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    Clinical Trial Results:
    A phase II, open label, non-randomized study of second or third line treatment with the combination of sorafenib and everolimus in patients affected by relapsed and non-resectable high-grade osteosarcoma.

    Summary
    EudraCT number
    2011-000561-12
    Trial protocol
    IT  
    Global end of trial date
    19 Jun 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    26 Jun 2022
    First version publication date
    26 Jun 2022
    Other versions
    Summary report(s)
    2015 - Lancet Oncol - SERIO

    Trial information

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    Trial identification
    Sponsor protocol code
    S.E.R.I.O.
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01804374
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    ISG Italian Sarcoma Group
    Sponsor organisation address
    Via Farini 31, Bologna, Italy, 40124
    Public contact
    D.O. Oncologia Medica a Dir.Univ., Fondazione del Piemonte per l'Oncologia IRCC Candiolo, 0039 0119933278, clinicaltrials@italiansarcomagroup.org
    Scientific contact
    D.O. Oncologia Medica a Dir.Univ., Fondazione del Piemonte per l'Oncologia IRCC Candiolo, 0039 0119933278, giovanni.grignani@ircc.it
    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
    18 Jul 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    03 Jun 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Jun 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Primary objective of the study will be to assess the antitumor activity of sorafenib 400 mg twice a day in combination with everolimus 5mg/die as second or third line treatment of relapsed unresectable/metastatic high-grade osteosarcoma
    Protection of trial subjects
    Any sign of tumor-related pain improvement was evaluated by Pain and Analgesic Score (PAS) and the Brief Pain Inventory short form score (BPI). Patients were carefully monitored for adverse events during the whole trial.
    Background therapy
    -
    Evidence for comparator
    This is an open-label, single arm trial.
    Actual start date of recruitment
    30 Apr 2011
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy, Scientific research
    Long term follow-up duration
    12 Months
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 38
    Worldwide total number of subjects
    38
    EEA total number of subjects
    38
    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)
    38
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    From June 16, 2011, to June 4, 2013, 38 patients were enrolled in Italy only.

    Pre-assignment
    Screening details
    Histologically-documented not amenable to surgery, locally advanced/metastatic high grade osteosarcoma progressing after standard treatments. Eligibility criteria: progressive and measurable disease according to RECIST 1.1 (bone lesions allowed), 18 years or older, ECOG PS <1, life expectancy ≥3 months, adequate organs and bone marrow function

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

    Arms
    Arm title
    Sorafenib+Everolimus
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Sorafenib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    400mg BID

    Investigational medicinal product name
    Everolimus
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    5mg QD

    Number of subjects in period 1
    Sorafenib+Everolimus
    Started
    38
    Completed
    38

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    overall trial
    Reporting group description
    -

    Reporting group values
    overall trial Total
    Number of subjects
    38 38
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    38 38
    Age continuous
    Units: years
        median (full range (min-max))
    31 (18 to 64) -
    Gender categorical
    Units: Subjects
        Female
    15 15
        Male
    23 23
    ECOG PS
    Units: Subjects
        ECOG 0
    16 16
        ECOG 1
    20 20
        ECOG 2
    2 2
    metastatic at diagnosis
    Units: Subjects
        yes
    9 9
        no
    29 29
    osteosarcoma histotypes
    Units: Subjects
        osteoblastic
    27 27
        chondroblastic
    8 8
        fibroblastic
    2 2
        teleangectatic
    1 1
    lines of chemotherapy after MAP/I
    Units: Subjects
        =1
    2 2
        >1
    36 36
    sites of metastases
    Units: Subjects
        lung only
    12 12
        lung + bone or viscera
    22 22
        bone only
    4 4
    previous surgery
    Units: number
        median (full range (min-max))
    2 (0 to 7) -

    End points

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    End points reporting groups
    Reporting group title
    Sorafenib+Everolimus
    Reporting group description
    -

    Subject analysis set title
    Overall trial
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Intention-to-treat

    Primary: Progression-free survival rate at 6-month

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    End point title
    Progression-free survival rate at 6-month
    End point description
    End point type
    Primary
    End point timeframe
    Progression Free Survival (PFS) refers to the time from registration into the study to the date of progressive disease or death. In the absence of progression time will be censored at the date of last tumor assessment or follow-up. The primary endpoint is
    End point values
    Sorafenib+Everolimus Overall trial
    Number of subjects analysed
    17
    21
    Units: subjects
    9
    8
    Statistical analysis title
    Final Statistical Analysis
    Comparison groups
    Sorafenib+Everolimus v Overall trial
    Number of subjects included in analysis
    38
    Analysis specification
    Pre-specified
    Analysis type
    other
    Method
    Parameter type
    Rate
    Point estimate
    0.45
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.28
         upper limit
    0.61

    Secondary: Progression-free Survival

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    End point title
    Progression-free Survival
    End point description
    End point type
    Secondary
    End point timeframe
    PFS was calculated from trial entry until progression, unacceptable toxicity, or death—whichever came first.
    End point values
    Sorafenib+Everolimus
    Number of subjects analysed
    38
    Units: months
        median (confidence interval 95%)
    5 (2 to 7)
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    End point type
    Secondary
    End point timeframe
    OS was calculated from trial entry until death. In the absence of an event or loss to follow-up, all survival endpoints were censored on the last date the patient was free from the event
    End point values
    Sorafenib+Everolimus
    Number of subjects analysed
    38
    Units: months
        median (confidence interval 95%)
    11 (8 to 15)
    No statistical analyses for this end point

