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    Clinical Trial Results:
    Phase II multicenter single-arm study evaluating the safety and efficacy of everolimus as a first-line treatment in newly-diagnosed patients with advanced GI neuroendocrine tumors.

    Summary
    EudraCT number
    2011-006160-48
    Trial protocol
    GR  
    Global end of trial date
    06 Aug 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    21 Aug 2020
    First version publication date
    21 Aug 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    HE 67/12
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01648465
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Hellenic Cooperative Oncology Group
    Sponsor organisation address
    Messoghion Avenue 41, Athens, Greece, 11526
    Public contact
    Clinical Trials, Hellenic Cooperative Oncology Group, 0030 2106912520, hecogoff@otenet.gr
    Scientific contact
    Clinical Trials, Hellenic Cooperative Oncology Group, 0030 2106912520, hecogoff@otenet.gr
    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
    19 Dec 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    06 Aug 2019
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The main purpose of this study is to evaluate the safety and efficacy of Everolimus (as first-line treatment) and 15month progression-free survival rate (15month PFS rate) (according to RECIST 1.1) in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors
    Protection of trial subjects
    The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, the Good Clinical Practice guidelines and the local regulatory requirements
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    06 Aug 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Greece: 25
    Worldwide total number of subjects
    25
    EEA total number of subjects
    25
    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)
    19
    From 65 to 84 years
    6
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients were enrolled between 6 August 2012 and 29 October 2015 in 8 sites in Greece

    Pre-assignment
    Screening details
    Patients were screened for eligibility before entering the study and signed the informed consent form which was obtained before any study procedure.

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

    Arms
    Arm title
    Everolimus
    Arm description
    Everolimus, which is a selective mTOR inhibitor, was administered as a first-line treatment at the dose of 10mg (2x5mg) orally once daily until disease progression, unacceptable toxicity, consent withdrawal or completion of 15 months of treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Everolimus
    Investigational medicinal product code
    RAD001
    Other name
    Afinitor
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Everolimus was administered at the dose of 10mg (2x5mg) orally (tablet) once daily, until disease progression, unacceptable toxicity, consent withdrawal or completion of 15 months of treatment

    Number of subjects in period 1
    Everolimus
    Started
    25
    Completed
    5
    Not completed
    20
         Physician decision
    1
         Consent withdrawn by subject
    5
         Disease progression
    10
         Adverse event, non-fatal
    2
         Second malignancy of urothelial carcinoma
    1
         6 weeks without therapy
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial (overall period)
    Reporting group description
    -

    Reporting group values
    Overall trial (overall period) Total
    Number of subjects
    25 25
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    19 19
        From 65-84 years
    6 6
    Age continuous
    Units: years
        median (full range (min-max))
    56.9 (37.6 to 79.9) -
    Gender categorical
    Units: Subjects
        Female
    15 15
        Male
    10 10

    End points

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    End points reporting groups
    Reporting group title
    Everolimus
    Reporting group description
    Everolimus, which is a selective mTOR inhibitor, was administered as a first-line treatment at the dose of 10mg (2x5mg) orally once daily until disease progression, unacceptable toxicity, consent withdrawal or completion of 15 months of treatment.

    Primary: 15-month PFS rate

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    End point title
    15-month PFS rate [1]
    End point description
    The primary endpoint was to evaluate the 15-month progression-free survival rate (15month PFS rate) (according to RECIST 1.1) in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors treated with Everolimus, as a first-line treatment. Prorgession-free survival was calculated as the time (in months) from study entry to the date of the first documented disease progression, death , or last contact (whichever occurred first).
    End point type
    Primary
    End point timeframe
    CT / MRI was done during the screening period and in a maximum period of up to 28 days before the first dose of the drug. Then it was repeated on Day 1 of Cycle 3, in each three subsequent cycles (every 12 weeks) and at the end of the study.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analyses for this end point
    End point values
    Everolimus
    Number of subjects analysed
    25
    Units: percentage of patients
    48
    No statistical analyses for this end point

