Flag of the European Union EU Clinical Trials Register Help

Clinical trials

The European Union Clinical Trials Register   allows you to search for protocol and results information on:
  • interventional clinical trials that were approved in the European Union (EU)/European Economic Area (EEA) under the Clinical Trials Directive 2001/20/EC
  • clinical trials conducted outside the EU/EEA that are linked to European paediatric-medicine development

  • EU/EEA interventional clinical trials approved under or transitioned to the Clinical Trial Regulation 536/2014 are publicly accessible through the
    Clinical Trials Information System (CTIS).


    The EU Clinical Trials Register currently displays   43845   clinical trials with a EudraCT protocol, of which   7282   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

    Phase 1 trials conducted solely on adults and that are not part of an agreed paediatric investigation plan (PIP) are not publicly available (see Frequently Asked Questions ).  
     
    Examples: Cancer AND drug name. Pneumonia AND sponsor name.
    How to search [pdf]
    Search Tips: Under advanced search you can use filters for Country, Age Group, Gender, Trial Phase, Trial Status, Date Range, Rare Diseases and Orphan Designation. For these items you should use the filters and not add them to your search terms in the text field.
    Advanced Search: Search tools
     

    < Back to search results

    Download PDF

    Clinical Trial Results:
    A Phase 3, Randomized, Two-Arm, Open-Label, Multicenter, International Trial of Alisertib (MLN8237) or Investigator’s Choice (Selected Single Agent) in Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma

    Summary
    EudraCT number
    2011-003545-18
    Trial protocol
    SE   CZ   PT   DE   HU   AT   GB   ES   DK   NL   BG   IT   BE  
    Global end of trial date
    18 Dec 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Jul 2018
    First version publication date
    27 Jul 2018
    Other versions

    Trial information

    Close Top of page
    Trial identification
    Sponsor protocol code
    C14012
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01482962
    WHO universal trial number (UTN)
    U1111-1181-8218
    Sponsors
    Sponsor organisation name
    Takeda Oncology
    Sponsor organisation address
    40 Landsdowne Street, Cambridge, United States, MA 02139
    Public contact
    Medical Director, Takeda, +1 8778253327, trialdisclosures@takeda.com
    Scientific contact
    Medical Director, Takeda, +1 8778253327, trialdisclosures@takeda.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
    18 Dec 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Dec 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This is a phase 3, randomized, 2-arm, open-label, international trial evaluating alisertib compared with single-agent treatment, as selected by the investigator from the offered options of pralatrexate or gemcitabine or romidepsin, in participants with relapsed or refractory peripheral T-cell lymphoma (PTCL). Note: romidepsin was not used as a single-agent comparator outside the United States of America (USA) as supply was not available.
    Protection of trial subjects
    All study participants were required to read and sign an Informed Consent Form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    11 Jun 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 9
    Country: Number of subjects enrolled
    Austria: 4
    Country: Number of subjects enrolled
    Belgium: 8
    Country: Number of subjects enrolled
    Brazil: 22
    Country: Number of subjects enrolled
    Bulgaria: 1
    Country: Number of subjects enrolled
    Canada: 3
    Country: Number of subjects enrolled
    Czech Republic: 7
    Country: Number of subjects enrolled
    Denmark: 5
    Country: Number of subjects enrolled
    France: 8
    Country: Number of subjects enrolled
    Germany: 7
    Country: Number of subjects enrolled
    Hungary: 16
    Country: Number of subjects enrolled
    Israel: 3
    Country: Number of subjects enrolled
    Italy: 12
    Country: Number of subjects enrolled
    Mexico: 4
    Country: Number of subjects enrolled
    Netherlands: 1
    Country: Number of subjects enrolled
    New Zealand: 5
    Country: Number of subjects enrolled
    Peru: 4
    Country: Number of subjects enrolled
    Poland: 10
    Country: Number of subjects enrolled
    Portugal: 2
    Country: Number of subjects enrolled
    Puerto Rico: 1
    Country: Number of subjects enrolled
    Romania: 3
    Country: Number of subjects enrolled
    Russian Federation: 8
    Country: Number of subjects enrolled
    Spain: 25
    Country: Number of subjects enrolled
    Sweden: 3
    Country: Number of subjects enrolled
    Turkey: 21
    Country: Number of subjects enrolled
    United States: 68
    Country: Number of subjects enrolled
    United Kingdom: 11
    Worldwide total number of subjects
    271
    EEA total number of subjects
    123
    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)
    147
    From 65 to 84 years
    122
    85 years and over
    2

    Subject disposition

    Close Top of page
    Recruitment
    Recruitment details
    Participants took part in the study at 105 investigative sites in the United States including Puerto Rico, Canada, European Union, Russian Federation, Turkey, Israel, Australia, New Zealand and Latin America from 11 June 2012 to the end of study on 18 December 2017. This study is completed.

    Pre-assignment
    Screening details
    Participants with a diagnosis of Relapsed or Refractory Peripheral T-Cell Lymphoma were randomized 1:1 to either alisertib or comparator (investigator’s choice of pralatrexate, romidepsin [USA only], or gemcitabine).

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Alisertib
    Arm description
    Alisertib 50 mg, enteric-coated tablet formulation, orally, twice daily for 7 consecutive days (Cycle Days 1-7) in a 21-day cycle (Up to 148 Weeks).
    Arm type
    Experimental

    Investigational medicinal product name
    Alisertib
    Investigational medicinal product code
    Other name
    MLN8237
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Alisertib Tablets

    Arm title
    Pralatrexate, or Romidepsin, or Gemcitabine
    Arm description
    Pralatrexate 30 mg/m^2, intravenous (IV) push over 3 to 5 minutes, once weekly, for 6 weeks in 7-week cycles with concurrent vitamin B12 and folic acid supplementation. Cycles were repeated every 7-weeks provided the participant continued to benefit from and tolerate the therapy (Up to 115 Weeks), or Gemcitabine 1,000 mg/m^2 over 30 minutes, intravenously, on Days 1, 8, and 15 of a 28-day cycle until the absence of disease progression or unacceptable toxicity (Up to 32 Weeks), or Romidepsin 14 mg/m^2, intravenously over a 4-hour period, on Days 1, 8, and 15 of a 28-cycle. Cycles were repeated every 28 days provided the patient continued to benefit from and tolerate the therapy (Up to 30 Weeks).
    Arm type
    Active comparator

    Investigational medicinal product name
    Pralatrexate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Pralatrexate Intravenous

    Investigational medicinal product name
    Gemcitabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Gemcitabine Intravenous

    Investigational medicinal product name
    Romidepsin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Romidepsin Intravenous

    Number of subjects in period 1
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Started
    138
    133
    Safety Population: Received Study Drug
    137
    127
    Completed
    0
    0
    Not completed
    138
    133
         Unsatisfactory Therapeutic Response
    37
    23
         Withdrawal by Participant
    8
    13
         Adverse event, non-fatal
    18
    22
         Progressive Disease
    65
    53
         Other Reason
    1
    5
         Hematopoietic Stem Cell Transplant
    3
    9
         Study Terminated by Sponsor
    5
    2
         Did not Receive Study Drug
    1
    6

    Baseline characteristics

    Close Top of page
    Baseline characteristics reporting groups
    Reporting group title
    Alisertib
    Reporting group description
    Alisertib 50 mg, enteric-coated tablet formulation, orally, twice daily for 7 consecutive days (Cycle Days 1-7) in a 21-day cycle (Up to 148 Weeks).