    Secondary: Duration of Response

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    End point title
    Duration of Response
    End point description
    End point type
    Secondary
    End point timeframe
    DOR was calculated from first non-progression assessment until either progression or death. In the absence of an event or loss to follow-up, all survival endpoints were censored on the last date the patient was free from the event
    End point values
    Sorafenib+Everolimus
    Number of subjects analysed
    38
    Units: months
        median (confidence interval 95%)
    5 (4 to 6)
    No statistical analyses for this end point

    Secondary: overall response rate

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    End point title
    overall response rate
    End point description
    End point type
    Secondary
    End point timeframe
    From treatment start to trial end
    End point values
    Sorafenib+Everolimus
    Number of subjects analysed
    38
    Units: subjects
        CR
    0
        PR
    2
        MR
    2
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From treatment start to end of safety follow up
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    All trial patients
    Reporting group description
    -

    Serious adverse events
    All trial patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 38 (2.63%)
         number of deaths (all causes)
    36
         number of deaths resulting from adverse events
    0
    Respiratory, thoracic and mediastinal disorders
    Pneumothorax
    Additional description: grade 3 sec CTCAE v 4.03
         subjects affected / exposed
    1 / 38 (2.63%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    All trial patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    38 / 38 (100.00%)
    Cardiac disorders
    Hypertension
         subjects affected / exposed
    6 / 38 (15.79%)
         occurrences all number
    6
    Ejection fraction decrease
         subjects affected / exposed
    2 / 38 (5.26%)
         occurrences all number
    2
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 38 (5.26%)
         occurrences all number
    2
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    22 / 38 (57.89%)
         occurrences all number
    22
    Anaemia
         subjects affected / exposed
    19 / 38 (50.00%)
         occurrences all number
    19
    Lymphopenia
         subjects affected / exposed
    14 / 38 (36.84%)
         occurrences all number
    14
    Leucopenia
         subjects affected / exposed
    12 / 38 (31.58%)
         occurrences all number
    12
    Neutropenia
         subjects affected / exposed
    10 / 38 (26.32%)
         occurrences all number
    10
    Febrile neutropenia
         subjects affected / exposed
    1 / 38 (2.63%)
         occurrences all number
    1
    Hypophosphataemia
         subjects affected / exposed
    18 / 38 (47.37%)
         occurrences all number
    18
    Hypercholesterolaemia
         subjects affected / exposed
    15 / 38 (39.47%)
         occurrences all number
    15
    Hypokalaemia
         subjects affected / exposed
    14 / 38 (36.84%)
         occurrences all number
    14
    Hypertriglyceridaemia
         subjects affected / exposed
    14 / 38 (36.84%)
         occurrences all number
    14
    Aminotransferase increase
         subjects affected / exposed
    12 / 38 (31.58%)
         occurrences all number
    12
    Hyperglycaemia
         subjects affected / exposed
    11 / 38 (28.95%)
         occurrences all number
    11
    CK increase
         subjects affected / exposed
    10 / 38 (26.32%)
         occurrences all number
    10
    Hypomagnesaemia
         subjects affected / exposed
    9 / 38 (23.68%)
         occurrences all number
    9
    GGT increase
         subjects affected / exposed
    8 / 38 (21.05%)
         occurrences all number
    8
    Bilirubin increase
         subjects affected / exposed
    5 / 38 (13.16%)
         occurrences all number
    5
    Amylase or lipase increase
         subjects affected / exposed
    4 / 38 (10.53%)
         occurrences all number
    4
    Creatinine increase
         subjects affected / exposed
    3 / 38 (7.89%)
         occurrences all number
    3
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    16 / 38 (42.11%)
         occurrences all number
    16
    Weight loss
         subjects affected / exposed
    13 / 38 (34.21%)
         occurrences all number
    13
    Cough
         subjects affected / exposed
    3 / 38 (7.89%)
         occurrences all number
    3
    Bleeding
         subjects affected / exposed
    2 / 38 (5.26%)
         occurrences all number
    2
    Gastrointestinal disorders
    Oral mucositis
         subjects affected / exposed
    20 / 38 (52.63%)
         occurrences all number
    20
    Diarrhoea
         subjects affected / exposed
    18 / 38 (47.37%)
         occurrences all number
    18
    Nausea
         subjects affected / exposed
    14 / 38 (36.84%)
         occurrences all number
    14
    Abdominal cramps
         subjects affected / exposed
    11 / 38 (28.95%)
         occurrences all number
    11
    Vomiting
         subjects affected / exposed
    8 / 38 (21.05%)
         occurrences all number
    8
    Constipation
         subjects affected / exposed
    8 / 38 (21.05%)
         occurrences all number
    8
    Dysphagia
         subjects affected / exposed
    1 / 38 (2.63%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Pneumothorax
         subjects affected / exposed
    1 / 38 (2.63%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Hand–foot skin reaction
         subjects affected / exposed
    27 / 38 (71.05%)
         occurrences all number
    27
    Rash
         subjects affected / exposed
    24 / 38 (63.16%)
         occurrences all number
    24
    Acneiform eruption
         subjects affected / exposed
    16 / 38 (42.11%)
         occurrences all number
    16
    Xerosis
         subjects affected / exposed
    11 / 38 (28.95%)
         occurrences all number
    11
    Pruritus
         subjects affected / exposed
    5 / 38 (13.16%)
         occurrences all number
    5
    Musculoskeletal and connective tissue disorders
    Myalgia/arthralgia
         subjects affected / exposed
    6 / 38 (15.79%)
         occurrences all number
    6
    Infections and infestations
    Infection
         subjects affected / exposed
    9 / 38 (23.68%)
         occurrences all number
    9

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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/25498219
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