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    Clinical Trial Results:
    Multicenter, Double-Blind, Randomized, Comparative Efficacy and Safety Study of MYL 1401H and European Sourced Neulasta® in Stage II/III Breast Cancer Patients Receiving Neoadjuvant or Adjuvant Chemotherapy

    Summary
    EudraCT number
    2014-002324-27
    Trial protocol
    HU   DE   BG   PL  
    Global end of trial date
    09 Feb 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    12 Jan 2024
    First version publication date
    12 Jan 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MYL-1401H-3001
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Mylan GmbH
    Sponsor organisation address
    Thurgauerstrasse 40, 8050 Zürich, Switzerland, Switzerland, 8010
    Public contact
    Eduardo J. Pennella, Mylan GmbH, 724 514-2369, Eduardo.Pennella@mylan.com
    Scientific contact
    Eduardo J. Pennella, Mylan GmbH, 724 514-2369, Eduardo.Pennella@mylan.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
    15 Sep 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    09 Feb 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    09 Feb 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the study is to compare the efficacy of MYL-1401H versus Neulasta® for the prophylactic treatment of chemotherapy-induced neutropenia in patients with stage II/III breast cancer receiving TAC anti-cancer chemotherapy.
    Protection of trial subjects
    Informed consent was obtained before a patient was enrolled in the study and prior to the commencement of any protocol-driven activities. The investigator (or designated staff member) met with the patient and explained the study in sufficient detail to permit an informed decision to participate. The investigator (or designated staff member), patient, and a witness signed an ICF. The original signed and dated ICF for each patient was kept with the patient’s chart, and a copy was provided to the patient. The ICF was written in compliance with ICH guidelines and other national regulations as appropriate.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    05 Jan 2015
    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
    Bulgaria: 15
    Country: Number of subjects enrolled
    Georgia: 56
    Country: Number of subjects enrolled
    Hungary: 13
    Country: Number of subjects enrolled
    Ukraine: 110
    Worldwide total number of subjects
    194
    EEA total number of subjects
    28
    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)
    194
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This was a multicenter, randomized, double-blind, parallel-group study with 2 treatment arms. Patients underwent 6 chemotherapy cycles planned every 3 weeks (Cycle 1 through Cycle 6), each cycle beginning on Day 1, when the chemotherapy dose was administered, with the administration of either MYL-1401H or EU-Neulasta® on Day 2 of each cycle.

    Pre-assignment
    Screening details
    The planned duration for the entire study was approximately 28 weeks (from Screening to follow-up [24 weeks from the first dose of study drug]), assuming no delays in dosing. The planned duration of patient treatment during the entire study was approximately 18 weeks (from the first day of chemotherapy [Day 1 Cycle 1] to the last scheduled asses

    Period 1
    Period 1 title
    Test product- MYL-1401H
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    The oncology pharmacist who prepared the doses and the person administering the drug (eg, study nurse, physician [other than the principal investigator or sub-principal investigator]) were the only individuals who had access or knowledge of the actual drug delivered. Other unblinded personnel in the study included the clinical research associate (CRA) who audited the drug dispensation log and drug accountability. There were 2 CRAs assigned to each site: with the CRA monitoring the study

    Arms
    Arm title
    Test arm
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Test Product
    Investigational medicinal product code
    MYL-1401H
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Test Product, Dose, Mode of Administration, and Batch Number: MYL-1401H 6 mg injection administered as a single sc dose, on Day 2 of each cycle, ie, 24 h (+ 2 h after) after the end of chemotherapy. Each prefilled syringe (PFS) contained 6 mg of MYL-1401H in 0.6 mL solution for injection. The concentration was 10 mg/mL based on protein only. Batch S14DBPEGI-0003 of MYL-1401H was used.