    Reporting group title
    Pralatrexate, or Romidepsin, or Gemcitabine
    Reporting group description
    Pralatrexate 30 mg/m^2, intravenous (IV) push over 3 to 5 minutes, once weekly, for 6 weeks in 7-week cycles with concurrent vitamin B12 and folic acid supplementation. Cycles were repeated every 7-weeks provided the participant continued to benefit from and tolerate the therapy (Up to 115 Weeks), or Gemcitabine 1,000 mg/m^2 over 30 minutes, intravenously, on Days 1, 8, and 15 of a 28-day cycle until the absence of disease progression or unacceptable toxicity (Up to 32 Weeks), or Romidepsin 14 mg/m^2, intravenously over a 4-hour period, on Days 1, 8, and 15 of a 28-cycle. Cycles were repeated every 28 days provided the patient continued to benefit from and tolerate the therapy (Up to 30 Weeks).

    Reporting group values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine Total
    Number of subjects
    138 133 271
    Age categorical
    Units: Subjects
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    61.1 ( 12.69 ) 61.4 ( 13.16 ) -
    Gender, Male/Female
    Units: Subjects
        Female
    46 47 93
        Male
    92 86 178
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    25 21 46
        Not Hispanic or Latino
    105 107 212
        Unknown or Not Reported
    8 5 13
    Race/Ethnicity, Customized
    Units: Subjects
        White
    115 114 229
        Black or African American
    8 8 16
        Asian
    3 2 5
        Other
    7 7 14
        Not Reported
    5 2 7
    Region of Enrollment
    Units: Subjects
        Australia
    5 4 9
        Austria
    2 2 4
        Belgium
    5 3 8
        Brazil
    12 10 22
        Bulgaria
    0 1 1
        Canada
    3 0 3
        Czech Republic
    5 2 7
        Denmark
    3 2 5
        France
    5 3 8
        Germany
    6 1 7
        Hungary
    9 7 16
        Israel
    0 3 3
        Italy
    6 6 12
        Mexico
    3 1 4
        Netherlands
    0 1 1
        New Zealand
    3 2 5
        Peru
    1 3 4
        Poland
    7 3 10
        Portugal
    1 1 2
        Puerto Rico
    0 1 1
        Romania
    2 1 3
        Russia
    4 4 8
        Spain
    14 11 25
        Sweden
    0 3 3
        Turkey
    10 11 21
        United Kingdom
    3 8 11
        United States
    29 39 68
    Height
    Units: cm
        arithmetic mean (standard deviation)
    170.3 ( 9.80 ) 168.2 ( 8.99 ) -
    Weight
    Units: kg
        arithmetic mean (standard deviation)
    76.85 ( 17.242 ) 74.63 ( 19.601 ) -
    Body Surface Area (BSA)
    Units: m^2
        arithmetic mean (standard deviation)
    1.897 ( 0.2465 ) 1.855 ( 0.2562 ) -

    End points

    Close Top of page
    End points reporting groups
    Reporting group title
    Alisertib
    Reporting group description
    Alisertib 50 mg, enteric-coated tablet formulation, orally, twice daily for 7 consecutive days (Cycle Days 1-7) in a 21-day cycle (Up to 148 Weeks).

    Reporting group title
    Pralatrexate, or Romidepsin, or Gemcitabine
    Reporting group description
    Pralatrexate 30 mg/m^2, intravenous (IV) push over 3 to 5 minutes, once weekly, for 6 weeks in 7-week cycles with concurrent vitamin B12 and folic acid supplementation. Cycles were repeated every 7-weeks provided the participant continued to benefit from and tolerate the therapy (Up to 115 Weeks), or Gemcitabine 1,000 mg/m^2 over 30 minutes, intravenously, on Days 1, 8, and 15 of a 28-day cycle until the absence of disease progression or unacceptable toxicity (Up to 32 Weeks), or Romidepsin 14 mg/m^2, intravenously over a 4-hour period, on Days 1, 8, and 15 of a 28-cycle. Cycles were repeated every 28 days provided the patient continued to benefit from and tolerate the therapy (Up to 30 Weeks).

    Primary: Overall Response Rate (ORR) based on Independent Review Committee (IRC) Assessment

    Close Top of page
    End point title
    Overall Response Rate (ORR) based on Independent Review Committee (IRC) Assessment
    End point description
    ORR was defined as the percentage of participants who achieve Complete Response (CR) or Partial Response (PR) as assessed by the IRC using International Working Group (IWG) criteria. CR=Disappearance of all evidence of disease and PR=Regression of measurable disease and no new sites. Response-evaluable population, participants with peripheral T-cell lymphoma confirmed by an independent hematopathology central review, with measurable disease at Baseline, who received at least 1 dose of alisertib or comparator and had postbaseline response assessment of CR, PR, stable disease (SD) or progressive disease (PD) by the IRC.
    End point type
    Primary
    End point timeframe
    Every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until progressive disease. Duration is approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    102
    92
    Units: percentage of participants
        number (confidence interval 95%)
    33 (24 to 43)
    45 (34 to 55)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Alisertib v Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects included in analysis
    194
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.038 [1]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.6
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.33
         upper limit
    1.08
    Notes
    [1] - P-value was stratified using disease type, International Prognostic Index (IPI) Score and region as stratification factors.