    Secondary: Overall survival

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    End point title
    Overall survival
    End point description
    Overall survival was defined as the time from study entry to the date of death from any cause or last contact in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors treated with Everolimus as a first-line treatment
    End point type
    Secondary
    End point timeframe
    Patients were followed-up for a median of 76.6 months (95% CI 62.6-79.5).
    End point values
    Everolimus
    Number of subjects analysed
    25
    Units: number of deaths
    8
    No statistical analyses for this end point

    Secondary: Progression-free survival

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    End point title
    Progression-free survival
    End point description
    Progression free survival was calculated from the date of patient's entry into the study until the first documented disease progression, death or last contact in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors treated with everolimus, as a first-line treatment
    End point type
    Secondary
    End point timeframe
    Patients were followed up for a median of 76.6 months (95% CI 62.6-79.5).
    End point values
    Everolimus
    Number of subjects analysed
    25
    Units: months
        median (confidence interval 95%)
    14.6 (5.8 to 15.7)
    No statistical analyses for this end point

    Secondary: Best overall response

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    End point title
    Best overall response
    End point description
    Best overall response was defined as the best response for each patient during the treatment period of everolimus, according to RECIST 1.1 criteria in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors, treated with Everolimus, as a first-line treatment
    End point type
    Secondary
    End point timeframe
    CT / MRI was done during the screening period and in a maximum period of up to 28 days before the first dose of the drug. Then was repeated on Day 1 of Cycle 3, in each three subsequent cycles (every 12 weeks) and at the end of the study.
    End point values
    Everolimus
    Number of subjects analysed
    25
    Units: number of patients
        CR
    1
        PR
    6
        SD
    12
        PD
    4
        Treatment discontinuation prior to evaluation
    2
    No statistical analyses for this end point

    Secondary: Safety profile

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    End point title
    Safety profile
    End point description
    Safety was assessed in the safety population consisting of all patients that received at least one dose of the study drug
    End point type
    Secondary
    End point timeframe
    Assessment of adverse events (AEs) was performed every 28 days (per cycle) throughout the course of treatment with Everolimus
    End point values
    Everolimus
    Number of subjects analysed
    25 [2]
    Units: number of patients
        Any adverse event
    24
        Fatal adverse event
    0
        Serious adverse event
    9
    Notes
    [2] - All 25 patients received at least one dose of everolimus and were assessed for safety.
    No statistical analyses for this end point

    Secondary: Time to best response

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    End point title
    Time to best response
    End point description
    Time to best response was estimated from the date of study entry until the date of best response throughout the study in newly-diagnosed patients with advanced or unresectable GI and pancreatic neuroendocrine tumors treated with Everolimus, as a first-line treatment
    End point type
    Secondary
    End point timeframe
    CT/MRI was performed during the screening period and in a maximum of up to 28 days before the first dose and repeated on Day 1 of Cycle 3, in each three subsequent cycles (every 12 weeks) and at the end of the study. Median follow-up 76.6 months.
    End point values
    Everolimus
    Number of subjects analysed
    25
    Units: months
    median (confidence interval 95%)
        Among patients with objective response
    2.6 (1.8 to 4.7)
        Among patients with CR/PR/SD
    2.3 (1.8 to 2.6)
    No statistical analyses for this end point

    Other pre-specified: Evaluation of possible association between biomarkers and disease progression

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    End point title
    Evaluation of possible association between biomarkers and disease progression
    End point description
    The differences in the levels of Chromogranin-A (CgA) were assessed at baseline and at the last treatment cycle.
    End point type
    Other pre-specified
    End point timeframe
    Analysis of biological markers should be performed at study initiation, on Day 1 of cycle 3 and then every 3 cycles (every 12 weeks) as well as at the end of the study.
    End point values
    Everolimus
    Number of subjects analysed
    12 [3]
    Units: nmol/l
    median (full range (min-max))
        Baseline
    3.5 (1.57 to 102)
        Last cycle
    4.0 (2.30 to 91.6)
    Notes
    [3] - In total, 24 patients had available CgA data at baseline and 12 at both baseline and last cycle.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Assessment of adverse events will be performed every 28 days (per cycle) during treatment with Everolimus.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23
    Reporting groups
    Reporting group title
    Everolimus
    Reporting group description
    Everolimus 10mg (5x2 mg) was administered orally once daily, until disease progression, unacceptable toxicity, consent withdrawal or completion of 15 months of treatment.

