    End point values
    Part B: Afatinib+V (Vinorelbine).
    Number of subjects analysed
    10 [8]
    Units: Percentage of participants
        number (confidence interval 95%)
    30 (7 to 65)
    Notes
    [8] - Part B: TS
    No statistical analyses for this end point

    Secondary: Part B: Duration of Unconfirmed Objective Response.

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    End point title
    Part B: Duration of Unconfirmed Objective Response.
    End point description
    Objective response was defined on a patient level as a best response of CR or PR. Duration of objective response was measured from the time of first unconfirmed objective response to the time of progression or death (or date of censoring for PFS).
    End point type
    Secondary
    End point timeframe
    From first drug administration until end of Part B, up to 929 days.
    End point values
    Part B: Afatinib+V (Vinorelbine).
    Number of subjects analysed
    3 [9]
    Units: Days
        median (confidence interval 95%)
    57 (56 to 140)
    Notes
    [9] - Part B: TS.
    No statistical analyses for this end point

    Secondary: Part A: Duration of Unconfirmed Objective Response.

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    End point title
    Part A: Duration of Unconfirmed Objective Response.
    End point description
    Objective response was defined on a patient level as a best response of CR (Complete Response) or PR (Partial Response). Duration of objective response was measured from the time of first unconfirmed objective response to the time of progression or death (or date of censoring for PFS-Progression Free Survival). 99999: Median is not calculable as the KM probability never falls to 0.5 therefore it can't be estimated.
    End point type
    Secondary
    End point timeframe
    From first drug administration until end of Part A, up to 929 days.
    End point values
    Part A: Afatinib Once Daily (OD).
    Number of subjects analysed
    11 [10]
    Units: Days
        median (confidence interval 95%)
    99999 (57 to 99999)
    Notes
    [10] - Part A: TS.
    No statistical analyses for this end point

    Secondary: Part A: Progression Free Survival.

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    End point title
    Part A: Progression Free Survival.
    End point description
    PD was evaluated according to the RECIST version 1.1. For patients with a known date of progression (or death), PFS was the earlier of date of progression or death - date of first administration + 1. The date of progression and date of first administration referred to the respective part of the study A.
    End point type
    Secondary
    End point timeframe
    From first drug administration until end of Part A, up to 713 days.
    End point values
    Part A: Afatinib Once Daily (OD).
    Number of subjects analysed
    26 [11]
    Units: Days
        median (confidence interval 95%)
    110.5 (58 to 386)
    Notes
    [11] - Part A: TS
    No statistical analyses for this end point

    Secondary: Part B: Progression Free Survival.

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    End point title
    Part B: Progression Free Survival.
    End point description
    PD was evaluated according to the RECIST version 1.1. For patients with a known date of progression (or death), PFS was the earlier of date of progression or death - date of first administration + 1. The date of progression and date of first administration referred to the respective part of the study B.
    End point type
    Secondary
    End point timeframe
    From first drug administration until end of Part B, up to 230 days.
    End point values
    Part B: Afatinib+V (Vinorelbine).
    Number of subjects analysed
    10 [12]
    Units: Days
        median (confidence interval 95%)
    106 (36 to 190)
    Notes
    [12] - Part B: TS
    No statistical analyses for this end point

    Secondary: Progression Free Survival Over the Whole Sudy.

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    End point title
    Progression Free Survival Over the Whole Sudy.
    End point description
    PD was evaluated according to the RECIST version 1.1. Number of days from the start of monotherapy to the date of second PD.
    End point type
    Secondary
    End point timeframe
    From first drug administration until end of study, up to 700 days.
    End point values
    Afatinib Once Daily (OD). Afatinib+V (Vinorelbine).
    Number of subjects analysed
    26 [13]
    Units: Days
        median (confidence interval 95%)
    253 (166 to 713)
    Notes
    [13] - TS
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Part A: From first study drug administration in Part A to last study drug administration in Part A + up to 28 days (max. 728). Part B: From first study drug administration in Part B to last study drug administration in Part B + up to 28 days (max. 265).
    Adverse event reporting additional description
    The additional 28 days is the residual effect period which was added to the last study drug administration in each part. This may have been truncated in Part A where patients started Vinorelbine prior to the 28 days elapsing.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Part A: Afatinib Once Daily (OD).
    Reporting group description
    Part A: Patients received Afatinib tablets, 40 mg taken orally Once Daily (OD) until progression of their disease. In case of treatment-related AEs, the 40 mg dose could be reduced by increments of 10 mg to 30 mg once daily or 20 mg once daily.

    Reporting group title
    Part B: Afatinib+V (Vinorelbine).
    Reporting group description
    Part B: Upon first Progression of Disease (PD), patients could enter Part B of the study, during which they continued to be treated with Afatinib and additionally were treated with Vinorelbine 25 mg/m2 per week via intravenous (i.v) infusion. Patients treated with Afatinib and Vinorelbine combination therapy could continue to receive treatment until second progression of disease, intolerable side effects, or withdrawal of consent.

