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    Clinical Trial Results:
    A controlled, randomized, assessor blinded, open-label study to investigate whether initiation of everolimus will reduce the incidence of developing a new Squamous Cell Carcinoma (SCC) and other malignancies in Renal Transplanted Recipients with at least one SCC during the last 2 years

    Summary
    EudraCT number
    2012-005481-35
    Trial protocol
    DK  
    Global end of trial date
    21 Apr 2015

    Results information
    Results version number
    v2(current)
    This version publication date
    28 Jun 2017
    First version publication date
    10 Sep 2016
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    ..

    Trial information

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    Trial identification
    Sponsor protocol code
    2012-005481-35
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Uppsala University Hospital
    Sponsor organisation address
    Sjukhusvägen, Uppsala, Sweden, 75185
    Public contact
    Andre Western, Smerud Medical Research Norway AS, 0047 90526246, andre.western@smerud.com
    Scientific contact
    Andre Western, Smerud Medical Research Norway AS, 0047 90526246, andre.western@smerud.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
    01 Aug 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    21 Apr 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    21 Apr 2015
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective is to investigate whether initiation of everolimus and discontinuation/ minimization of calcineurin inhibitors (CNI) in maintenance renal transplant patients with at least one earlier diagnosed SCC incident within the last two years prior to inclusion, will reduce the risk of new SCC incidents (per definition, SCC includes SCC in situ (Mb Bowen) and keratoacanthoma (KA) like SCC).
    Protection of trial subjects
    Subjects were fully informed of all pertinent aspects of the clinical trial as well as the possibility to withdraw at any time. Patients were treated in the clinic with stadard care for this population.
    Background therapy
    No treatments that were not test or comparator products were used across the two arms in the trial.
    Evidence for comparator
    Patients in the control arm continued their standard immunosuppressive regimen, i.e CNI, +/- MPA, +/- steriods, +/- AZA.
    Actual start date of recruitment
    04 Jun 2013
    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
    Sweden: 11
    Country: Number of subjects enrolled
    Denmark: 9
    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)
    5
    From 65 to 84 years
    15
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    All subjects who signed the ICF and entered the formal screening process were assigned a unique patient number automatically via the eCRF system. On Day 1 (preferably both screening and randomization day) the patients were randomized, in a 1:1 ratio, to one of the treatment groups according to a randomization list generated by the statistician.

    Pre-assignment
    Screening details
    Male or female kidney transplant recipients aged 18 years or older. Patient transplanted at least 12 months prior to enrolment. Patient had experienced at least one SCC within the last 2 years. Patients receiving a standard immunosuppressive treatment with CNI, +/- MPA, +/ steroids and/or +/- AZA

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    The pathologist assessing the biopsy will be blinded to treatment arm.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Control
    Arm description
    Standard immunosuppressive regimen with CNI
    Arm type
    Active comparator

    Investigational medicinal product name
    Tacrolimus/cyclosporine
    Investigational medicinal product code
    L04AD
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Per patient standard dose of Tacrolimus given QD per patient standard, or cyclosporin given BID

    Arm title
    Everolimus
    Arm description
    Patients randomized to the everolimus arm received study drug twice a day corresponding to a blood trough level of 6-10 ng/mL. The CNI was down-titrated and finally stopped on Day 28.
    Arm type
    Experimental

    Investigational medicinal product name
    Everolimus
    Investigational medicinal product code
    L04AA
    Other name
    Certican
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Up-titration to reach a blood trough level of 6-10 ng/mL at Day 28

    Number of subjects in period 1
    Control Everolimus
    Started
    6
    14
    Completed
    0
    0
    Not completed
    6
    14
         Sponsor stopped study
    6
    14

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Control
    Reporting group description
    Standard immunosuppressive regimen with CNI

    Reporting group title
    Everolimus
    Reporting group description
    Patients randomized to the everolimus arm received study drug twice a day corresponding to a blood trough level of 6-10 ng/mL. The CNI was down-titrated and finally stopped on Day 28.

