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    Clinical Trial Results:
    A randomized, open-label, parallel-group, multi-center Phase II clinical trial evaluating effect of addition of DCVAC/OvCa to standard chemotherapy in women with relapsed platinum resistant epithelial ovarian carcinoma

    Summary
    EudraCT number
    2013-001325-24
    Trial protocol
    CZ   DE   PL  
    Global end of trial date
    02 Aug 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    17 Aug 2017
    First version publication date
    17 Aug 2017
    Other versions
    Summary report(s)
    Public Disclosure Summary_SOV03_Version 1.0_26-Jul-2017

    Trial information

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    Trial identification
    Sponsor protocol code
    SOV03
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02107378
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    SOTIO a.s.
    Sponsor organisation address
    Jankovcova 1518/2, Prague, Czech Republic, 170 00
    Public contact
    Clinical Trial Sotio, SOTIO a.s., +420 224175111, clinicaltrial@sotio.com
    Scientific contact
    Clinical Trial Sotio, SOTIO a.s., +420 224175111, clinicaltrial@sotio.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
    02 Aug 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    02 Aug 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Aug 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To explore the effect of adding DCVAC/OvCa to standard of care chemotherapy on overall survival in women with ovarian cancer who experienced relapse ≤6 months after achieving complete remission following standard first line (platinum-based) chemotherapy or did not reach complete remission
    Protection of trial subjects
    Not applicable
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Jan 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 8
    Country: Number of subjects enrolled
    Czech Republic: 16
    Country: Number of subjects enrolled
    Germany: 1
    Worldwide total number of subjects
    25
    EEA total number of subjects
    25
    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)
    20
    From 65 to 84 years
    5
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Screened: 33; Randomized: 25; Analyzed for efficacy: 21; Analyzed for safety: 22

    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
    Not applicable

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Treatment group A
    Arm description
    DCVAC/OvCa in parallel with standard of care chemotherapy (paclitaxel 80 mg/m2 intravenously [i.v.] on days 1, 8, 15, 22 of each 4-week cycle; or topotecan 4 mg/m2 i.v. on days 1, 8, 15 of each 4-week cycle; or liposomal doxorubicin 40 mg/m2 i.v. every 4 weeks)
    Arm type
    Experimental

    Investigational medicinal product name
    DCVAC/OvCa
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Dispersion for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subcutaneous injection of approximately 1×10e7 autologous dendritic cells

    Arm title
    Treatment group B
    Arm description
    Standard of care chemotherapy only (paclitaxel 80 mg/m2 intravenously [i.v.] on days 1, 8, 15, 22 of each 4-week cycle; or topotecan 4 mg/m2 i.v. on days 1, 8, 15 of each 4-week cycle; or liposomal doxorubicin 40 mg/m2 i.v. every 4 weeks)
    Arm type
    Control

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Treatment group A Treatment group B
    Started
    13
    12
    Completed
    2
    3
    Not completed
    11
    9
         Adverse event, serious fatal
    3
    2
         Physician decision
    1
    2
         Patient’s decision
    1
    3
         Disease progression
    3
    2
         DCVAC/OvCa manufacturing failure
    2
    -
         Protocol deviation
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    25 25
    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)
    20 20
        From 65-84 years
    5 5
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    25 25
        Male
    0 0
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All randomized patients regardless of whether they received treatment or not; patients randomized to treatment group A and who failed to receive at least 1 dose of DCVAC/OvCa were planned in the Protocol to be replaced and excluded from the ITT population. However, the sponsor decided to terminate the enrollment into this trial prematurely due to slow recruitment, and no patient was replaced.

    Subject analysis set title
    PP
    Subject analysis set type
    Per protocol
    Subject analysis set description
    All randomized patients who received at least 3 cycles of standard of care chemotherapy and, for treatment group A, 8 doses of DCVAC/OvCa, did not violate any inclusion criteria, and did not have any major protocol violation. Before database lock, all protocol deviations were reviewed, and for each patient it was determined whether she belonged to the PP population or not. However, this population was not used in any analysis due to the low number of patients.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All patients who received at least 1 dose of standard of care chemotherapy or DCVAC/OvCa.

