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    Clinical Trial Results:
    Everolimus After (Chemo)Embolization for Liver Metastases From Digestive Endocrine Tumors (EVACEL)

    Summary
    EudraCT number
    2012-002224-32
    Trial protocol
    FR  
    Global end of trial date
    12 Oct 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2025
    First version publication date
    13 Jul 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    FFCD 1104
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01678664
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Fédération Francophone de Cancérologie Digestive (FFCD)
    Sponsor organisation address
    7 Boulevard Jeanne d’Arc, BP 87900, Dijon, France, 21079
    Public contact
    Marie Moreau, Fédération Francophone de Cancérologie Digestive, marie.moreaut@u-bourgogne.fr
    Scientific contact
    Marie Moreau, Fédération Francophone de Cancérologie Digestive (FFCD), +33 0755676632, marie.moreau@u-bourgogne.fr
    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
    27 Nov 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    21 Aug 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    12 Oct 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary end-point of this study was the hepatic progression-free survival rate (based on the central assessment) as defined by RECIST v1.1 at 24 months after treatment
    Protection of trial subjects
    This protocol was authorised by the French Medicines Agency (Agence Francaise de Securite Sanitaire des Produits de Sante´) on 29 June 2012. (A120657-42), and the trial was registered on the clinicaltrials.gov website (NCT01678664). The study complies with the Declaration of Helsinki rules and the principles of Good Clinical Practice guidelines. All patients gave written informed consent for participation in this trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Nov 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
    France: 74
    Worldwide total number of subjects
    74
    EEA total number of subjects
    74
    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)
    32
    From 65 to 84 years
    41
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 74 patients were included between January 2013 and March 2016.

    Pre-assignment
    Screening details
    Before enrollement, standard examinations (biological, clinical, TDM, ECG) were done. Inclusion and non inclusion criteria had to be met.

    Period 1
    Period 1 title
    Baseline period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Not blinding

    Arms
    Arm title
    Embolization or chemoembolization plus everolimus
    Arm description
    The hepatic arterial embolisation therapy (HAET) including hepatic arterial embolisation (HAE) by particulate embolisation of the hepatic arterial branches feeding the targeted liver metastases or transarterial chemoembolisation (TACE) using a mixture of lipiodol with either doxorubicin (50 mg/m2, up to a target of total dose of 100 mg) or streptozotocin (1500 mg/m2) followed by particulate embolisation using either gelatin sponge particles or spherical embolics up to stasis. The treatment plan allowed for a maximum of two procedures. Everolimus (10 mg/day) was started 7 days after the HAET and once hepatic toxicity had improved to grade <= I. The treatment had to start <=30 days after HAET.
    Arm type
    Experimental

    Investigational medicinal product name
    Everolimus
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    10 mg/day (either 1 tablet of 10mg or 2 tablets of 5mg) during 24 months or until progression disease. started 7 days after the HAET and once hepatic toxicity had improved to grade <= I. The treatment had to start <=30 days after HAET. The duration of everolimus treatment was 24 months after the first procedure in the absence of unacceptable toxicity.

    Investigational medicinal product name
    Embolization
    Investigational medicinal product code
    Other name
    spheric particules of 100 to 500 µm
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intraarterial use
    Dosage and administration details
    2 sessions embolization with spheric particle

    Investigational medicinal product name
    Doxorubicin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intraarterial use
    Dosage and administration details
    2 sessions chemoembolization with 10 ml of lipiodol and either 100 mg of doxorubicin or streptozotocin (1500 mg/m2) (reconstituted in 5 ml or the smallest possible volume of liquid).

    Investigational medicinal product name
    Lipiodol
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intraarterial use
    Dosage and administration details
    2 sessions chemoembolization with 10 ml of lipiodol and either 100 mg of doxorubicin or streptozotocin (1500 mg/m2) (reconstituted in 5 ml or the smallest possible volume of liquid).

    Investigational medicinal product name
    Streptozotocin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intraarterial use
    Dosage and administration details
    2 sessions chemoembolization with 10 ml of lipiodol and either 100 mg of doxorubicin or streptozotocin (1500 mg/m2) (reconstituted in 5 ml or the smallest possible volume of liquid).