    Primary: Progression-Free Survival (PFS) based on IRC Assessment

    Close Top of page
    End point title
    Progression-Free Survival (PFS) based on IRC Assessment
    End point description
    PFS was defined as the time from the date of randomization to the date of first documentation of progressive disease (PD) or death due to any cause, whichever occurred first. Intent-to-treat (ITT) population was defined as all participants who were randomized. The participants were analyzed according to the treatment they were randomized to receive, regardless of any errors of dosing.
    End point type
    Primary
    End point timeframe
    Every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until progressive disease. Duration is approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    138
    133
    Units: days
        median (confidence interval 95%)
    115 (83 to 174)
    104 (61 to 114)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Alisertib v Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects included in analysis
    271
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.177
    Method
    Stratified Log Rank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.87
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.637
         upper limit
    1.178

    Secondary: Overall Survival (OS)

    Close Top of page
    End point title
    Overall Survival (OS)
    End point description
    OS was defined as the time from the date of randomization to the date of death. Participants without documentation of death were censored at the date last known to be alive. ITT population was defined as all participants who were randomized. The participants were analyzed according to the treatment they were randomized to receive, regardless of any errors of dosing.
    End point type
    Secondary
    End point timeframe
    Participants were followed for survival for 2 years from date of last participant off study treatment, or death, whichever occurs first. Contacts were every 4 months (Median follow-up 519 days in the alisertib arm and 586 days in the comparative arm)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    138
    133
    Units: days
        median (confidence interval 95%)
    415 (263 to 514)
    367 (258 to 572)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Alisertib v Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects included in analysis
    271
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.338
    Method
    Stratified Log-rank Test
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.98
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.707
         upper limit
    1.369

    Secondary: Number of Participants with Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)

    Close Top of page
    End point title
    Number of Participants with Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
    End point description
    An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. A TEAE is defined as an adverse event with an onset that occurs after receiving study drug. A SAE is any untoward medical occurrence that at any dose: results in death, is life-threatening, requires inpatient hospitalization or prolongation of an existing hospitalization, results in persistent or significant disability or incapacity, is a congenital anomaly/ birth defect or is a medically important event. Safety population was defined as all participants who received at least 1 dose of alisertib, or one of the comparator drugs. Participants were analyzed according to the treatment actually received.
    End point type
    Secondary
    End point timeframe
    First dose to 30 days after last dose of study drug or comparator (Up to 152 Weeks)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    137
    127
    Units: participants
        TEAE
    136
    126
        SAE
    75
    69
    No statistical analyses for this end point

    Secondary: Number of Participants with Clinically Important Abnormal Laboratory Values Reported as AEs

    Close Top of page
    End point title
    Number of Participants with Clinically Important Abnormal Laboratory Values Reported as AEs
    End point description
    Clinical laboratory tests included chemistry, hematology and urinalysis test. Clinically significant treatment-emergent laboratory abnormalities were reported by the investigator as TEAEs. Safety population was defined as all participants who received at least 1 dose of alisertib, or one of the comparator drugs. Participants were analyzed according to the treatment actually received.
    End point type
    Secondary
    End point timeframe
    First dose to 30 days after last dose of study drug or comparator (Up to 152 Weeks)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    137
    127
    Units: participants
        Neutrophil Count Decreased
    18
    14
        White Blood Cell Count Decreased
    17
    10
        Lymphocyte Count Decreased
    6
    5
        Monocyte Count Decreased
    2
    1
        Lymphocyte Count Increased
    1
    0
        Monocyte Count Increased
    1
    0
        White Blood Cell Count Increased
    1
    0
        Platelet Count Decreased
    15
    22
        Alanine Aminotransferase Increased
    8
    11
        Aspartate Aminotransferase Increased
    5
    11
        Gamma-glutamyltransferase Increased
    6
    3
        Blood Bilirubin Increased
    2
    1
        Hepatic Enzyme Increased
    2
    0
        Liver Function Test Abnormal
    0
    1
        Transaminases Increased
    0
    1
        Blood Alkaline Phosphatase Increased
    9
    7
        Blood Lactate Dehydrogenase Increased
    5
    1
        Blood Creatinine Increased
    3
    7
        Blood Creatinine Decreased
    0
    1
        Blood Urea Increased
    1
    0
        Blood Potassium Decreased
    1
    4
        Blood Magnesium Decreased
    1
    2
        Blood Bicarbonate Decreased
    0
    1
        Blood Calcium Decreased
    0
    1
        Blood Calcium Increased
    1
    0
        Blood Phosphorus Decreased
    0
    1
        Calcium Ionised Increased
    1
    0
        Haemoglobin Decreased
    1
    3
        Haematocrit Increased
    1
    2
        Haematocrit Decreased
    1
    0
        Coagulation Factor XIII Level Decreased
    1
    0
        International Normalised Ratio Increased
    1
    0
        Blood Albumin Decreased
    0
    2
        Myocardial Necrosis Marker Increased
    1
    0
        Troponin Increased
    0
    1
        Blood Glucose Increased
    0
    1
        Immunoglobulins Increased
    1
    0
        Blood Uric Acid Increased
    1
    0
        Enterovirus Test Positive
    0
    1
    No statistical analyses for this end point

    Secondary: Number of Participants with Clinically Important Vital Sign Measurements Reported as AEs

    Close Top of page
    End point title
    Number of Participants with Clinically Important Vital Sign Measurements Reported as AEs
    End point description
    Vital signs included blood pressure, heart rate and temperature. Individual clinically significant changes in vital signs were reported by the investigator as TEAEs. Safety population was defined as all participants who received at least 1 dose of alisertib, or one of the comparator drugs. Participants were analyzed according to the treatment actually received.
    End point type
    Secondary
    End point timeframe
    First dose to 30 days after last dose of study drug or comparator (Up to 152 Weeks)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    137
    127
    Units: participants
        Heart Rate Increased
    1
    0
        Body Temperature Increased
    0
    1
        Hypotension
    4
    6
        Orthostatic Hypotension
    2
    1
        Hypertension
    5
    7
        Pyrexia
    48
    40
    No statistical analyses for this end point

    Secondary: Complete Response (CR) Rate

    Close Top of page
    End point title
    Complete Response (CR) Rate
    End point description
    Complete Response (CR) rate is defined as the percentage of participants with CR as assessed by the IRC using IWG criteria (2007 Cheson). CR= Disappearance of all evidence of disease. Response-evaluable population was defined as participants with peripheral T-cell lymphoma confirmed by an independent hematopathology central review, with measurable disease at baseline, who receive at least 1 dose of alisertib or the comparator drug, and 1 postbaseline response assessment of CR, PR, SD or PD by the independent radiology committee.
    End point type
    Secondary
    End point timeframe
    At the end of every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until PD (approximately 3 years)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    102
    92
    Units: percentage of participants
        number (confidence interval 95%)
    18 (11 to 26)
    27 (18 to 37)
    No statistical analyses for this end point

    Secondary: Time to Disease Progression (TTP)

    Close Top of page
    End point title
    Time to Disease Progression (TTP)
    End point description
    Time to Progression (TTP) was defined as the time from the date of randomization to the date of first documentation of PD/relapse. ITT population was defined as all participants who were randomized. The participants were analyzed according to the treatment they were randomized to receive, regardless of any errors of dosing.
    End point type
    Secondary
    End point timeframe
    At the end of every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until progressive disease. Duration is approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    138
    133
    Units: days
        median (confidence interval 95%)
    162 (114 to 231)
    116 (101 to 227)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Alisertib v Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects included in analysis
    271
    Analysis specification
    Pre-specified
    Analysis type
    superiority [2]
    P-value
    = 0.362
    Method
    Stratified Log Rank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.95
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.679
         upper limit
    1.329
    Notes
    [2] - Hazard ratio was based on a stratified Cox’s proportional hazard regression model with stratification factors: disease type, IPI Score and region with treatment as a factor in the model.