    Subject analysis sets values
    ITT PP Safety
    Number of subjects
    21
    7
    22
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    18
        From 65-84 years
    3
        85 years and over
    0
    Age continuous
    Units:
        
    ( )
    ( )
    ( )
    Gender categorical
    Units: Subjects
        Female
        Male

    End points

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    End points reporting groups
    Reporting group title
    Treatment group A
    Reporting group description
    DCVAC/OvCa in parallel with standard of care chemotherapy (paclitaxel 80 mg/m2 intravenously [i.v.] on days 1, 8, 15, 22 of each 4-week cycle; or topotecan 4 mg/m2 i.v. on days 1, 8, 15 of each 4-week cycle; or liposomal doxorubicin 40 mg/m2 i.v. every 4 weeks)

    Reporting group title
    Treatment group B
    Reporting group description
    Standard of care chemotherapy only (paclitaxel 80 mg/m2 intravenously [i.v.] on days 1, 8, 15, 22 of each 4-week cycle; or topotecan 4 mg/m2 i.v. on days 1, 8, 15 of each 4-week cycle; or liposomal doxorubicin 40 mg/m2 i.v. every 4 weeks)

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All randomized patients regardless of whether they received treatment or not; patients randomized to treatment group A and who failed to receive at least 1 dose of DCVAC/OvCa were planned in the Protocol to be replaced and excluded from the ITT population. However, the sponsor decided to terminate the enrollment into this trial prematurely due to slow recruitment, and no patient was replaced.

    Subject analysis set title
    PP
    Subject analysis set type
    Per protocol
    Subject analysis set description
    All randomized patients who received at least 3 cycles of standard of care chemotherapy and, for treatment group A, 8 doses of DCVAC/OvCa, did not violate any inclusion criteria, and did not have any major protocol violation. Before database lock, all protocol deviations were reviewed, and for each patient it was determined whether she belonged to the PP population or not. However, this population was not used in any analysis due to the low number of patients.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All patients who received at least 1 dose of standard of care chemotherapy or DCVAC/OvCa.

    Primary: Overall survival

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    End point title
    Overall survival
    End point description
    Defined as the time from randomization until death due to any cause, ITT population
    End point type
    Primary
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: days
        median (inter-quartile range (Q1-Q3))
    206 (180 to 1000000)
    1000000 (100 to 1000000)
    Statistical analysis title
    Primary analysis
    Statistical analysis description
    1000000 means "not reached"
    Comparison groups
    Treatment group A v Treatment group B
    Number of subjects included in analysis
    21
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.7208
    Method
    Logrank
    Confidence interval

    Secondary: Progression-free survival

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    End point title
    Progression-free survival
    End point description
    Measured by modifications to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1; defined as the time from randomization to tumor progression or death from any cause, ITT population
    End point type
    Secondary
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: days
        median (inter-quartile range (Q1-Q3))
    52 (50 to 162)
    100 (54 to 489)
    Statistical analysis title
    Secondary analysis
    Comparison groups
    Treatment group A v Treatment group B
    Number of subjects included in analysis
    21
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.225
    Method
    Logrank
    Confidence interval

    Secondary: Objective response rate

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    End point title
    Objective response rate
    End point description
    Complete response and partial response, ITT population
    End point type
    Secondary
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: Not applicable
        number (confidence interval 95%)
    0 (0 to 0.336)
    0.167 (0.021 to 0.484)
    No statistical analyses for this end point

    Secondary: Biological progression-free interval

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    End point title
    Biological progression-free interval
    End point description
    Defined by increasing CA 125 levels according to Gynecologic Cancer Intergroup, ITT population
    End point type
    Secondary
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: Days
        median (inter-quartile range (Q1-Q3))
    52 (50 to 162)
    100 (54 to 489)
    Statistical analysis title
    Secondary analysis
    Comparison groups
    Treatment group A v Treatment group B
    Number of subjects included in analysis
    21
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.1278
    Method
    Logrank
    Confidence interval

    Secondary: Immunological response

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    End point title
    Immunological response
    End point description
    Immunological response was not analyzed as a significant proportion of patients did not return for a sufficient number of visits.
    End point type
    Secondary
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: Not applicable
        number (not applicable)
    0
    0
    No statistical analyses for this end point

    Other pre-specified: Evaluation of quality of life using the standardized Functional Assessment of Cancer Therapy–Ovarian questionnaire

