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    Clinical Trial Results:
    A single arm, multicenter, phase II study of BEZ235 as monotherapy in patients with locally advanced or metastatic Transitional Cell Carcinoma (TCC) after failure of platinum based chemotherapy.

    Summary
    EudraCT number
    2012-004123-20
    Trial protocol
    BE  
    Global end of trial date
    16 Jun 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Mar 2021
    First version publication date
    13 Mar 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    UCL-ONCO2012-01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01856101
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    CBEZ235ZBE01T: UCL-ONCO2012-01
    Sponsors
    Sponsor organisation name
    Cliniques universitaires Saint-Luc- Université Catholique de Louvain
    Sponsor organisation address
    Avenue Hippocrate 10, Brussels, Belgium, 1200
    Public contact
    Jean-Pascal Machiels, Centre du Cancer, Cliniques universitaires Saint-Luc, 0032 27645457, jean-pascal.machiels@uclouvain.be
    Scientific contact
    Jean-Pascal Machiels, Centre du Cancer, Cliniques universitaires Saint-Luc, 0032 27645457, jean-pascal.machiels@uclouvain.be
    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
    16 Jun 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    16 Jun 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess, in a multicentre phase II trial, the safety and efficacy of BEZ235, an oral pan-class I phosphoinositol-3- kinase (PI3K) and mammalian target of rapamycin (mTOR) complex1/2 inhibitor, in locally advanced or metastatic transitional cell carcinoma (TCC) after failure of platinumbased therapy.
    Protection of trial subjects
    All observed or volunteered adverse events regardless of treatment group or suspected causal relationship to the investigational product(s) were reported. For all adverse events, the investigator must pursue and obtain information adequate both to determine the outcome of the adverse event and to assess whether it meets the criteria for classification as a serious adverse event requiring immediate notification to the study coordinator or its designated representative. For all adverse events, sufficient information should be obtained by the investigator to determine the causality of the adverse event. The investigator is required to assess causality.
    Background therapy
    BEZ235 was administered orally and continuously at a starting dose of 300 mg twice daily. Although it was not a dose‐escalation study, at day 15, based on a clinical evaluation of adverse events, the dose was adjusted for the rest of study.
    Evidence for comparator
    Not applicable
    Actual start date of recruitment
    15 Nov 2012
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    2 Years
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Luxembourg: 2
    Country: Number of subjects enrolled
    Belgium: 18
    Worldwide total number of subjects
    20
    EEA total number of subjects
    20
    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)
    9
    From 65 to 84 years
    11
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Between March 2013 and October 2013, 20 patients from 10 centers including 9 in Belgium and 1 in Luxembourg were included. All patients had locally advanced or metastatic TBI and were previously exposed to platinum-based chemotherapy in the (neo) adjuvant and / or metastatic setting. Out of the 20 patients, only two exhibited PI3K/Akt/mTORpathway.

    Pre-assignment
    Screening details
    Initially, patients were stratified into two groups according to activation of the PI3K / Akt / mTOR pathway (loss of PTEN expression and / or PIK3CA activation vs no loss of PTEN expression and no PIK3CA activation). After Novartis' decision to stop the development of BEZ235, the study design was reviewed and the two groups were merged.

    Period 1
    Period 1 title
    BEZ235 (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    BEZ235
    Arm description
    BEZ235 was administered orally and continuously at a starting dose of 300 mg twice daily. Although it was not a dose‐escalation study, at day 15, based on a clinical evaluation of adverse events, the dose was adjusted for the rest of study.
    Arm type
    Experimental

    Investigational medicinal product name
    BEZ235
    Investigational medicinal product code
    BEZ235
    Other name
    Pharmaceutical forms
    Powder for oral solution in sachet
    Routes of administration
    Oral use
    Dosage and administration details
    BEZ235, supplied in sachets of 200 mg, 300 mg and 400 mg. The starting dose is 300 mg PO bid. It is administered orally on the same day on a continuous basis twice a day and should be taken immediately after a meal (e.g. breakfast / dinner), 12 ± 2 hours apart (dinner in the evening), at about the same time every day, except cycle 1, day 1. The full cycle is 28 days. Patients were treated until progression or until criteria for discontinuation were met.

    Number of subjects in period 1
    BEZ235
    Started
    20
    Completed
    11
    Not completed
    9
         Consent withdrawn by subject
    1
         Adverse event, non-fatal
    6
         rapid clinical deterioration
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    BEZ235
    Reporting group description
    BEZ235 was administered orally and continuously at a starting dose of 300 mg twice daily. Although it was not a dose‐escalation study, at day 15, based on a clinical evaluation of adverse events, the dose was adjusted for the rest of study.