    Secondary: Duration of Response (DOR)

    Close Top of page
    End point title
    Duration of Response (DOR)
    End point description
    DOR was defined as the time from the date of first documentation of a PR or better to the date of first documentation of progressive disease (PD)/relapse for responders as assessed by the IRC using IWG criteria. Responders without documentation of PD/relapse were censored at the date of last response assessment that was stable disease (SD) or better. All responders in response-evaluable population defined as participants with peripheral T-cell lymphoma confirmed by independent hematopathology central review with measurable disease at baseline who receive at least 1 dose of alisertib or comparator drug and 1 postbaseline response assessment of CR, PR, SD or PD by independent radiology committee. 9999=NA (Not Available) Upper Limit Confidence Interval was not estimable due to the insufficient number of participants with the event.
    End point type
    Secondary
    End point timeframe
    At the end of every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until progressive disease. Duration is approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    34 [3]
    41 [4]
    Units: days
        median (confidence interval 95%)
    225 (125 to 9999)
    172 (119 to 9999)
    Notes
    [3] - Here 9999=Upper CI is not estimable as upper boundary becomes nonsensical at certain value.
    [4] - Here 9999=Upper CI is not estimable as upper boundary becomes nonsensical at certain value.
    No statistical analyses for this end point

    Secondary: Time to Response

    Close Top of page
    End point title
    Time to Response
    End point description
    Time to Response is defined as the time from the date of randomization to the date of first documentation of PR or better. All responders in response-evaluable population defined as participants with peripheral T-cell lymphoma confirmed by independent hematopathology central review with measurable disease at baseline who receive at least 1 dose of alisertib or comparator drug and 1 postbaseline response assessment of CR, PR, SD or PD by independent radiology committee.
    End point type
    Secondary
    End point timeframe
    At the end of every 8 weeks from date of first dose treatment; every 12 weeks after 40 week assessment; at end of treatment visit until progressive disease. Duration is approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    34
    41
    Units: days
        median (confidence interval 95%)
    62 (57 to 67)
    64 (60 to 71)
    No statistical analyses for this end point

    Secondary: Time to Subsequent Antineoplastic Therapy

    Close Top of page
    End point title
    Time to Subsequent Antineoplastic Therapy
    End point description
    Time to subsequent antineoplastic therapy was defined as the time from randomization to the first date of subsequent antineoplastic therapy (excluding transplant). Participants without subsequent antineoplastic therapy were censored at the date of death or last known to be alive. ITT population was defined as all participants who were randomized. The participants were analyzed according to the treatment they were randomized to receive, regardless of any errors of dosing.
    End point type
    Secondary
    End point timeframe
    From date of last study drug to date of subsequent antineoplastic therapy, if required; approximately 3 years
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    138
    133
    Units: days
        median (confidence interval 95%)
    336 (201 to 490)
    233 (144 to 429)
    No statistical analyses for this end point

    Secondary: Plasma Concentration-time Data to Contribute to Future Population Pharmacokinetics (PK) Analysis

    Close Top of page
    End point title
    Plasma Concentration-time Data to Contribute to Future Population Pharmacokinetics (PK) Analysis [5]
    End point description
    End point type
    Secondary
    End point timeframe
    Cycle 1, Days 1 and 7; Cycle 2, Day 8; Cycle 3, Day 8; Cycle 4, Day 8. Duration is approximately 4 months.
    Notes
    [5] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Only the Alisertib Arm is applicable to this Endpoint.
    End point values
    Alisertib
    Number of subjects analysed
    0 [6]
    Units: nM
        arithmetic mean (standard deviation)
    ( )
    Notes
    [6] - This Outcome Measure was registered in error and is not a Primary or Secondary Outcome Measure.
    No statistical analyses for this end point

    Secondary: Change Form Baseline in Reported Symptoms and Quality of Life (QoL) Assessment per Functional Assessment of Cancer Therapy-Lymphoma (FACT-LYM) for Functioning and Symptoms

    Close Top of page
    End point title
    Change Form Baseline in Reported Symptoms and Quality of Life (QoL) Assessment per Functional Assessment of Cancer Therapy-Lymphoma (FACT-LYM) for Functioning and Symptoms
    End point description
    The FACT-LYM includes the Functional Assessment of Cancer Therapy General Scale (FACT-G) and a 15-item lymphoma-specific subscale (LYM) over the past week. The FACT-G has 27 items that incorporate 4 scales including physical well-being (PWB; 7 items), social/family well-being (SWB, 7 items), emotional well-being (EWB; 6 items), and functional well-being (FWB; 7 items). The combined FACT-LYM instrument consists of a total of a 42 item questionnaire. Each question is answered on a 5- point scale of 0 (not at all) to 4 (very much) for a total possible score of 168. Higher scores indicate better well-being and a positive change from Baseline indicates improvement. ITT population was defined as all participants who were randomized. The participants were analyzed according to the treatment they were randomized to receive, regardless of any errors of dosing. Here, n= number of participants analyzed for this outcome measure.
    End point type
    Secondary
    End point timeframe
    Baseline and End of Treatment (EOT) (Up to 152 Weeks)
    End point values
    Alisertib Pralatrexate, or Romidepsin, or Gemcitabine
    Number of subjects analysed
    138
    133
    Units: score on a scale
    arithmetic mean (standard deviation)
        Physical Well-Being, EOT (n= 81,70)
    -2.4 ( 6.21 )
    -1.3 ( 5.27 )
        Social/Family Well-Being, EOT (n=81, 69)
    -0.3 ( 4.50 )
    0.0 ( 4.44 )
        Emotional Well-Being, EOT (n=80, 67)
    -1.4 ( 4.59 )
    -0.8 ( 3.93 )
        Functional Well-Being, EOT (n=80, 66)
    -2.4 ( 5.40 )
    -0.3 ( 4.79 )
    No statistical analyses for this end point

    Adverse events

    Close Top of page
    Adverse events information
    Timeframe for reporting adverse events
    First dose to 30 days after last dose of study drug or comparator (Up to 152 Weeks)
    Adverse event reporting additional description
    At each visit investigator documented any occurrence of adverse events (AEs) and abnormal laboratory findings. Any event reported by the subject or observed by investigator was recorded, irrespective of relation to study treatment. AEs for arm "Gemcitabine or Pralatrexate or Romidepsin" were reported separately.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.0
    Reporting groups
    Reporting group title
    Alisertib
    Reporting group description
    Alisertib 50 mg, enteric-coated tablet formulation, orally, twice daily for 7 consecutive days (Cycle Days 1-7) in a 21-day cycle (Up to 148 Weeks).