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    End point title
    Evaluation of quality of life using the standardized Functional Assessment of Cancer Therapy–Ovarian questionnaire
    End point description
    Functional Assessment of Cancer Therapy–Ovarian questionnaire scores showed that the treatment groups were similar in relation to quality of life.
    End point type
    Other pre-specified
    End point timeframe
    Until the end of the study
    End point values
    Treatment group A Treatment group B
    Number of subjects analysed
    9
    12
    Units: Not applicable
        number (not applicable)
    1
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the study treatment start date/time to 30 days after the last dose of study treatment (DCVAC/OvCa or standard of care chemotherapy)
    Adverse event reporting additional description
    Adverse events were reported until 30 days after the last administration of DCVAC/OvCa (treatment group A) and until 30 days after the last dose of standard of care chemotherapy (treatment group B). Therefore, the reporting period differed significantly between the treatment groups (median duration 162 days in group A and 88.5 days in group B).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    Treatment group A
    Reporting group description
    -

    Reporting group title
    Treatment group B
    Reporting group description
    -

    Serious adverse events
    Treatment group A Treatment group B
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 12 (66.67%)
    3 / 10 (30.00%)
         number of deaths (all causes)
    6
    4
         number of deaths resulting from adverse events
    0
    0
    General disorders and administration site conditions
    Impaired healing
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    Ascites
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Treatment group A Treatment group B
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    10 / 12 (83.33%)
    9 / 10 (90.00%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Neuropathy peripheral
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    General physical health deterioration
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    Asthenia
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    5 / 12 (41.67%)
    2 / 10 (20.00%)
         occurrences all number
    5
    2
    Anaemia
         subjects affected / exposed
    5 / 12 (41.67%)
    1 / 10 (10.00%)
         occurrences all number
    5
    1
    Neutropenia
         subjects affected / exposed
    5 / 12 (41.67%)
    1 / 10 (10.00%)
         occurrences all number
    5
    1
    Thrombocytopenia
         subjects affected / exposed
    5 / 12 (41.67%)
    0 / 10 (0.00%)
         occurrences all number
    5
    0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    3 / 12 (25.00%)
    2 / 10 (20.00%)
         occurrences all number
    3
    2
    Diarrhoea
         subjects affected / exposed
    3 / 12 (25.00%)
    2 / 10 (20.00%)
         occurrences all number
    3
    2
    Ascites
         subjects affected / exposed
    3 / 12 (25.00%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    Intestinal obstruction
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    Ileus
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Nausea
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Subileus
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Vomiting
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 12 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    2
    Infections and infestations
    Cystitis
         subjects affected / exposed
    0 / 12 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    2
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    3 / 12 (25.00%)
    1 / 10 (10.00%)
         occurrences all number
    3
    1
    Hyperuricaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Hypokalaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Aug 2013
    Specification of application sites (inguinal and axillary areas) for DCVAC/OvCa; specification of standard of care toxicity management based on institutional standards or applicable oncology guidelines; specification of pre treatment assessment of infection markers, if required by local/national regulations; correction of scheduling of the leukapheresis procedure and prolongation of the time frame for the transport of the cells harvested during the leukapheresis procedure to the processing facility; specification of time points of the follow up clinic visits and CA125 assessments.
    21 Nov 2013
    Specification of methods of contraception (exclusion criterion 13); added the justification of the applied DCVAC/OvCa dose; added the definition of slow progressive disease; added information about continuation of DCVAC/OvCa administration after disease progression; specification that not only the medications must be recorded, but the doses taken/administered as well; added information regarding the use of historical heart and lung X ray scans obtained prior to study entry; specification of exclusion criterion 6 (previous or concurrent radiotherapy to the abdomen and pelvis).
    11 Mar 2014
    Historical heart and lung X ray scans up to 4 weeks before screening are acceptable; change in the definition of secondary endpoints; specification of the follow up period including definition of the EoT visit, efficacy follow up and survival follow up; specification of the methods of contraception (exclusion criterion 13); changed the AE reporting period; definition and collection of SADRs; added determination of the sample size; added specification for patient replacement.
    20 May 2014
    Inclusion criteria 2 and 10, exclusion criteria 1 and 2; chest X-ray may be replaced by CT or thorax at investigators’ decision; withdrawal of central reading for the evaluation of patient eligibility; specification that pregnant women must come for the EoT visit; during the efficacy follow up hematology, serum chemistry, and urinalysis tests were withdrawn; an independent blinded radiologist to evaluate sensitivity analysis of PFS and ORR.

    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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