    Serious adverse events
    Part A: Afatinib Once Daily (OD). Part B: Afatinib+V (Vinorelbine).
    Total subjects affected by serious adverse events
         subjects affected / exposed
    12 / 26 (46.15%)
    4 / 10 (40.00%)
         number of deaths (all causes)
    5
    6
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant neoplasm progression
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Metastases to central nervous system
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Metastases to liver
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Tumour haemorrhage
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Hepatic haematoma
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound complication
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    3 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    2 / 4
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatic lesion
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumonitis
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Muscular weakness
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperphosphataemia
         subjects affected / exposed
    1 / 26 (3.85%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Part A: Afatinib Once Daily (OD). Part B: Afatinib+V (Vinorelbine).
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 26 (100.00%)
    10 / 10 (100.00%)
    Vascular disorders
    Lymphoedema
         subjects affected / exposed
    1 / 26 (3.85%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    General disorders and administration site conditions
    Catheter site erythema
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Fatigue
         subjects affected / exposed
    4 / 26 (15.38%)
    5 / 10 (50.00%)
         occurrences all number
    5
    5
    Mucosal inflammation
         subjects affected / exposed
    10 / 26 (38.46%)
    3 / 10 (30.00%)
         occurrences all number
    12
    3
    Pyrexia
         subjects affected / exposed
    1 / 26 (3.85%)
    2 / 10 (20.00%)
         occurrences all number
    1
    2
    Reproductive system and breast disorders
    Breast pain
         subjects affected / exposed
    2 / 26 (7.69%)
    1 / 10 (10.00%)
         occurrences all number
    3
    1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    0 / 26 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    3
    Dysphonia
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Epistaxis
         subjects affected / exposed
    4 / 26 (15.38%)
    0 / 10 (0.00%)
         occurrences all number
    7
    0
    Pleural effusion
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Oropharyngeal pain
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Rhinorrhoea
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    4 / 26 (15.38%)
    0 / 10 (0.00%)
         occurrences all number
    4
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    4 / 26 (15.38%)
    0 / 10 (0.00%)
         occurrences all number
    4
    0
    Blood alkaline phosphatase increased
         subjects affected / exposed
    2 / 26 (7.69%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Blood creatine phosphokinase increased
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Neutrophil count decreased
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Weight decreased
         subjects affected / exposed
    7 / 26 (26.92%)
    4 / 10 (40.00%)
         occurrences all number
    11
    4
    White blood cell count decreased
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Injury, poisoning and procedural complications
    Allergic transfusion reaction
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Contusion
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    2
    Fall
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Procedural haemorrhage
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Cardiac disorders
    Atrial flutter
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 26 (7.69%)
    3 / 10 (30.00%)
         occurrences all number
    3
    3
    Headache
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences all number
    3
    1
    Memory impairment
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Migraine
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Neuropathy peripheral
         subjects affected / exposed
    1 / 26 (3.85%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    4 / 26 (15.38%)
    5 / 10 (50.00%)
         occurrences all number
    4
    6
    Neutropenia
         subjects affected / exposed
    1 / 26 (3.85%)
    8 / 10 (80.00%)
         occurrences all number
    1
    29
    Eye disorders
    Dry eye
         subjects affected / exposed
    3 / 26 (11.54%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    Panophthalmitis
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 26 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    3
    Abdominal pain upper
         subjects affected / exposed
    2 / 26 (7.69%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    Diarrhoea
         subjects affected / exposed
    23 / 26 (88.46%)
    6 / 10 (60.00%)
         occurrences all number
    75
    8
    Dry mouth
         subjects affected / exposed
    2 / 26 (7.69%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Nausea
         subjects affected / exposed
    7 / 26 (26.92%)
    5 / 10 (50.00%)
         occurrences all number
    9
    8
    Stomatitis
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences all number
    3
    3
    Vomiting
         subjects affected / exposed
    7 / 26 (26.92%)
    1 / 10 (10.00%)
         occurrences all number
    9
    1
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Dermatitis
         subjects affected / exposed
    1 / 26 (3.85%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Dry skin
         subjects affected / exposed
    2 / 26 (7.69%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    Dermatitis acneiform
         subjects affected / exposed
    5 / 26 (19.23%)
    0 / 10 (0.00%)
         occurrences all number
    5
    0
    Erythema
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences all number
    3
    1
    Fungating wound
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Hand dermatitis
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    3 / 26 (11.54%)
    1 / 10 (10.00%)
         occurrences all number
    3
    1
    Pruritus
         subjects affected / exposed
    2 / 26 (7.69%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Rash
         subjects affected / exposed
    17 / 26 (65.38%)
    1 / 10 (10.00%)
         occurrences all number
    21
    2
    Skin lesion
         subjects affected / exposed
    2 / 26 (7.69%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Muscle spasms
         subjects affected / exposed