    Number of subjects in period 1
    Embolization or chemoembolization plus everolimus
    Started
    74
    Completed
    13
    Not completed
    61
         Physician decision
    7
         Not recovered at day 30 from HAET
    3
         Disease progression
    21
         Adverse event, non-fatal
    24
         Unknown
    4
         Patient choice
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Baseline period
    Reporting group description
    -

    Reporting group values
    Baseline period Total
    Number of subjects
    74 74
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    32 32
        From 65-84 years
    41 41
        85 years and over
    1 1
    Age continuous
    Units: years
        median (full range (min-max))
    66 (43 to 86) -
    Gender categorical
    Units: Subjects
        Female
    31 31
        Male
    43 43
    Primary site
    Units: Subjects
        Small bowel
    64 64
        Caecum and colon
    3 3
        Rectum
    2 2
        Stomach
    2 2
        Unknown
    3 3
    Performance status
    Units: Subjects
        PS 0
    48 48
        PS 1
    25 25
        PS 2
    1 1
    Tumor grade
    Units: Subjects
        Grade I
    32 32
        Grade II
    42 42
    Median liver tumour burden
    Units: Subjects
        < 25%
    29 29
        25% - 50%
    24 24
        50% - 75%
    14 14
        > 75%
    7 7
    Disease progression at study entry
    by RECIST criteria
    Units: Subjects
        Yes
    74 74
    Previous carcinoid syndrome
    Units: Subjects
        Yes
    32 32
        No
    42 42
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All patients included in the trial, whatever the eligibility criteria are and the treatment received.

    Subject analysis set title
    mITT
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    Modified intention-to-treat population is defined as the ITT population who have received at least one (chemo) embolization and at least one dose of everolimus.

    Subject analysis sets values
    ITT mITT
    Number of subjects
    74
    67
    Age categorical
    Units: Subjects
        In utero
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
        Newborns (0-27 days)
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
        Children (2-11 years)
    0
    0
        Adolescents (12-17 years)
    0
    0
        Adults (18-64 years)
    32
    29
        From 65-84 years
    41
    37
        85 years and over
    1
    1
    Age continuous
    Units: years
        median (full range (min-max))
    66 (43 to 86)
    66 (43 to 86)
    Gender categorical
    Units: Subjects
        Female
    31
    28
        Male
    43
    39
    Primary site
    Units: Subjects
        Small bowel
    64
        Caecum and colon
    3
        Rectum
    2
        Stomach
    2
        Unknown
    3
    Performance status
    Units: Subjects
        PS 0
    48
        PS 1
    25
        PS 2
    1
    Tumor grade
    Units: Subjects
        Grade I
    32
        Grade II
    42
    Median liver tumour burden
    Units: Subjects
        < 25%
    29
        25% - 50%
    24
        50% - 75%
    14
        > 75%
    7
    Disease progression at study entry
    by RECIST criteria
    Units: Subjects
        Yes
    74
    Previous carcinoid syndrome
    Units: Subjects
        Yes
    32
        No
    42

    End points

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    End points reporting groups
    Reporting group title
    Embolization or chemoembolization plus everolimus
    Reporting group description
    The hepatic arterial embolisation therapy (HAET) including hepatic arterial embolisation (HAE) by particulate embolisation of the hepatic arterial branches feeding the targeted liver metastases or transarterial chemoembolisation (TACE) using a mixture of lipiodol with either doxorubicin (50 mg/m2, up to a target of total dose of 100 mg) or streptozotocin (1500 mg/m2) followed by particulate embolisation using either gelatin sponge particles or spherical embolics up to stasis. The treatment plan allowed for a maximum of two procedures. Everolimus (10 mg/day) was started 7 days after the HAET and once hepatic toxicity had improved to grade <= I. The treatment had to start <=30 days after HAET.

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All patients included in the trial, whatever the eligibility criteria are and the treatment received.

    Subject analysis set title
    mITT
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    Modified intention-to-treat population is defined as the ITT population who have received at least one (chemo) embolization and at least one dose of everolimus.

