E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10017758 |
E.1.2 | Term | Gastric cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10066354 |
E.1.2 | Term | Adenocarcinoma of the gastroesophageal junction |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To evaluate the efficacy of onartuzumab + mFOLFOX6 compared with placebo + mFOLFOX6 as measured by overall survival (OS) in patients with previously untreated HER2–negative metastatic gastroesophageal cancer (GEC) classified as Met IHC 2+ or 3+ (Met 2+/3+ subgroup)
• To evaluate the efficacy of onartuzumab + mFOLFOX6 compared with placebo + mFOLFOX6 as measured by OS in patients with previously untreated HER2 negative metastatic GEC classified as Met-IHC 1+, 2+, or 3+ (intent-to-treat [ITT] population)
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E.2.2 | Secondary objectives of the trial |
• To evaluate the efficacy of onartuzumab + mFOLFOX6 relative to placebo + mFOLFOX6 as measured by PFS and ORR in the Met 2+/3+ subgroup and in the ITT population
• To evaluate the safety of onartuzumab + mFOLFOX6 compared with placebo + mFOLFOX6 in patients with metastatic HER2-negative, Met-positive GEC, focusing on all adverse events, National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v4.0) Grade ≥ 3 adverse events, and
Grade ≥ 3 laboratory toxicities
• To compare patient-reported outcomes (PROs) following treatment with onartuzumab + mFOLFOX6 relative to placebo + mFOLFOX6, as measured by the EORTC QLQ-C30 and its gastric cancer module (the QLQ-STO22).
• To characterize the pharmacokinetics of onartuzumab when given with mFOLFOX6
• To evaluate serum levels and incidence of anti-therapeutic antibodies (ATAs) against onartuzumab |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Male or female, 18 years of age or older
• ECOG performance status of 0 or 1
• Life expectancy > 3 months
• Histologically confirmed adenocarcinoma of the stomach or GEJ with inoperable metastatic disease not amenable to curative therapy
• Adequate archival or newly obtained formalin-fixed paraffin-embedded (FFPE) tissue for central IHC assay of Met receptor and HER2 status
• Tumor (either primary or metastatic lesion) defined as Met positive by IHC (≥ 50% of tumor cells with membrane and/or cytoplasmic staining at weak, moderate, or high intensity)
• Measurable disease or non-measurable but evaluable disease, according to the Response Evaluation Criteria in Solid Tumors (RECIST v1.1)
Patients with peritoneal disease would generally be regarded as having evaluable disease and be allowed to enter the trial.
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E.4 | Principal exclusion criteria |
• HER2-positive tumor (primary tumor or metastasis)
HER2-positivity is defined as either IHC 3+ or IHC 2+/ISH+; ISH positivity is defined as a HER2:CEP17 ratio of ≥ 2.0.
• Previous chemotherapy for locally advanced or metastatic gastric carcinoma Patients may have received either neoadjuvant or adjuvant chemotherapy as long as it was completed at least 6 months prior to randomization.
• Prior exposure to experimental treatment targeting either the HGF or Met pathway
• History of another malignancy within the previous 5 years, except for appropriately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, Stage I uterine cancer, localized prostate cancer that has been treated surgically with curative intent and presumed cured, or other malignancies with an expected curative outcome
Hematologic, Biochemical, and Organ Function
• Granulocyte count < 1500/mm3, platelet count < 100,000/mm3, and hemoglobin < 9.0 g/dL within 7 days prior to enrollment
• Partial thromboplastin time (PTT), international normalized ratio (INR), or prothrombin time (PT) > 1.5 x the upper limit of normal (ULN), except for patients receiving anticoagulation therapy
• AST (SGOT), ALT (SGPT), alkaline phosphatase (ALP) ≥ 2.5 × ULN (≥ 5 × ULN with liver metastases)
• Total bilirubin ≥ 1.5 × ULN (except in patients diagnosed with Gilbert’s disease)
• Serum calcium > ULN (corrected for low serum albumin concentrations) Corrected calcium (mg/dL) = serum Ca2+ + [(4.0–measured serum albumin) x 0.8] Corrected calcium (mmol/L) = serum Ca2+ + 0.02 × (40–serum albumin)
• Serum creatinine > 1.5 × ULN or calculated creatinine clearance < 60 mL/min (Cockcroft and Gault 1976)
• Uncontrolled diabetes as evidenced by fasting serum glucose level > 200 mg/dL
• Clinically significant gastrointestinal abnormalities, apart from gastric cancer, including uncontrolled inflammatory gastrointestinal diseases (Crohn’s disease, ulcerative colitis, etc.)
• Known active infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV), or known HIV-seropositivity.
• Major surgery within 4 weeks before start of study treatment, without complete recovery |
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E.5 End points |
E.5.1 | Primary end point(s) |
• One interim efficacy and futility analysis planned for the Met 2+/3+ subgroup occurring at the time of the ITT final analysis, which is triggered by obtaining 67% of total OS information (79 events) from the Met 2+/3+ subgroup and 449 events from the ITT population
• Final efficacy analysis for the 2+/3+ subgroup triggered by 118 OS events (this will likely occur after the final analysis of the ITT population)
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
OS is defined as the time from randomization to death to any cause |
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E.5.2 | Secondary end point(s) |
Progression-Free Survival, ORR, Safety, PK and PRO |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability, QoL, Serum levels and incidence of anti-therapeutic
antibodies (ATAs) against MetMAb |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 50 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 52 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Belgium |
Brazil |
Canada |
China |
Czech Republic |
France |
Germany |
Guatemala |
Hong Kong |
Israel |
Italy |
Korea, Republic of |
Malaysia |
Mexico |
Panama |
Poland |
Russian Federation |
Singapore |
Spain |
Switzerland |
Taiwan |
Thailand |
Turkey |
Ukraine |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The final analysis for the ITT population will occur after 449 deaths have been observed (expected 29 months after first patient in [FPI]), while the final analysis for the Met 2+/3+ subgroup will occur after 118 deaths in the Met 2+/3+ subgroup have been observed (expected 38 months after FPI). Follow-up for survival will continue until all patients have either died, or are lost to follow-up, or the Sponsor decides to end the trial, whichever occurs first. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 2 |
E.8.9.2 | In all countries concerned by the trial days | 0 |