    Serious adverse events
    Everolimus
    Total subjects affected by serious adverse events
         subjects affected / exposed
    9 / 25 (36.00%)
         number of deaths (all causes)
    8
         number of deaths resulting from adverse events
    0
    Investigations
    Blood creatinine phosphokinase increased
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Wound abscess
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Fever
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Allergic reaction
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Mucositis oral
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bacteraemia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia viral
    Additional description: H1N1
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Biliary tract infection
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Everolimus
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    24 / 25 (96.00%)
    Investigations
    Alkaline phosphatase increased
         subjects affected / exposed
    8 / 25 (32.00%)
         occurrences all number
    16
    Alanine aminotransferase increased
         subjects affected / exposed
    11 / 25 (44.00%)
         occurrences all number
    75
    Aspartate aminotransferase increased
         subjects affected / exposed
    10 / 25 (40.00%)
         occurrences all number
    37
    CPK increased
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    11
    Cholesterol high
         subjects affected / exposed
    8 / 25 (32.00%)
         occurrences all number
    21
    Creatinine increased
         subjects affected / exposed
    4 / 25 (16.00%)
         occurrences all number
    13
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    10 / 25 (40.00%)
         occurrences all number
    25
    Platelet count decreased
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences all number
    2
    Neutrophil count decreased
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    11
    Weight loss
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    5
    White blood cell count decreased
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    22
    LDH increased
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    5
    Vascular disorders
    Hypertension
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    12
    Thromboembollic Event
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    6
    Headache
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Peripheral sensory neuropathy
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    9 / 25 (36.00%)
         occurrences all number
    33
    General disorders and administration site conditions
    Oedema
    Additional description: limbs
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    11
    Fatigue
         subjects affected / exposed
    6 / 25 (24.00%)
         occurrences all number
    14
    Flu-like symptoms
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Fever
         subjects affected / exposed
    4 / 25 (16.00%)
         occurrences all number
    18
    Eye disorders
    Conjunctivitis
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Dyspesia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Mycositis oral
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    14
    Nausea
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    3
    Diarrhoea
         subjects affected / exposed
    8 / 25 (32.00%)
         occurrences all number
    27
    Vomiting
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    4
    Epistaxis
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Pleural effusion
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Pneumonitis
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Nail dystrophy
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Rash
    Additional description: Head and hair
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Rash acneiform
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Rash maculo-papular
         subjects affected / exposed
    6 / 25 (24.00%)
         occurrences all number
    8
    Dry skin
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Nail loss
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    2
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    3
    Pruritus
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    15
    Skin hypopigmentation
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    3 / 25 (12.00%)
         occurrences all number
    15
    Infections and infestations
    Viral infection
    Additional description: Upper respiratory
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Papulopustular rash
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Upper respiratory infection
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    3
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences all number
    3
    Hyperglycaemia
         subjects affected / exposed
    17 / 25 (68.00%)
         occurrences all number
    69
    Hyperkalaemia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    5
    Hypertriglyceridaemia
         subjects affected / exposed
    6 / 25 (24.00%)
         occurrences all number
    24
    Hyperuricaemia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Hypoalbuminaemia
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences all number
    2
    Hypocalcaemia
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    7
    Hypoglycaemia
         subjects affected / exposed
    1 / 25 (4.00%)
         occurrences all number
    1
    Hypokalaemia
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    10
    Hypomagnesaemia
         subjects affected / exposed
    2 / 25 (8.00%)
         occurrences all number
    2
    Hypophosphataemia
         subjects affected / exposed
    5 / 25 (20.00%)
         occurrences all number
    15

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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