    Primary: Hepatic Progression-free survival rate at 24 months (24 months hPFS)

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    End point title
    Hepatic Progression-free survival rate at 24 months (24 months hPFS) [1]
    End point description
    The primary end-point of this study was the hPFS rate (based on the central assessment) as defined by RECIST v1.1 (including death considered as progression) at 24 months after treatment. In the 67 mITT patients : If 31 or more patients are alive without hepatic progression at 24 months, we conclude that the treatment is effective.
    End point type
    Primary
    End point timeframe
    at 24 months after treatment.
    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: This is a non-comparative study, so there are no inferential statistics.
    End point values
    mITT
    Number of subjects analysed
    67
    Units: patients
        Yes
    22
        No
    45
    No statistical analyses for this end point

    Secondary: Hepatic progression-free survival (hPFS)

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    End point title
    Hepatic progression-free survival (hPFS)
    End point description
    Progression-free survival rate (PFS) (based on the investigator) according to RECIST v1.1 according to RECIST v1.1 will be defined as the time from the date of inclusion to the date of hepatic progression or death (due to any cause). For patients who are alive with no hepatic progression, it will be defines as the time from the date of inclusion and the date of the last tumor assessment.
    End point type
    Secondary
    End point timeframe
    until the date of first hepatic progression or death from any cause whichever came first, assessed up to 3 years
    End point values
    ITT
    Number of subjects analysed
    74
    Units: months
        median (confidence interval 95%)
    18.5 (14.0 to 22.8)
    Attachments
    PFS and hPFS
    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 the date of inclusion to the date of death, regardless of the cause of death, or the date of last contact for patients who are alive.
    End point type
    Secondary
    End point timeframe
    Until the end of the follow-up or death (Whatever the cause)
    End point values
    ITT
    Number of subjects analysed
    74
    Units: months
        median (confidence interval 95%)
    51.0 (33.0 to 60.3)
    Attachments
    OS
    No statistical analyses for this end point

    Secondary: Progression-free survival (PFS)

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    End point title
    Progression-free survival (PFS)
    End point description
    Progression-free survival rate was defined as the time from the date of inclusion to the date of disease progression (hepatic or not) evaluated by RECIST V1.1 criteria or death (due to any cause) or the date of the last news for alive patients
    End point type
    Secondary
    End point timeframe
    until the date of first progression (clinical or radiological) or death from any cause whichever came first, assessed up to 3 years
    End point values
    ITT
    Number of subjects analysed
    74
    Units: months
        median (confidence interval 95%)
    16.9 (12.6 to 22.4)
    Attachments
    PFS and hPFS
    No statistical analyses for this end point

    Secondary: Objective response

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    End point title
    Objective response
    End point description
    Objective response (Complete or partial response) evaluated by investigator and RECIST v1.1 criteria
    End point type
    Secondary
    End point timeframe
    during treatment
    End point values
    ITT
    Number of subjects analysed
    74
    Units: patients
        Yes
    40
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were collected every 3 months between 2 consultations until the end of the treatment period.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    NCI-CTC
    Dictionary version
    4.0
    Reporting groups
    Reporting group title
    mITT
    Reporting group description
    All the patients included in the study having at least one (chemo) embolization and taken at least one dose of everolimus.

