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    Clinical Trial Results:
    Investigation of the intra-tumoural concentration and activity of sorafenib in cutaneous schwannomas

    Summary
    EudraCT number
    2011-001789-16
    Trial protocol
    GB  
    Global end of trial date
    05 Apr 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    03 May 2021
    First version publication date
    03 May 2021
    Other versions
    Summary report(s)
    Letter to JNNP

    Trial information

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    Trial identification
    Sponsor protocol code
    PenCTU/2011/CTIMP-005
    Additional study identifiers
    ISRCTN number
    ISRCTN49989464
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    REC Reference: 11/LO/0771, Local R&D No: 11/P/014
    Sponsors
    Sponsor organisation name
    University Hospitals Plymouth NHS Trust (previously known as Plymouth Hospitals NHS Trust)
    Sponsor organisation address
    Research Office, L2 MSCP, Bircham Park Offices, 1 Roscoff Rise, Derriford, Plymouth, United Kingdom, PL6 5FP
    Public contact
    Dr Chris Rollinson, Research Governance Manager, Research Development and Innovation, University Hospitals Plymouth NHS Trust (formerly Plymouth Hospitals NHS Trust), 01752 431045, crollinson@nhs.net
    Scientific contact
    Prof. C. Oliver Hanemann, Consultant in Neurology, Faculty of Medicine and Dentistry, University of Plymouth, 01752 437418, oliver.hanemann@plymouth.ac.uk
    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
    31 Jan 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    02 Mar 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Apr 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objectives of the study are: To measure steady-state plasma concentrations and intra-tumoural concentrations of sorafenib in cutaneous schwannomas after 11 days of oral dosing with sorafenib To investigate indices of molecular activity of sorafenib in tumour and blood, before and after treatment with sorafenib.
    Protection of trial subjects
    Study was approved by the MHRA and a Research Ethics Committee. The study was monitored by the Peninsula Clinical Trials Unit (PenCTU) and an Independent Trial steering Committee was set up for the study oversight.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    29 Feb 2012
    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
    United Kingdom: 5
    Worldwide total number of subjects
    5
    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)
    4
    From 65 to 84 years
    1
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients will be identified and recruited into the trial via two routes: (i) from existing clinic patient databases held by the two Investigators, and (ii) from patients who contact the Investigators in response to information about the trial posted on the Neuro Foundation UK and Advocure NF2 websites. Recruitment is limited to two sites in the UK.

    Pre-assignment
    Screening details
    Screening procedures will be undertaken after informed consent: Medical history; Serum pregnancy test ; Physical examination (inc neurological examination); Blood pressure; 12 lead Electrocardiograph; Blood sample for haematology, chemistry, coagulation, target inhibition analysis; CS biopsy; Concomitant medication; Adverse events.

    Pre-assignment period milestones
    Number of subjects started
    5
    Number of subjects completed
    5

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

    Arms
    Arm title
    Sorafenib
    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
    800mg per day (400mg bd): orally on Days 1-10 inclusive , 400mg od on Day 11 (morning)

    Number of subjects in period 1
    Sorafenib
    Started
    5
    Completed
    5

    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
    5 5
    Age categorical
    Diagnosis of NF2, over 18 years in age and with cutaneous schwannoma(s) accessible for two biopsies >1cm3 in area
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    4 4
        From 65-84 years
    1 1
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    1 1
        Male
    4 4

    End points

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

    Primary: Steady-state plasma and intra-tumoural concentrations

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    End point title
    Steady-state plasma and intra-tumoural concentrations [1]
    End point description
    Primary objective: measure steady-state plasma concentrations and intra-tumoural concentrations of sorafenib in cutaneous schwannomas after 11 days of oral dosing with sorafenib. At day 11 participation will undergo: Post-dose CS biopsy, Physical examination, Blood pressure, ECG, Blood sample for Haematology, chemistry and coagulation and Blood sample for plasma concentration of sorafenib.
    End point type
    Primary
    End point timeframe
    Baseline vs Day 11
    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: Descriptive analysis only, see linked publication.
    End point values
    Sorafenib
    Number of subjects analysed
    5
    Units: ng/mg
        number (not applicable)
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    SAEs will be reported to the Sponsor and PenCTU by telephone/fax within 24 hours. Fatal or life threatening SUSARs reported to NCA within 7 days. Non-fatal or non-life threatening SUSARs reported to NCA within 15 days.
    Adverse event reporting additional description
    The sponsor and PenCTU must be made aware of any AEs by the CI or a member of the research in the appropriate time frame. The Sponsor will then inform the NCA where applicable.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    None
    Dictionary version
    0
    Reporting groups
    Reporting group title
    Sorafenib
    Reporting group description
    -

    Serious adverse events
    Sorafenib
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 5 (20.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Skin and subcutaneous tissue disorders
    Rash
    Additional description: Severe rash face, leg, arms, rash whole body worse knees.
         subjects affected / exposed
    1 / 5 (20.00%)
         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
    Sorafenib
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 5 (100.00%)
    General disorders and administration site conditions
    Nausea
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Headache
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Hypersensitivity
    Additional description: Sensitive scalp, lips, tongue
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    3
    Hot flush
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Fatigue
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Abdominal discomfort
    Additional description: Abdominal soreness
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Hunger
    Additional description: Lack of appetite
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Dysgeusia
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Lethargy
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Immune system disorders
    Rhinitis
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Menstruation irregular
    Additional description: Worsened menstrual bleeding
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
    Additional description: Breathlessness
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Anxiety
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Investigations
    Liver function test
    Additional description: ALT (alanine aminotransferase), ALP (Alkaline phosphatase), AST (Aspartate aminotransferase)
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    5
    Amylase
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Prothrombin time prolonged
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    2
    Nervous system disorders
    Tremor
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Paraesthesia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Pain
    Additional description: Neuropathic pain
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Ear and labyrinth disorders
    Ear discomfort
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Hearing disability
    Additional description: Reduced hearing in right ear.
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    4
    Diarrhoea
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    6
    Urticaria chronic
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Erythema
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Skin exfoliation
    Additional description: Left thumb palmar side
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Renal and urinary disorders
    Cystitis
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Limb discomfort
    Additional description: Leg pain
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Back pain
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Pain
    Additional description: Joint pain
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    3
    Infections and infestations
    Throat irritation
    Additional description: Sore throat
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Influenza like illness
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Oral bacterial infection
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Jul 2011
    Protocol Version 2.0: Amendment made primarily to add section describing recruitment of participants via Neuro Foundation UK and Advocure NF2 websites.
    23 Jul 2012
    Protocol Version 6.0: Substantial amendment to the statistical section to reduce the sample size required for the study. Wording added to utilise further sites / PICs as required to improve recruitment.
    02 Jul 2013
    Protocol Version 8.0: Substantial amendment to section 16.1 ‘Side effects of Sorafenib’ and removal of appendix I, to ensure the current SmPC is the main point of reference for side effects.

    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/30718294
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