    Reporting group values
    Control Everolimus Total
    Number of subjects
    6 14 20
    Age categorical
    Of the 20 randomized subjects, 8 subjects were randomized to the control arm and 12 to the everolimus arm. However, two subject in the control arm were given everolimus due to a misunderstanding in the randomization process. These two subjects are included in the everolimus arm in the report, hence there are 6 subjects in the countrol arm and 14 in the everolimus arm.
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    0 5 5
        From 65-84 years
    6 9 15
        85 years and over
    0 0 0
    Gender categorical
    Female
    Units: Subjects
        Female
    1 5 6
        Male
    5 9 14

    End points

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    End points reporting groups
    Reporting group title
    Control
    Reporting group description
    Standard immunosuppressive regimen with CNI

    Reporting group title
    Everolimus
    Reporting group description
    Patients randomized to the everolimus arm received study drug twice a day corresponding to a blood trough level of 6-10 ng/mL. The CNI was down-titrated and finally stopped on Day 28.

    Primary: Proportion of patients who develop one new SCC while in the trial

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    End point title
    Proportion of patients who develop one new SCC while in the trial
    End point description
    End point type
    Primary
    End point timeframe
    Baseline, Month 24.
    End point values
    Control Everolimus
    Number of subjects analysed
    6
    14
    Units: Number of new SCC
    2
    3
    Statistical analysis title
    Not done
    Statistical analysis description
    NA
    Comparison groups
    Control v Everolimus
    Number of subjects included in analysis
    20
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    ≤ 0.05 [2]
    Method
    Fisher exact
    Confidence interval
    Notes
    [1] - Analysis not performed because the study was stopped prematurely.
    [2] - Analysis not performed because the study was stopped prematurely.

    Secondary: Days to first SCC per group since last SCC

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    End point title
    Days to first SCC per group since last SCC
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline, Month 24
    End point values
    Control Everolimus
    Number of subjects analysed
    6
    14
    Units: Days to first SCC
    71
    177
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline, Month 24
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.0
    Reporting groups
    Reporting group title
    Control
    Reporting group description
    -

