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    Clinical Trial Results:
    A multicenter phase II study in patients with HER2-negative metastatic breast cancer and persisting HER2-negative circulating tumor cells (CTCs).

    Summary
    EudraCT number
    2013-001269-18
    Trial protocol
    DE  
    Global end of trial date
    03 Apr 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    24 Dec 2025
    First version publication date
    24 Dec 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    D-IVa/D-IVb
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02035813
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Universitätsklinikum Ulm
    Sponsor organisation address
    Albert-Einstein-Allee 29, Ulm, Germany, 89081
    Public contact
    Studienzentrale, Universitätsfrauenklinik Ulm, 0049 73150058520, studienzentrale.ufk@uniklinik-ulm.de
    Scientific contact
    Studienzentrale, Universitätsfrauenklinik Ulm, 0049 73150058520, studienzentrale.ufk@uniklinik-ulm.de
    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
    10 Jan 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    10 Jan 2024
    Global end of trial reached?
    Yes
    Global end of trial date
    03 Apr 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Two independent cohorts: Everolimus/Ribociclib cohort (DIVa) The primary objective is to investigate the clinical efficacy of everolimus/ribociclib (as assessed by the CTC clearance rate) in combination with endocrine therapy in postmenopausal patients with hormone-receptor positive, HER2-negative metastatic breast cancer and persisting HER2-negative circulating tumor cells (CTCs). Eribulin cohort (DIVb) The primary objective is to investigate the clinical efficacy of eribulin (as assessed by progression-free survival, PFS) both in patients with HER2-negative, hormone-receptor positive metastatic breast cancer and indication to chemotherapy and triple-negative metastatic breast cancer both with persisting HER2-negative CTCs.
    Protection of trial subjects
    Adequate drug supply of all IMPs for self-administration at home. IMP prescribed according to approved label with known side effect profil. After treatment period the treatment with everolimus/ribociclib or eribulin can be extended if medically indicated. Adequate safety follow up for toxicity and efficacy. Safety and tolerability were assessed by evaluation of adverse events and serious adverse events (CTCAE) during course of trial and follow up. Trial-related additianl expenses (e.g. visits, blood samples) reduced to a minimum.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Feb 2014
    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
    Germany: 225
    Worldwide total number of subjects
    225
    EEA total number of subjects
    225
    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)
    126
    From 65 to 84 years
    96
    85 years and over
    3

    Subject disposition

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    Recruitment
    Recruitment details
    FPI (date of first enrolment): 12th Feb 2014; LPO: 10th January 2024 in multiple centers in Germany

    Pre-assignment
    Screening details
    Screening-Phase: N= 2000 metastatic breast cancer patients 1st-3rd line with HER2-negative primary tumor; CTC determination (Determination of HER2 status on CTCs); Inclusion criteria: indication for an endocrine therapy (ER+) and/or PgR+) and up to two lines of previous cytostatic treatment for mBC.

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    DETECT-IV a - Everolimus/Ribociclib cohort
    Arm description
    -
    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
    Everolimus prescribed according to approved label. All patients reveive everolimus + standard endocrine therapy and will take everolimus tablets orally per day and will also take standard endocrine therapy once daily

    Investigational medicinal product name
    Ribociclib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Ribociclib dosed for first 21 days out of 28 day cycle orally

    Arm title
    DETECT-IV b Eribulin
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Eribulin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Eribulin doses 1.23 mg/m2 administered intravenously over 2-5 min on day 1, 8 of every 21 cycle.

    Number of subjects in period 1
    DETECT-IV a - Everolimus/Ribociclib cohort DETECT-IV b Eribulin
    Started
    116
    109
    Completed
    116
    109

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    DETECT-IV a - Everolimus/Ribociclib cohort
    Reporting group description
    -

    Reporting group title
    DETECT-IV b Eribulin
    Reporting group description
    -

    Reporting group values
    DETECT-IV a - Everolimus/Ribociclib cohort DETECT-IV b Eribulin Total
    Number of subjects
    116 109 225
    Age categorical
    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)
    58 68 126
        From 65-84 years
    55 41 96
        85 years and over
    3 0 3
    Gender categorical
    Units: Subjects
        Female
    116 109 225
        Male
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    DETECT-IV a - Everolimus/Ribociclib cohort
    Reporting group description
    -