    Number of subjects in period 1 [1]
    Test arm
    Started
    127
    Completed
    120
    Not completed
    7
         Physician decision
    1
         Consent withdrawn by subject
    2
         Adverse event, non-fatal
    4
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Number of Patients (Planned and Analyzed): Planned: Approximately 189 patients were planned for enrolment into the study in a 2:1 ratio of the 2 treatment groups (126:63 in the MYL-1401H and EU-Neulasta® arm, respectively). Actual: 194 patients were randomized and received study treatment; 127 patients were randomized to receive MYL-1401H and 67 patients were randomized to receive EU-Neulasta®. Completed: 186 patients completed the study. Analyzed: 194 patients were included in the data an
    Period 2
    Period 2 title
    Reference product, US-Neulasta®
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    The oncology pharmacist who prepared the doses and the person administering the drug (eg, study nurse, physician [other than the principal investigator or sub-principal investigator]) were the only individuals who had access or knowledge of the actual drug delivered. Other unblinded personnel in the study included the clinical research associate (CRA) who audited the drug dispensation log and drug accountability. There were 2 CRAs assigned to each site: with the CRA monitoring the study bei

    Arms
    Arm title
    Reference Product- EU-Neulasta®
    Arm description
    -
    Arm type
    Active comparator

    Investigational medicinal product name
    Reference
    Investigational medicinal product code
    EU-Neulasta®
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Reference Product, Dose, Mode of Administration, and Batch Numbers: EU-Neulasta® 6 mg injection administered as a single sc dose, on Day 2 of each cycle, ie, 24 h (+ 2 h) after the end of chemotherapy. Each PFS contained 6 mg of pegfilgrastim in 0.6 mL solution for injection. The concentration was 10 mg/mL based on protein only. Batches 1048603D and 1053573B of EU-Neulasta® were used.

    Number of subjects in period 2 [2]
    Reference Product- EU-Neulasta®
    Started
    67
    Completed
    66
    Not completed
    1
         Other
    1
    Notes
    [2] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Number of Patients (Planned and Analyzed): Planned: Approximately 189 patients were planned for enrolment into the study in a 2:1 ratio of the 2 treatment groups (126:63 in the MYL-1401H and EU-Neulasta® arm, respectively). Actual: 194 patients were randomized and received study treatment; 127 patients were randomized to receive MYL-1401H and 67 patients were randomized to receive EU-Neulasta®. Completed: 186 patients completed the study. Analyzed: 194 patients were included in the data an

    Baseline characteristics

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    End points

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    End points reporting groups
    Reporting group title
    Test arm
    Reporting group description
    -
    Reporting group title
    Reference Product- EU-Neulasta®
    Reporting group description
    -

    Primary: Primary Efficacy Endpoint:

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    End point title
    Primary Efficacy Endpoint: [1]
    End point description
    End point type
    Primary
    End point timeframe
    Primary Efficacy Endpoint: The primary efficacy endpoint was the duration of severe neutropenia (DSN) in Cycle 1, defined as days with ANC <0.5 × 109/L.
    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: Primary Efficacy Analysis: An analysis of variance (ANOVA) model, with treatment as an independent variable, and a 2-sided 95% confidence interval (CI) for the difference in least squares mean (LS Mean) of the DSN for the 2 treatments, was employed. Equivalence between the 2 treatments was declared if the CI was completely within the range of ± 1 day.
    End point values
    Test arm
    Number of subjects analysed
    126
    Units: ANC <0.5 × 109/L.
    least squares mean (confidence interval 95%)
        MYL-1401H
    131 (1 to 148)
        EU-Neulasta®
    130 (1 to 148)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    A total of 1220 TEAEs were reported in the safety population. A total of 806 TEAEs were reported in 114 (89.8%) patients in the MYL-1401H group and 414 TEAEs were reported in 58 (86.6%) patients in the EU-Neulasta® group (Table 14.3.1.1.2). Refer to Tab
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.0
    Reporting groups
    Reporting group title
    Test- MYL-1401H
    Reporting group description
    -

    Reporting group title
    Reference arm- EU-Neulasta®
    Reporting group description
    -