    Reporting group values
    BEZ235 Total
    Number of subjects
    20 20
    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)
    9 9
        From 65-84 years
    11 11
        85 years and over
    0 0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    66.5 (41 to 78) -
    Gender categorical
    Units: Subjects
        Female
    3 3
        Male
    17 17

    End points

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    End points reporting groups
    Reporting group title
    BEZ235
    Reporting group description
    BEZ235 was administered orally and continuously at a starting dose of 300 mg twice daily. Although it was not a dose‐escalation study, at day 15, based on a clinical evaluation of adverse events, the dose was adjusted for the rest of study.

    Primary: Determine the efficacy of BEZ235 in patients with palliative TCC in term of progression free survival rate (PFSR) at 16 weeks in one group of patients with PI3K/Akt/mTOR pathway deregulations and in one group of patients without PI3K/Akt/mTOR pathway dere

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    End point title
    Determine the efficacy of BEZ235 in patients with palliative TCC in term of progression free survival rate (PFSR) at 16 weeks in one group of patients with PI3K/Akt/mTOR pathway deregulations and in one group of patients without PI3K/Akt/mTOR pathway dere [1]
    End point description
    The PFS rate was defined as the proportion of patients alive and progression-free at 16 weeks. Patients who did not progress were considered as having stable disease, a partial response or a complete response at 16 weeks, according to RECIST 1.1. Patients who were unable to be evaluated at 16 weeks, because of rapid clinical deterioration or death from any cause, or the start of an additional anti-tumour therapy, were considered as having progressive disease.
    End point type
    Primary
    End point timeframe
    16 weeks
    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 formal statistical tests were performed on the primary and secondary endpoints. Efficacy analyses were reported overall. The reported results are mainly descriptive (median and range for continuous variables, frequencies and percentages for categorical variables).
    End point values
    BEZ235
    Number of subjects analysed
    20
    Units: Percentage
    10
    No statistical analyses for this end point

    Primary: Progression-free survival rate at 8 weeks.

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    End point title
    Progression-free survival rate at 8 weeks. [2]
    End point description
    The definition used for PFS was the time interval between the date of inclusion and the date of progressive disease or death from any cause.
    End point type
    Primary
    End point timeframe
    8 weeks
    Notes
    [2] - 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: The reported results are mainly descriptive.
    End point values
    BEZ235
    Number of subjects analysed
    20
    Units: Percentage
    15
    No statistical analyses for this end point

    Secondary: Progression free survival

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    End point title
    Progression free survival
    End point description
    End point type
    Secondary
    End point timeframe
    Progression free survival (PFS) will be measured from the date of registration to the date of progression or death, whatever the cause. Patients who are still alive and without progression at the time of the analyse will be censored at the date of last fo
    End point values
    BEZ235
    Number of subjects analysed
    20
    Units: days
        median (confidence interval 95%)
    62 (38 to 588)
    No statistical analyses for this end point

    Secondary: overall survival

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    End point title
    overall survival
    End point description
    End point type
    Secondary
    End point timeframe
    Overall survival (OS) is defined as the time from the date of registration to the date of death from any cause.
    End point values
    BEZ235
    Number of subjects analysed
    20
    Units: days
        median (inter-quartile range (Q1-Q3))
    127 (41 to 734)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All patients will have a follow-up visit scheduled 28 days after the last dose of the study drug to follow for AEs and SAEs that may have occurred after discontinuation from the study.
    Adverse event reporting additional description
    For adverse events with a causal relationship to the investigational product, follow-up by the investigator is required until the event or its sequelae resolve or stabilize at a level acceptable to the investigator, and the study coordinator concurs with that assessment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE GRADE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    BEZ235
    Reporting group description
    BEZ235 was administered orally and continuously at a starting dose of 300 mg twice daily.

    Serious adverse events
    BEZ235
    Total subjects affected by serious adverse events
         subjects affected / exposed
    10 / 20 (50.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhea
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Hepatotoxicity
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Cutaneous disorder
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Stomatitis
         subjects affected / exposed
    3 / 20 (15.00%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    BEZ235
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    18 / 20 (90.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    8 / 20 (40.00%)
         occurrences all number
    1
    Fever
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Malaise
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Weight loss
         subjects affected / exposed
    4 / 20 (20.00%)
         occurrences all number
    1
    Dry mouth
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    6 / 20 (30.00%)
         occurrences all number
    1
    Vomiting
         subjects affected / exposed
    4 / 20 (20.00%)
         occurrences all number
    1
    Pyrosis/gastritis
         subjects affected / exposed
    3 / 20 (15.00%)
         occurrences all number
    1
    Constipation
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Rash/pruritus
         subjects affected / exposed
    7 / 20 (35.00%)
         occurrences all number
    1
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Psychiatric disorders
    Confusion
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Anorexia
         subjects affected / exposed
    6 / 20 (30.00%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jan 2013
    amend 1
    20 Oct 2013
    amend 2

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    20 Oct 2013
    This study was, however, closed prematurely because BEZ235 was withdrawn from further development.
    -

    Limitations and caveats

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