    Reporting group title
    Gemcitabine
    Reporting group description
    Gemcitabine 1,000 mg/m^2 over 30 minutes, intravenously, on Days 1, 8, and 15 of a 28-day cycle until the absence of disease progression or unacceptable toxicity (Up to 32 Weeks).

    Reporting group title
    Pralatrexate
    Reporting group description
    Pralatrexate 30 mg/m^2, intravenous (IV) push over 3 to 5 minutes, once weekly, for 6 weeks in 7-week cycles with concurrent vitamin B12 and folic acid supplementation. Cycles were repeated every 7-weeks provided the participant continued to benefit from and tolerate the therapy (Up to 115 Weeks).

    Reporting group title
    Romidepsin
    Reporting group description
    Romidepsin 14 mg/m^2, intravenously over a 4-hour period, on Days 1, 8, and 15 of a 28-cycle. Cycles were repeated every 28 days provided the patient continued to benefit from and tolerate the therapy (Up to 30 Weeks).

    Serious adverse events
    Alisertib Gemcitabine Pralatrexate Romidepsin
    Total subjects affected by serious adverse events
         subjects affected / exposed
    75 / 137 (54.74%)
    18 / 29 (62.07%)
    46 / 76 (60.53%)
    6 / 22 (27.27%)
         number of deaths (all causes)
    11
    5
    8
    2
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Peripheral T-cell lymphoma unspecified
    Additional description: Five treatment-emergent deaths occurred during treatment and are not related, two with alisertib, one with gemcitabine, and two with romidepsin.
         subjects affected / exposed
    2 / 137 (1.46%)
    2 / 29 (6.90%)
    1 / 76 (1.32%)
    2 / 22 (9.09%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
    0 / 2
    Lymphoma
    Additional description: One treatment-emergent death occurred during treatment with alisertib and is not related.
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    Anaplastic large cell lymphoma T- and null-cell types
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Adenocarcinoma of colon
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Squamous cell carcinoma
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Plasma cell myeloma
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Myelodysplastic syndrome
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Adult T-cell lymphoma/leukaemia
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Shock haemorrhagic
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Thrombosis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    12 / 137 (8.76%)
    6 / 29 (20.69%)
    6 / 76 (7.89%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    3 / 12
    3 / 6
    3 / 6
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General physical health deterioration
    Additional description: Three treatment-emergent deaths occurred during treatment with pralatrexate and are not related.
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    3 / 76 (3.95%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
    0 / 0
    Multiple organ dysfunction syndrome
    Additional description: Two treatment-emergent deaths occurred during treatment, one with alisertib, not related and one with pralatrexate, related.
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    1 / 1
    0 / 0
    Influenza like illness
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hypothermia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Catheter site phlebitis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pain
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Adverse drug reaction
    Additional description: One treatment-emergent death occurred during treatment with gemcitabine and is related.
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 4
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Anaphylactoid reaction
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    2 / 137 (1.46%)
    2 / 29 (6.90%)
    3 / 76 (3.95%)
    2 / 22 (9.09%)
         occurrences causally related to treatment / all
    1 / 2
    2 / 2
    0 / 3
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory distress
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Sleep apnoea syndrome
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hypoxia
    Additional description: Two treatment-emergent deaths occurred during treatment, one with alisertib and one with pralatrexate and are not related.
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 137 (0.73%)
    1 / 29 (3.45%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory failure
    Additional description: One treatment-emergent death occurred during treatment with gemcitabine and is not related.
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    Pleural effusion
    Additional description: One treatment-emergent death occurred during treatment with pralatrexate and is not related.
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cough
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hiccups
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Lymphocyte count decreased
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    White blood cell count decreased
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Contusion
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiopulmonary failure
    Additional description: One treatment-emergent death occurred during treatment with gemcitabine and is not related.
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    2 / 22 (9.09%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Sinus tachycardia
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Tachycardia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Atrioventricular block second degree
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiomegaly
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pericarditis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Carotid artery aneurysm
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatic encephalopathy
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Facial paralysis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Presyncope
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    24 / 137 (17.52%)
    1 / 29 (3.45%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    21 / 27
    1 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    2 / 7
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    7 / 137 (5.11%)
    1 / 29 (3.45%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    6 / 8
    1 / 1
    4 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    7 / 137 (5.11%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    4 / 9
    0 / 0
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Microcytic anaemia
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Stomatitis
         subjects affected / exposed
    7 / 137 (5.11%)
    0 / 29 (0.00%)
    11 / 76 (14.47%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    6 / 8
    0 / 0
    11 / 11
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    6 / 137 (4.38%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    5 / 6
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 137 (0.73%)
    1 / 29 (3.45%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Intestinal perforation
    Additional description: One treatment-emergent death occurred during treatment with gemcitabine and is not related.
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    Jejunal perforation
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Dysphagia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Ileus
    Additional description: One treatment-emergent death occurred during treatment with pralatrexate and is not related.
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    Haematemesis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Mouth haemorrhage
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Ascites
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Drug-induced liver injury
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatotoxicity
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cholangitis acute
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cholestasis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatic failure
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Venoocclusive liver disease
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash maculo-papular
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Dermatitis bullous
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Toxic epidermal necrolysis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pain of skin
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Acute generalised exanthematous pustulosis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Acute prerenal failure
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Renal failure
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cystitis haemorrhagic
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hydronephrosis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    1 / 137 (0.73%)