    Reporting group title
    Everolimus
    Reporting group description
    -

    Serious adverse events
    Control Everolimus
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 6 (16.67%)
    5 / 14 (35.71%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Gastrointestinal disorders
    Ileus
    Additional description: DOB: 1936, Male, Control Group (cyclosporine). Randomized on 12Nov2014. Hospitalized on 08Nov2014 due to abdominal pain, while in the screening period. CT abdomen was performed which verified ILEUS.
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 14 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
    Additional description: DOB: 1949, Female, Everolimus Group. First dose of study drug given 08Oct2014. The patient experience diarrhea and was hospitalized on 18Dec2014 due to dehydration. SUSPECTED relationship to study medication.
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumonitis
    Additional description: DOB: 1939, Female, DOB: 1939 Male: Everolimus Group. Both treated in the out-patient clinic for suspected pneumonia. HRCT showed bilateral infiltrates, and diagnosed with PNEUMONITIS. Both SUSPECTED relationship to study drug.
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Urinary retention
    Additional description: DOB: 1938, Male, Everolimus Group. First dose of study drug given 01Dec2014. The patient had Benign prostatic hyperplasia (BPH) since 2012. Hospitalized (start 03Mar2015) and an ultrasound showed residual urine > 300 mL after insertion of a KAD.
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Endocrine disorders
    Hyperparathyroidism tertiary
    Additional description: DOB: 1939, Female, Everolimus Group. Last dose of study drug was given on 27May2014 and tacrolimus re-started. The patient was hospitalized late October 2014 with the diagnosis Tertiary hyperparathyroidism.
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Gastroenteritis novovirus
    Additional description: DOB: 1941, Male. Everolimus Group. This event was stated as due to an epidemic and diagnosed as a Novovirus infection, judged as not related to study medication.
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cytomegalovirus colitis
    Additional description: DOB: 1949, Female, Everolimus Group. First dose of study drug given 08Oct2014. Colon biopsy, taken 13Jan2015, verified Cytomegalovirus colitis. Hospitalized on 24Feb2015 starting treatment with Cymevene. SUSPECTED relationship to everolimus.
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Control Everolimus
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 6 (66.67%)
    14 / 14 (100.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Fatigue
         subjects affected / exposed
    1 / 6 (16.67%)
    2 / 14 (14.29%)
         occurrences all number
    1
    2
    Feeling cold
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Malaise
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Oedema
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 14 (0.00%)
         occurrences all number
    1
    0
    Psychiatric disorders
    Restlessness
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Investigations
    Blood cholesterol increased
         subjects affected / exposed
    0 / 6 (0.00%)
    3 / 14 (21.43%)
         occurrences all number
    0
    4
    Blood creatine phosphokinase MB increased
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Blood creatine phosphokinase increased
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Blood glucose increased
         subjects affected / exposed
    0 / 6 (0.00%)
    3 / 14 (21.43%)
         occurrences all number
    0
    3
    Haemoglobin increased
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Hepatic enzyme increased
         subjects affected / exposed
    1 / 6 (16.67%)
    2 / 14 (14.29%)
         occurrences all number
    1
    2
    Nervous system disorders
    Paraesthesia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Lymphadenopathy
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Oral mucosal blistering
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences all number
    0
    2
    Skin and subcutaneous tissue disorders
    Dry skin
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences all number
    0
    2
    Pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences all number
    0
    2
    Skin fissures
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Urticaria
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Renal and urinary disorders
    Albuminuria
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences all number
    0
    2
    Haematuria
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Proteinuria
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 14 (14.29%)
         occurrences all number
    0
    2
    Back pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Myalgia
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 14 (7.14%)
         occurrences all number
    1
    1
    Infections and infestations
    Localised infection
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    2
    Oral fungal infection
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    2
    Oral infection
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Pneumonia
         subjects affected / exposed
    0 / 6 (0.00%)
    5 / 14 (35.71%)
         occurrences all number
    0
    6
    Skin infection
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 14 (0.00%)
         occurrences all number
    1
    0
    Urinary tract infection
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 14 (7.14%)
         occurrences all number
    1
    1
    Viral infection
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Gout
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    3
    Hypercholesterolaemia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Hypertriglyceridaemia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1
    Increased insulin requirement
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 14 (7.14%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    09 Oct 2013
    The rational for the amendment was comments from the Swedish Medicinal Products Agency in connection with their 30-day response. Changes were mainly tighter inclusion/exclusion criteria. Also measurements of AST/ALT were added in order to evaluate liver function, and urine glucose was to detect possible side effects of Certican.
    26 May 2014
    The amendment was made because the study changed sponsor from Oslo University Hospital, Norway, to Uppsala University Hospital, Sweden.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    21 Apr 2015
    After 1.5 years of patient recruitment the scientific steering committee of the study evaluated the study and drew the conclusion that the study had to be terminated prematurely. This was based solely on futility, i.e. the committee could not see it possible to recruit sufficient number of patients in order to reach the goal of the study within a reasonable time frame. Further, an evaluation of involvement of other countries was done, but it was considered not possible to obtain the same local financial support as achieved in Scandinavia, and therefore, such an alternative was rejected. The discussion within the steering committee furthermore clarified that the reasons for futility was different among countries and regions. In Norway, a huge proportion of patients had already been converted to everolimus, whereas this situation was different in Denmark and Sweden. On the other hand, several patients in Denmark had actually declined participation, simply as they (presumably were pleased with their current medication and) did not wish to risk being converted. Due to the decision of prematurely terminate the study, all patients were taken in for a final study visit.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    The study was stopped after inclusion of 20 patients due to futility. This means that the planned statistical analysis could not be performed as planned. Data are presented as listings only.
    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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