    Reporting group title
    DETECT-IV b Eribulin
    Reporting group description
    -

    Primary: CTC-clearance rate

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    End point title
    CTC-clearance rate [1] [2]
    End point description
    Proportion of patients with at least one CTC detected in 7.5 ml of peripheral blood drawn before treatment that show no evidence of CTCs in the blood after treatment.
    End point type
    Primary
    End point timeframe
    siehe protocol definition - CTC clearance at end of intervention
    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: The study DETECT IV comprised two single (independent) cohorts (IVa and IVb), which are analysed separately and are not compared. The primary objective of the DETECT IV trial is to estimate treatment efficacy in patients. Treatment efficacy will be assessed by the CTC clearance rate for patients recruited in DETECT IVa and by PFS for patients recruited in DETECT IVb.
    [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: The study DETECT IV comprised two single (independent) cohorts (IVa and IVb), which are analysed separately and are not compared. The primary objective of the DETECT IV trial is to estimate treatment efficacy in patients. Treatment efficacy will be assessed by the CTC clearance rate for patients recruited in DETECT IVa and by PFS for patients recruited in DETECT IVb.
    End point values
    DETECT-IV a - Everolimus/Ribociclib cohort
    Number of subjects analysed
    46 [3]
    Units: Number of patients
    21
    Notes
    [3] - Samples from 46 patients were available for this endpoint analysis.
    No statistical analyses for this end point

    Primary: Progression free survival

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    End point title
    Progression free survival [4] [5]
    End point description
    PFS is defined as the time interval between the date of recruitment and the date of PD or death from any cause, whichever comes first.
    End point type
    Primary
    End point timeframe
    defined in protocol
    Notes
    [4] - 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 study DETECT IV comprised two single (independent) cohorts (IVa and IVb), which are analysed separately and are not compared. The primary objective of the DETECT IV trial is to estimate treatment efficacy in patients. Treatment efficacy will be assessed by the CTC clearance rate for patients recruited in DETECT IVa and by PFS for patients recruited in DETECT IVb.
    [5] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: The study DETECT IV comprised two single (independent) cohorts (IVa and IVb), which are analysed separately and are not compared. The primary objective of the DETECT IV trial is to estimate treatment efficacy in patients. Treatment efficacy will be assessed by the CTC clearance rate for patients recruited in DETECT IVa and by PFS for patients recruited in DETECT IVb.
    End point values
    DETECT-IV b Eribulin
    Number of subjects analysed
    109
    Units: month
        median (confidence interval 95%)
    4.6 (3.3 to 6.0)
    No statistical analyses for this end point

    Secondary: Overall survival OS

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    End point title
    Overall survival OS
    End point description
    End point type
    Secondary
    End point timeframe
    according to protocol
    End point values
    DETECT-IV a - Everolimus/Ribociclib cohort DETECT-IV b Eribulin
    Number of subjects analysed
    116
    109
    Units: month
        median (confidence interval 95%)
    24.1 (18.4 to 29.9)
    13.4 (10.7 to 16.1)
    Statistical analysis title
    Overall survival OS
    Statistical analysis description
    Overall survival (OS), defined as the time interval from start of treatment until death due to any cause. If a patient is not known to have died, survival is censored at the date of last contact
    Comparison groups
    DETECT-IV b Eribulin v DETECT-IV a - Everolimus/Ribociclib cohort
    Number of subjects included in analysis
    225
    Analysis specification
    Pre-specified
    Analysis type
    other [6]
    Method
    Parameter type
    Median OS
    Point estimate
    13.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    10.7
         upper limit
    16.1
    Notes
    [6] - Secondary objective, no comparison (single cohort), descriptive statistics only

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Safety and tolerability were assessed by evaluation of adverse event (AE) and serious adverse event (SAE) reports using the international Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. The safety population comprised all randomize
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    7
    Reporting groups
    Reporting group title
    D-IVa
    Reporting group description
    -