    1 / 29 (3.45%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Compartment syndrome
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
    Additional description: One treatment-emergent death occurred during treatment with alisertib and is related.
         subjects affected / exposed
    9 / 137 (6.57%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    5 / 14
    0 / 0
    2 / 5
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
    Lung infection
         subjects affected / exposed
    1 / 137 (0.73%)
    1 / 29 (3.45%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Sepsis
    Additional description: One treatment-emergent death occurred during treatment with alisertib and is not related.
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    Septic shock
    Additional description: Four treatment-emergent deaths occurred during treatment with alisertib, two related and two not related.
         subjects affected / exposed
    4 / 137 (2.92%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    2 / 5
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    2 / 4
    0 / 0
    0 / 0
    0 / 0
    Skin infection
    Additional description: One treatment-emergent death occurred during treatment with pralatrexate and is not related.
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    Dermatitis infected
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Epiglottitis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Tonsillitis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cytomegalovirus infection
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cytomegalovirus chorioretinitis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pneumonia bacterial
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile infection
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pseudomonal sepsis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Meningitis aseptic
         subjects affected / exposed
    0 / 137 (0.00%)
    1 / 29 (3.45%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Oral infection
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pneumonia haemophilus
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Eczema herpeticum
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Staphylococcal skin infection
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    2 / 22 (9.09%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Decreased appetite
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hypophagia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Electrolyte imbalance
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Tumour lysis syndrome
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hypoalbuminaemia
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Alisertib Gemcitabine Pralatrexate Romidepsin
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    134 / 137 (97.81%)
    29 / 29 (100.00%)
    72 / 76 (94.74%)
    21 / 22 (95.45%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    5 / 137 (3.65%)
    2 / 29 (6.90%)
    2 / 76 (2.63%)
    3 / 22 (13.64%)
         occurrences all number
    5
    2
    2
    4
    Hypotension
         subjects affected / exposed
    4 / 137 (2.92%)
    2 / 29 (6.90%)
    2 / 76 (2.63%)
    2 / 22 (9.09%)
         occurrences all number
    6
    3
    4
    2
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    49 / 137 (35.77%)
    11 / 29 (37.93%)
    14 / 76 (18.42%)
    6 / 22 (27.27%)
         occurrences all number
    64
    23
    19
    9
    Pyrexia
         subjects affected / exposed
    42 / 137 (30.66%)
    7 / 29 (24.14%)
    20 / 76 (26.32%)
    3 / 22 (13.64%)
         occurrences all number
    64
    7
    33
    4
    Oedema peripheral
         subjects affected / exposed
    21 / 137 (15.33%)
    5 / 29 (17.24%)
    10 / 76 (13.16%)
    5 / 22 (22.73%)
         occurrences all number
    24
    5
    14
    6
    Asthenia
         subjects affected / exposed
    24 / 137 (17.52%)
    2 / 29 (6.90%)
    10 / 76 (13.16%)
    0 / 22 (0.00%)
         occurrences all number
    46
    2
    15
    0
    Chills
         subjects affected / exposed
    9 / 137 (6.57%)
    2 / 29 (6.90%)
    5 / 76 (6.58%)
    2 / 22 (9.09%)
         occurrences all number
    12
    2
    7
    2
    Malaise
         subjects affected / exposed
    4 / 137 (2.92%)
    3 / 29 (10.34%)
    1 / 76 (1.32%)
    1 / 22 (4.55%)
         occurrences all number
    6
    3
    1
    1
    Mucosal inflammation
         subjects affected / exposed
    3 / 137 (2.19%)
    1 / 29 (3.45%)
    5 / 76 (6.58%)
    0 / 22 (0.00%)
         occurrences all number
    4
    1
    5
    0
    Peripheral swelling
         subjects affected / exposed
    1 / 137 (0.73%)
    2 / 29 (6.90%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences all number
    1
    2
    2
    0
    Chest discomfort
         subjects affected / exposed
    1 / 137 (0.73%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    2 / 22 (9.09%)
         occurrences all number
    1
    0
    0
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    14 / 137 (10.22%)
    4 / 29 (13.79%)
    17 / 76 (22.37%)
    3 / 22 (13.64%)
         occurrences all number
    18
    4
    24
    5
    Dyspnoea
         subjects affected / exposed
    12 / 137 (8.76%)
    4 / 29 (13.79%)
    8 / 76 (10.53%)
    4 / 22 (18.18%)
         occurrences all number
    16
    4
    9
    7
    Epistaxis
         subjects affected / exposed
    5 / 137 (3.65%)
    1 / 29 (3.45%)
    11 / 76 (14.47%)
    1 / 22 (4.55%)
         occurrences all number
    5
    1
    17
    1
    Oropharyngeal pain
         subjects affected / exposed
    6 / 137 (4.38%)
    1 / 29 (3.45%)
    6 / 76 (7.89%)
    1 / 22 (4.55%)
         occurrences all number
    9
    1
    6
    1
    Productive cough
         subjects affected / exposed
    4 / 137 (2.92%)
    1 / 29 (3.45%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    5
    2
    5
    0
    Nasal congestion
         subjects affected / exposed
    1 / 137 (0.73%)
    1 / 29 (3.45%)
    4 / 76 (5.26%)
    2 / 22 (9.09%)
         occurrences all number
    3
    1
    6
    2
    Hypoxia
         subjects affected / exposed
    2 / 137 (1.46%)
    2 / 29 (6.90%)
    1 / 76 (1.32%)
    2 / 22 (9.09%)
         occurrences all number
    2
    2
    1
    2
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    12 / 137 (8.76%)
    2 / 29 (6.90%)
    3 / 76 (3.95%)
    1 / 22 (4.55%)
         occurrences all number
    16
    2
    3
    1
    Anxiety
         subjects affected / exposed
    5 / 137 (3.65%)
    1 / 29 (3.45%)
    4 / 76 (5.26%)
    3 / 22 (13.64%)
         occurrences all number
    6
    1
    5
    3
    Investigations
    Platelet count decreased
         subjects affected / exposed
    16 / 137 (11.68%)
    11 / 29 (37.93%)
    6 / 76 (7.89%)
    5 / 22 (22.73%)
         occurrences all number
    41
    38
    23
    7
    Neutrophil count decreased
         subjects affected / exposed
    18 / 137 (13.14%)
    5 / 29 (17.24%)
    5 / 76 (6.58%)
    4 / 22 (18.18%)
         occurrences all number
    56
    9
    18
    4
    White blood cell count decreased
         subjects affected / exposed
    16 / 137 (11.68%)
    5 / 29 (17.24%)
    3 / 76 (3.95%)
    2 / 22 (9.09%)
         occurrences all number
    33
    10
    11
    2
    Alanine aminotransferase increased
         subjects affected / exposed
    8 / 137 (5.84%)
    2 / 29 (6.90%)
    9 / 76 (11.84%)
    0 / 22 (0.00%)
         occurrences all number
    20
    2
    16
    0
    Weight decreased
         subjects affected / exposed
    12 / 137 (8.76%)
    1 / 29 (3.45%)
    6 / 76 (7.89%)
    0 / 22 (0.00%)
         occurrences all number
    13
    1
    7
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    5 / 137 (3.65%)
    3 / 29 (10.34%)
    8 / 76 (10.53%)
    0 / 22 (0.00%)
         occurrences all number
    11
    3
    12
    0
    Blood alkaline phosphatase increased
         subjects affected / exposed
    9 / 137 (6.57%)
    1 / 29 (3.45%)
    5 / 76 (6.58%)
    1 / 22 (4.55%)
         occurrences all number
    14
    1
    6
    1
    Blood creatinine increased
         subjects affected / exposed
    3 / 137 (2.19%)
    3 / 29 (10.34%)
    3 / 76 (3.95%)
    2 / 22 (9.09%)
         occurrences all number
    3
    5
    4
    2
    Haemoglobin decreased
         subjects affected / exposed
    1 / 137 (0.73%)
    2 / 29 (6.90%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences all number
    1
    2
    2
    0
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    5 / 137 (3.65%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    5
    0
    4
    0
    Angina pectoris
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    2 / 22 (9.09%)
         occurrences all number
    0
    0
    0
    2
    Palpitations
         subjects affected / exposed
    0 / 137 (0.00%)
    2 / 29 (6.90%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences all number
    0
    2
    0