    1 / 26 (3.85%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Myalgia
         subjects affected / exposed
    1 / 26 (3.85%)
    2 / 10 (20.00%)
         occurrences all number
    1
    2
    Pain in extremity
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    2
    Cystitis
         subjects affected / exposed
    1 / 26 (3.85%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Cellulitis
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Eye infection
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Paronychia
         subjects affected / exposed
    9 / 26 (34.62%)
    0 / 10 (0.00%)
         occurrences all number
    9
    0
    Rhinitis
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 26 (7.69%)
    2 / 10 (20.00%)
         occurrences all number
    2
    3
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    10 / 26 (38.46%)
    2 / 10 (20.00%)
         occurrences all number
    11
    2
    Hypomagnesaemia
         subjects affected / exposed
    2 / 26 (7.69%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Hypokalaemia
         subjects affected / exposed
    5 / 26 (19.23%)
    1 / 10 (10.00%)
         occurrences all number
    7
    1
    Hyponatraemia
         subjects affected / exposed
    0 / 26 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Oct 2012
    This amendment introduced a number of minor clarifications or updates of study procedures, administrative changes (such as updating the address of the coordinating investigator and including a citation for recently published data in place of previously unpublished data), and corrections to ensure consistency between the synopsis and the main text of the protocol and between different sections of the protocol. Changes to study procedures included the following: 1. A fresh tissue biopsy could be taken up to 2 days before C1V1. 2. No ECG was required at Day 15 of Course 1 in Part B. 3. Dispensing of trial medication was not required at the EOT visit in Part B. 4. It was clarified that patients having a short course palliative radiotherapy had to have a tumour assessment within 14 days of the first dose of Vinorelbine. 5. A statement on risk of keratitis and ulcerative keratitis was added since the European Medicines Agency (EMA) has requested a class labelling following treatment with currently approved EGFR inhibitors for cancer. 6. Exclusion criterion no. 7 was clarified: bilateral primary breast cancer, metastases to the contralateral breast. 7. Exclusion criterion no. 14 and the text of the CTP regarding dose adjustments with Vinorelbine was updated to be consistent with a newly released SmPC for Vinorelbine. 8. Exclusion criterion no. 17 was amended to allow higher values of ALT/AST (changed from 2.5 to 3 x ULN). 9. Exclusion criterion no. 26 was clarified to indicate that Trastuzumab failure patients had to have received Trastuzumab. 10. The time between first and second dose of afatinib could be less than 24 h. 11. The type of MRI to be used to assess brain lesions was updated. 12. The reporting of the worsening of underlying disease or other pre-existing conditions, and the change in vital signs, ECG, physical examination and laboratory tests results was amended as requested by regulatory authorities.
    01 Jul 2013
    This amendment introduced major changes to the study design. The reasons for the changes were slow recruitment of Trastuzumab-failure patients into Part A of the study (7 in total at 17 Jun 2013) plus a change in the benefit/risk of the combination of Afatinib and Vinorelbine (experimental arm). For BI trial 1200.75, an independent DMC conducted a benefit risk analysis when over half of the planned number of patients had been enrolled. The PFS analysis showed a low likelihood of the 1200.75 study meeting the pre-defined criteria for increased efficacy combined with an increased rate of treatment discontinuation and dose reduction and a higher rate of SAEs and deaths in the Afatinib and Vinorelbine arm of the study. The DMC recommended discontinuing recruitment into the 1200.75 trial. Boehringer Ingelheim decided to stop further randomisation into trial 1200.75 and to discontinue further treatment with the combination of Afatinib and Vinorelbine as of 26 Apr 2013. Boehringer Ingelheim decided as a precautionary measure, to stop the inclusion of new patients into Part B of the present study on 03 May 2013. Also, any patients in screening for Part B at that date were not permitted to start treatment. Due to the slow recruitment, it was also decided to stop further inclusion of patients into Part A. In addition, it was clarified that tumour assessments were to be performed in Part B every 8 weeks from the first dose of Vinorelbine. Also, precautionary information added regarding ILD (in line with the standard wording in other Afatinib trials) and keratitis (at the request of the French Health Authority for all Afatinib trials).
    10 Apr 2014
    After the introduction of protocol amendment 2 recruitment for trial 1200.89 was ceased before it was fully completed. Therefore when protocol amendment 3 was implemented, there were only a few patients still receiving trial medication. Rather than perform the primary analysis and update it shortly thereafter, it was considered better to wait until most or all patients had progressed or started further treatment. No changes were made to the analysis only to the timing. To allow flexibility as to when the primary analysis was to be performed, the sentence regarding timing was updated. Additionally, collection of Observation Period data was no longer considered necessary. Patients still benefiting from treatment were to continue to receive trial medication. However, once they ceased trial medication they were to complete their study participation at the time of their last follow-up visit and did not enter the observation period.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    03 May 2013
    Boehringer Ingelheim decided to stop further randomisation into that trial and to discontinue further treatment with the combination of afatinib and vinorelbine as of 26 Apr 2013. Boehringer Ingelheim decided as a precautionary measure, to stop the inclusion of new patients into Part B of the 1200.89 study on 03 May 2013. Also, any patients in screening for Part B at that date were not permitted to start treatment. Due to the slow recruitment, it was also decided to stop further inclusion of patients into Part A.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Boehringer Ingelheim (BI) decided to stop further inclusion of patients and stop further treatment with the combination of Afatinib and Vinorelbine as of 03-May-2013. Recruitment into the trial was stopped by amendment in Jul 2013.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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