    Serious adverse events
    mITT
    Total subjects affected by serious adverse events
         subjects affected / exposed
    35 / 67 (52.24%)
         number of deaths (all causes)
    32
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour compression
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Shock
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vena cava thrombosis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Chest pain
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Right ventricular failure
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Loss of consciousness
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Anemia
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Hyperthermia
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Asthenia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences causally related to treatment / all
    2 / 6
         deaths causally related to treatment / all
    0 / 0
    Generalised oedema
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Ascite
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    5 / 67 (7.46%)
         occurrences causally related to treatment / all
    3 / 5
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea exertional
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung disorder
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    7 / 67 (10.45%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Cholangitis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatic cirrhosis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatic failure
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hepatic necrosis
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hepatitis alcoholic
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute prerenal failure
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Chronic kidney disease
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal colic
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Parotitis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Abscess
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    staphylococcal sepsis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Deshydration
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypocalcaemia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypomagnesaemia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatremia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Malnutrition
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    mITT
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    67 / 67 (100.00%)
    Vascular disorders
    Flush
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences all number
    6
    Thromboembolic event
         subjects affected / exposed
    4 / 67 (5.97%)
         occurrences all number
    4
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    59 / 67 (88.06%)
         occurrences all number
    59
    Fever
         subjects affected / exposed
    25 / 67 (37.31%)
         occurrences all number
    25
    Oedema of the limbs
         subjects affected / exposed
    26 / 67 (38.81%)
         occurrences all number
    26
    Immune system disorders
    Allergic reaction
         subjects affected / exposed
    4 / 67 (5.97%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Dyspnea
         subjects affected / exposed
    15 / 67 (22.39%)
         occurrences all number
    15
    Epistaxis
         subjects affected / exposed
    7 / 67 (10.45%)
         occurrences all number
    7
    Pneumonitis
         subjects affected / exposed
    7 / 67 (10.45%)
         occurrences all number
    7
    Cough
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    11
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    4 / 67 (5.97%)
         occurrences all number
    4
    Investigations
    High cholesterol
         subjects affected / exposed
    37 / 67 (55.22%)
         occurrences all number
    37
    Lymphocyte count decreased
         subjects affected / exposed
    9 / 67 (13.43%)
         occurrences all number
    9
    Weight loss
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    8
    Nervous system disorders
    Dysgueusia
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    8
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    61 / 67 (91.04%)
         occurrences all number
    61
    White blood cell count decreased
         subjects affected / exposed
    38 / 67 (56.72%)
         occurrences all number
    38
    Neutrophils decreased
         subjects affected / exposed
    21 / 67 (31.34%)
         occurrences all number
    21
    Thrombocytopenia
         subjects affected / exposed
    21 / 67 (31.34%)
         occurrences all number
    21
    Gastrointestinal disorders
    Diarrhea
         subjects affected / exposed
    47 / 67 (70.15%)
         occurrences all number
    47
    Abdominal pain
         subjects affected / exposed
    27 / 67 (40.30%)
         occurrences all number
    27
    Oral mucositis
         subjects affected / exposed
    32 / 67 (47.76%)
         occurrences all number
    32
    Nausea
         subjects affected / exposed
    25 / 67 (37.31%)
         occurrences all number
    25
    Vomiting
         subjects affected / exposed
    22 / 67 (32.84%)
         occurrences all number
    22
    Hepatobiliary disorders
    Alanine aminotransferase increased
         subjects affected / exposed
    45 / 67 (67.16%)
         occurrences all number
    45
    Aspartate aminotransferase increased
         subjects affected / exposed
    53 / 67 (79.10%)
         occurrences all number
    53
    Bilirubin increased
         subjects affected / exposed
    20 / 67 (29.85%)
         occurrences all number
    20
    Creatinine increased
         subjects affected / exposed
    25 / 67 (37.31%)
         occurrences all number
    25
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    60 / 67 (89.55%)
         occurrences all number
    60
    Hyperuricemia
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    11
    Alkaline phosphatase increased
         subjects affected / exposed
    57 / 67 (85.07%)
         occurrences all number
    57
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    10 / 67 (14.93%)
         occurrences all number
    10
    Maculopapular rash
         subjects affected / exposed
    9 / 67 (13.43%)
         occurrences all number
    9
    Nail loss
         subjects affected / exposed
    4 / 67 (5.97%)
         occurrences all number
    4
    Pruritus
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences all number
    6
    Dry skin
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    8
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences all number
    6
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    8
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    21 / 67 (31.34%)
         occurrences all number
    21
    Hyperglycemia
         subjects affected / exposed
    51 / 67 (76.12%)
         occurrences all number
    51
    Hyperkaliemia
         subjects affected / exposed
    5 / 67 (7.46%)
         occurrences all number
    5
    Hypertriglyceridemia
         subjects affected / exposed
    38 / 67 (56.72%)
         occurrences all number
    38
    Hypoalbuminemia
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    11
    Hypocalcemia
         subjects affected / exposed
    26 / 67 (38.81%)
         occurrences all number
    26
    Hypokaliemia
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    11
    Hypomagnesemia
         subjects affected / exposed
    14 / 67 (20.90%)
         occurrences all number
    14
    Hyponatremia
         subjects affected / exposed
    23 / 67 (34.33%)
         occurrences all number
    23
    Hypophosphatemia
         subjects affected / exposed
    22 / 67 (32.84%)
         occurrences all number
    22

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31678771
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