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    16 / 137 (11.68%)
    2 / 29 (6.90%)
    6 / 76 (7.89%)
    1 / 22 (4.55%)
         occurrences all number
    22
    2
    6
    1
    Headache
         subjects affected / exposed
    15 / 137 (10.95%)
    2 / 29 (6.90%)
    5 / 76 (6.58%)
    2 / 22 (9.09%)
         occurrences all number
    22
    3
    7
    2
    Somnolence
         subjects affected / exposed
    15 / 137 (10.95%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    1 / 22 (4.55%)
         occurrences all number
    26
    0
    1
    1
    Dysgeusia
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    4 / 22 (18.18%)
         occurrences all number
    3
    0
    2
    5
    Disturbance in attention
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    0 / 76 (0.00%)
    2 / 22 (9.09%)
         occurrences all number
    2
    0
    0
    2
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    74 / 137 (54.01%)
    7 / 29 (24.14%)
    30 / 76 (39.47%)
    6 / 22 (27.27%)
         occurrences all number
    166
    12
    46
    8
    Neutropenia
         subjects affected / exposed
    66 / 137 (48.18%)
    11 / 29 (37.93%)
    21 / 76 (27.63%)
    7 / 22 (31.82%)
         occurrences all number
    351
    25
    43
    7
    Thrombocytopenia
         subjects affected / exposed
    51 / 137 (37.23%)
    12 / 29 (41.38%)
    29 / 76 (38.16%)
    7 / 22 (31.82%)
         occurrences all number
    140
    26
    82
    17
    Leukopenia
         subjects affected / exposed
    39 / 137 (28.47%)
    6 / 29 (20.69%)
    6 / 76 (7.89%)
    2 / 22 (9.09%)
         occurrences all number
    115
    12
    18
    3
    Lymphopenia
         subjects affected / exposed
    14 / 137 (10.22%)
    2 / 29 (6.90%)
    5 / 76 (6.58%)
    1 / 22 (4.55%)
         occurrences all number
    29
    2
    15
    1
    Febrile neutropenia
         subjects affected / exposed
    7 / 137 (5.11%)
    1 / 29 (3.45%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences all number
    9
    1
    1
    0
    Lymph node pain
         subjects affected / exposed
    1 / 137 (0.73%)
    2 / 29 (6.90%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences all number
    1
    3
    1
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    61 / 137 (44.53%)
    5 / 29 (17.24%)
    18 / 76 (23.68%)
    10 / 22 (45.45%)
         occurrences all number
    139
    5
    37
    12
    Stomatitis
         subjects affected / exposed
    42 / 137 (30.66%)
    0 / 29 (0.00%)
    48 / 76 (63.16%)
    2 / 22 (9.09%)
         occurrences all number
    99
    0
    114
    3
    Nausea
         subjects affected / exposed
    35 / 137 (25.55%)
    7 / 29 (24.14%)
    23 / 76 (30.26%)
    15 / 22 (68.18%)
         occurrences all number
    48
    7
    35
    17
    Constipation
         subjects affected / exposed
    17 / 137 (12.41%)
    6 / 29 (20.69%)
    20 / 76 (26.32%)
    3 / 22 (13.64%)
         occurrences all number
    18
    6
    25
    5
    Vomiting
         subjects affected / exposed
    18 / 137 (13.14%)
    3 / 29 (10.34%)
    15 / 76 (19.74%)
    4 / 22 (18.18%)
         occurrences all number
    25
    4
    23
    5
    Abdominal pain
         subjects affected / exposed
    16 / 137 (11.68%)
    1 / 29 (3.45%)
    7 / 76 (9.21%)
    2 / 22 (9.09%)
         occurrences all number
    40
    1
    13
    2
    Dyspepsia
         subjects affected / exposed
    12 / 137 (8.76%)
    1 / 29 (3.45%)
    5 / 76 (6.58%)
    2 / 22 (9.09%)
         occurrences all number
    16
    1
    5
    2
    Abdominal pain upper
         subjects affected / exposed
    8 / 137 (5.84%)
    2 / 29 (6.90%)
    2 / 76 (2.63%)
    0 / 22 (0.00%)
         occurrences all number
    14
    2
    2
    0
    Mouth ulceration
         subjects affected / exposed
    5 / 137 (3.65%)
    0 / 29 (0.00%)
    5 / 76 (6.58%)
    0 / 22 (0.00%)
         occurrences all number
    5
    0
    5
    0
    Odynophagia
         subjects affected / exposed
    2 / 137 (1.46%)
    0 / 29 (0.00%)
    5 / 76 (6.58%)
    0 / 22 (0.00%)
         occurrences all number
    2
    0
    5
    0
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    43 / 137 (31.39%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences all number
    47
    0
    1
    0
    Pruritus
         subjects affected / exposed
    19 / 137 (13.87%)
    1 / 29 (3.45%)
    11 / 76 (14.47%)
    5 / 22 (22.73%)
         occurrences all number
    31
    1
    14
    5
    Rash
         subjects affected / exposed
    5 / 137 (3.65%)
    1 / 29 (3.45%)
    7 / 76 (9.21%)
    1 / 22 (4.55%)
         occurrences all number
    9
    1
    9
    1
    Night sweats
         subjects affected / exposed
    5 / 137 (3.65%)
    2 / 29 (6.90%)
    4 / 76 (5.26%)
    1 / 22 (4.55%)
         occurrences all number
    5
    2
    5
    1
    Skin lesion
         subjects affected / exposed
    2 / 137 (1.46%)
    2 / 29 (6.90%)
    4 / 76 (5.26%)
    1 / 22 (4.55%)
         occurrences all number
    5
    4
    8
    1
    Skin ulcer
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    4
    0
    13
    0
    Musculoskeletal and connective tissue disorders
    Pain in extremity
         subjects affected / exposed
    15 / 137 (10.95%)
    3 / 29 (10.34%)
    6 / 76 (7.89%)
    1 / 22 (4.55%)
         occurrences all number
    35
    4
    9
    1
    Back pain
         subjects affected / exposed
    12 / 137 (8.76%)
    0 / 29 (0.00%)
    6 / 76 (7.89%)
    0 / 22 (0.00%)
         occurrences all number
    14
    0
    8
    0
    Arthralgia
         subjects affected / exposed
    8 / 137 (5.84%)
    1 / 29 (3.45%)
    3 / 76 (3.95%)
    1 / 22 (4.55%)
         occurrences all number
    9
    1
    5
    1
    Muscle spasms
         subjects affected / exposed
    9 / 137 (6.57%)
    2 / 29 (6.90%)
    1 / 76 (1.32%)
    1 / 22 (4.55%)
         occurrences all number
    11
    2
    1
    1
    Musculoskeletal pain
         subjects affected / exposed
    7 / 137 (5.11%)
    0 / 29 (0.00%)
    1 / 76 (1.32%)
    0 / 22 (0.00%)
         occurrences all number
    8
    0
    3
    0
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    14 / 137 (10.22%)
    3 / 29 (10.34%)
    3 / 76 (3.95%)
    1 / 22 (4.55%)
         occurrences all number
    21
    5
    4
    1
    Influenza
         subjects affected / exposed
    8 / 137 (5.84%)
    1 / 29 (3.45%)
    3 / 76 (3.95%)
    0 / 22 (0.00%)
         occurrences all number
    13
    2
    3
    0
    Conjunctivitis
         subjects affected / exposed
    4 / 137 (2.92%)
    0 / 29 (0.00%)
    7 / 76 (9.21%)
    0 / 22 (0.00%)
         occurrences all number
    4
    0
    9
    0
    Pneumonia
         subjects affected / exposed
    4 / 137 (2.92%)
    0 / 29 (0.00%)
    5 / 76 (6.58%)
    1 / 22 (4.55%)
         occurrences all number
    4
    0
    5
    1
    Sinusitis
         subjects affected / exposed
    5 / 137 (3.65%)
    0 / 29 (0.00%)
    2 / 76 (2.63%)
    3 / 22 (13.64%)
         occurrences all number
    7
    0
    2
    3
    Viral upper respiratory tract infection
         subjects affected / exposed
    4 / 137 (2.92%)
    2 / 29 (6.90%)
    3 / 76 (3.95%)
    1 / 22 (4.55%)
         occurrences all number
    4
    2
    3
    1
    Skin infection
         subjects affected / exposed
    2 / 137 (1.46%)
    1 / 29 (3.45%)
    6 / 76 (7.89%)
    0 / 22 (0.00%)
         occurrences all number
    4
    1
    6
    0
    Bronchitis
         subjects affected / exposed
    4 / 137 (2.92%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    5
    0
    5
    0
    Pharyngitis
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    4
    0
    4
    0
    Oral herpes
         subjects affected / exposed
    3 / 137 (2.19%)
    3 / 29 (10.34%)
    0 / 76 (0.00%)
    0 / 22 (0.00%)
         occurrences all number
    3
    4
    0
    0
    Mucosal infection
         subjects affected / exposed
    0 / 137 (0.00%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    0 / 22 (0.00%)
         occurrences all number
    0
    0
    5
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    27 / 137 (19.71%)
    1 / 29 (3.45%)
    14 / 76 (18.42%)
    9 / 22 (40.91%)
         occurrences all number
    39
    1
    16
    11
    Hypokalaemia
         subjects affected / exposed
    13 / 137 (9.49%)
    0 / 29 (0.00%)
    5 / 76 (6.58%)
    2 / 22 (9.09%)
         occurrences all number
    18
    0
    8
    2
    Hypomagnesaemia
         subjects affected / exposed
    9 / 137 (6.57%)
    1 / 29 (3.45%)
    6 / 76 (7.89%)
    0 / 22 (0.00%)
         occurrences all number
    10
    3
    6
    0
    Dehydration
         subjects affected / exposed
    4 / 137 (2.92%)
    0 / 29 (0.00%)
    7 / 76 (9.21%)
    2 / 22 (9.09%)
         occurrences all number
    4
    0
    9
    2
    Hyponatraemia
         subjects affected / exposed
    3 / 137 (2.19%)
    0 / 29 (0.00%)
    4 / 76 (5.26%)
    1 / 22 (4.55%)
         occurrences all number
    3
    0
    5
    1