    Serious adverse events
    Test- MYL-1401H Reference arm- EU-Neulasta®
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 127 (6.30%)
    1 / 67 (1.49%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 67 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    6 / 127 (4.72%)
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 6
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Erysipelas
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 67 (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
    Hypokalaemia
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 67 (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: 0%
    Non-serious adverse events
    Test- MYL-1401H Reference arm- EU-Neulasta®
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    34 / 127 (26.77%)
    13 / 67 (19.40%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    7 / 127 (5.51%)
    8 / 67 (11.94%)
         occurrences all number
    7
    8
    Aspartate aminotransferase increased
         subjects affected / exposed
    7 / 127 (5.51%)
    7 / 67 (10.45%)
         occurrences all number
    7
    7
    Blood alkaline phosphatase increased
         subjects affected / exposed
    3 / 127 (2.36%)
    2 / 67 (2.99%)
         occurrences all number
    3
    2
    Platelet count decreased
         subjects affected / exposed
    7 / 127 (5.51%)
    5 / 67 (7.46%)
         occurrences all number
    7
    5
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    3 / 127 (2.36%)
    2 / 67 (2.99%)
         occurrences all number
    3
    2
    Nervous system disorders
    Headache
         subjects affected / exposed
    12 / 127 (9.45%)
    8 / 67 (11.94%)
         occurrences all number
    12
    8
    Peripheral sensory neuropathy
         subjects affected / exposed
    4 / 127 (3.15%)
    1 / 67 (1.49%)
         occurrences all number
    4
    1
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    14 / 127 (11.02%)
    9 / 67 (13.43%)
         occurrences all number
    14
    9
    Febrile neutropenia
         subjects affected / exposed
    7 / 127 (5.51%)
    1 / 67 (1.49%)
         occurrences all number
    7
    1
    Thrombocytopenia
         subjects affected / exposed
    14 / 127 (11.02%)
    6 / 67 (8.96%)
         occurrences all number
    14
    6
    Thrombocytosis
         subjects affected / exposed
    8 / 127 (6.30%)
    0 / 67 (0.00%)
         occurrences all number
    8
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    23 / 127 (18.11%)
    10 / 67 (14.93%)
         occurrences all number
    23
    10
    Fatigue
         subjects affected / exposed
    19 / 127 (14.96%)
    13 / 67 (19.40%)
         occurrences all number
    19
    16
    Pyrexia
         subjects affected / exposed
    3 / 127 (2.36%)
    5 / 67 (7.46%)
         occurrences all number
    3
    5
    Eye disorders
    Lacrimation increased
         subjects affected / exposed
    3 / 127 (2.36%)
    1 / 67 (1.49%)
         occurrences all number
    3
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    3 / 127 (2.36%)
    4 / 67 (5.97%)
         occurrences all number
    3
    4
    Abdominal pain upper
         subjects affected / exposed
    3 / 127 (2.36%)
    2 / 67 (2.99%)
         occurrences all number
    3
    2
    Constipation
         subjects affected / exposed
    3 / 127 (2.36%)
    2 / 67 (2.99%)
         occurrences all number
    3
    2
    Diarrhea
         subjects affected / exposed
    16 / 127 (12.60%)
    12 / 67 (17.91%)
         occurrences all number
    16
    12
    Dyspepsia
         subjects affected / exposed
    4 / 127 (3.15%)
    0 / 67 (0.00%)
         occurrences all number
    4
    0
    Nausea
         subjects affected / exposed
    34 / 127 (26.77%)
    13 / 67 (19.40%)
         occurrences all number
    37
    25
    Stomatitis
         subjects affected / exposed
    11 / 127 (8.66%)
    2 / 67 (2.99%)
         occurrences all number
    11
    2
    Vomiting
         subjects affected / exposed
    12 / 127 (9.45%)
    7 / 67 (10.45%)
         occurrences all number
    12
    7
    Reproductive system and breast disorders
    Menstruation irregular
         subjects affected / exposed
    3 / 127 (2.36%)
    1 / 67 (1.49%)
         occurrences all number
    3
    1
    Hepatobiliary disorders
    Hyperbilirubinaemia
         subjects affected / exposed
    4 / 127 (3.15%)
    1 / 67 (1.49%)
         occurrences all number
    4
    1
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    34 / 127 (26.77%)
    13 / 67 (19.40%)
         occurrences all number
    76
    36
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    2 / 127 (1.57%)
    2 / 67 (2.99%)
         occurrences all number
    2
    2
    Bone pain
         subjects affected / exposed
    34 / 127 (26.77%)
    13 / 67 (19.40%)
         occurrences all number
    51
    24
    Myalgia
         subjects affected / exposed
    5 / 127 (3.94%)
    1 / 67 (1.49%)
         occurrences all number
    5
    1
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    8 / 127 (6.30%)
    0 / 67 (0.00%)
         occurrences all number
    8
    0
    Hypocalcaemia
         subjects affected / exposed
    3 / 127 (2.36%)
    2 / 67 (2.99%)
         occurrences all number
    3
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

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