    Reporting group title
    D-IV b
    Reporting group description
    -

    Serious adverse events
    D-IVa D-IV b
    Total subjects affected by serious adverse events
         subjects affected / exposed
    66 / 108 (61.11%)
    71 / 108 (65.74%)
         number of deaths (all causes)
    74
    89
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Metastases to bone
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metastases to central nervous system
         subjects affected / exposed
    2 / 108 (1.85%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasm progression
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    Metastase to liver
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Malignant neoplasm progression
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Metastases to meninges
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Vascular disorders
    Embolism
         subjects affected / exposed
    0 / 108 (0.00%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Mucosal inflammation
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    2 / 108 (1.85%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    3 / 108 (2.78%)
    5 / 108 (4.63%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    Death
         subjects affected / exposed
    0 / 108 (0.00%)
    5 / 108 (4.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 5
    Pain
         subjects affected / exposed
    0 / 108 (0.00%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Immune system disorders
    Allergy to arthropod sting
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Adnexa uteri cyst
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast inflammation
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    5 / 108 (4.63%)
    5 / 108 (4.63%)
         occurrences causally related to treatment / all
    2 / 5
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Haemoptysis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Pleural effusion
         subjects affected / exposed
    2 / 108 (1.85%)
    5 / 108 (4.63%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Pneumonitis
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Investigations
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Endoscopic retrograde cholangiopancreatography
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic enzyme increased
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Lumbar vertebral fracture
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Femoral neck fracture
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subdural haemorrhage
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
    Additional description: Stroke
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Nervous system disorder
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Intracranial mass
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dizziness
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Seizure
         subjects affected / exposed
    0 / 108 (0.00%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervus system disorder
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    1 / 108 (0.93%)
    4 / 108 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
    4 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Diplopia
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dysphagia
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    2 / 108 (1.85%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oesophagitis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    2 / 108 (1.85%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain upper*
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal pain
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhoids
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Melaena
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oesophageal obstruction
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Faecalith
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic failure
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Renal and urinary disorders
    Akute kidney injury
         subjects affected / exposed
    3 / 108 (2.78%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Prerenal failure
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract obstruction
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Bone pain
         subjects affected / exposed
    2 / 108 (1.85%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    2 / 108 (1.85%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 108 (0.93%)
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 2
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Device related infection
    Additional description: port infection
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 108 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Helicobacter gastritis
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumocystis jirovecii pneumonia
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Meningoencephalitis viral (Epstein-Barr virus associated)
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyponatraemia
         subjects affected / exposed
    1 / 108 (0.93%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Electrolyte imbalance
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    D-IVa D-IV b
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    105 / 108 (97.22%)
    106 / 108 (98.15%)
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    18 / 108 (16.67%)
    32 / 108 (29.63%)
         occurrences all number
    37
    112
    White blood cell decreased
         subjects affected / exposed
    26 / 108 (24.07%)
    25 / 108 (23.15%)
         occurrences all number
    58
    55
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    28 / 108 (25.93%)
    28 / 108 (25.93%)
         occurrences all number
    43
    89
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    27 / 108 (25.00%)
    59 / 108 (54.63%)
         occurrences all number
    35
    82
    Gastrointestinal disorders
    Mucositis oral
         subjects affected / exposed
    45 / 108 (41.67%)
    18 / 108 (16.67%)
         occurrences all number
    77
    23

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Feb 2015
    Version 2.0 vom 31.03.2014 Aufnahme von Eribulin
    25 Jul 2016
    Version 3.0 vom 15.02.2016 "Amendment 2: 1. Neuer primärer Endpunkt: CTC Clearance-Rate 2. Erhöhung der Vergütung (Everolimus Arm) 3. Mögliche Startdosis für Everolimus mit 5mg / Tag"
    10 Aug 2018
    Version 4.1 vom 18.12.2017 (nicht ausgehändigt, zusammen mit Amendment 4) "Amendment 3: 1. Aufnahme des CDK4/6 Inhibitors Ribociclib 2. Fulvestrant als mögliche endokrine Therapieoption"
    10 Aug 2018
    Version 5.0 vom 12.03.2018 "Amendment 4: Streichung von Tamoxifen in Kombination mit Ribociclib"

    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
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