    More information

    Close Top of page

    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Oct 2012
    Protocol Amendments 3 and 4 were developed in parallel for all countries and for those where romidepsin use was not permitted. The key purposes of Amendments 3 and 4 were to: 1. Remove the NPO (nothing by mouth) requirements around alisertib administration. 2. Update that OS would be analyzed twice, first at the final analysis, and then again after approximately 80% of all patients in the ITT population had death events, which was anticipated to be approximately 42 months after the last patient in. 3. Add that HIV testing was to be performed during screening, only where required by local regulations. 4. Remove the eligibility criterion excluding patients with albumin below the lower limit of normal. 5. Remove the censoring method from the protocol and indicate that details of censoring would be described in the SAP. 6. Change the analysis of ORR at the second interim analysis from stratified CMH test to unstratified CMH test because the sample size might be too small for a stratified CMH test. 7. Confirm that up to a maximum of 354 patients (ie, not response-evaluable patients) would be enrolled to reach a maximum of 261 PFS events (Amendment 3). 8. Specify that patients with CD30+ ALCL ALK+ disease are expected to have received anti- CD30+ targeted therapy, where approved, prior to entering this study. 9. Remove blastic NK lymphoma as a PTCL subtype included in this study. 10. Add the EQ5D-3L as a QOL assessment during OS follow-up. 11. Remove statements regarding the use of flumazenil and CNS stimulants (such as modafinil or methylphenidate). 12. Update the Clinical Pharmacokinetics and Clinical Experience sections to align with the current Investigator’s Brochure. 13. Update the anticipated number of sites and countries participating in this study. 14. Delete redundant SAE reporting language and update reporting period for SAEs to Millennium from 1 working day to 24 hours. 15. Permitted food at dosing and clarified that Chesson 2007 guidance to be followed
    11 Mar 2014
    Protocol Amendments 5 and 6 were developed in parallel for all countries and for those where romidepsin use was not permitted. The key purposes of Amendments 5 and 6 were to: 1. Indicate a change in the SAE reporting center from PPD, Inc. to Cognizant. 2. Update language to current company standards and remove text regarding the start of antineoplastic or anticancer therapy as it related to follow-up of AEs. 3. Made key secondary endpoint OS (not OS and CR rate)

    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
    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.

    European Medicines Agency © 1995-Fri Apr 19 08:25:17 CEST 2024 | Domenico Scarlattilaan 6, 1083 HS Amsterdam, The Netherlands
    EMA HMA