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    Clinical Trial Results:
    A Phase 1b/2 Study of Ibrutinib Combination Therapy in Selected Advanced Gastrointestinal And Genitourinary Tumors

    Summary
    EudraCT number
    2015-003656-40
    Trial protocol
    ES   GB  
    Global end of trial date

    Results information
    Results version number
    v1
    This version publication date
    10 Feb 2021
    First version publication date
    10 Feb 2021
    Other versions
    v2

    Trial information

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    Trial identification
    Sponsor protocol code
    PCYC-1128-CA
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02599324
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Pharmacyclics LCC
    Sponsor organisation address
    999 East Arques Ave, Sunnyvale, CA, United States, 94085
    Public contact
    Clinical Trial information, Pharmacyclics LLC, Pharmacyclics LLC, 1 4087740330, info@pcyc.com
    Scientific contact
    Clinical Trial information, Pharmacyclics LLC , Pharmacyclics LLC, 1 4087740330, info@pcyc.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
    Interim
    Date of interim/final analysis
    23 Mar 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    27 Jan 2020
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    Phase 1b: Primary Objective: To determine the recommended Phase 2 dose (RP2D) of ibrutinib in combination with everolimus in RCC, paclitaxel in urothelial carcinoma, docetaxel in gastric adenocarcinoma and cetuximab in CRC. Phase 2: Primary Objectives: • To assess progression-free survival (PFS) of ibrutinib combination therapy in RCC and urothelial carcinoma • To assess the ORR of ibrutinib combination therapy in gastric adenocarcinoma and CRC
    Protection of trial subjects
    This study was conducted in accordance with the ethical principles that have their origins in the Declaration of Helsinki and that are consistent with Good Clinical Practices and applicable regulatory requirements.
    Background therapy
    None
    Evidence for comparator
    No comparators were used for this Phase 1b/2 cohort study. The combination partners were selected based on whether these were already approved for the different solid tumor indications.
    Actual start date of recruitment
    17 Nov 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
    Korea, Republic of: 48
    Country: Number of subjects enrolled
    Spain: 32
    Country: Number of subjects enrolled
    United Kingdom: 25
    Country: Number of subjects enrolled
    United States: 41
    Worldwide total number of subjects
    146
    EEA total number of subjects
    57
    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)
    88
    From 65 to 84 years
    58
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This study was conducted in 38 sites: 18 in the US, 8 in the South Korea, 4 in the UK and 8 in Spain. The first subject consented 01 Dec 2015 and the last visit of the last subjects for this interim analysis was 27 Jan 2020.

    Pre-assignment
    Screening details
    Disease-related cohort inclusion criteria included histologically confirmed RCC, GC or gastroesophageal junction adenocarcinoma, and K-RAS or N-RAS wild-type epidermal growth factor receptor-expressing CRC. Patients had to have 1 or more measurable lesions per RECIST 1.1 criteria.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    This was an open-label study; no blinding was performed. Subjects were enrolled into cohorts according to disease type.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Renal cell carcinoma
    Arm description
    Subjects were to receive ibrutinib PO qd in combination with everolimus (6 hours after ibrutinib) at a dose of 10 mg PO qd in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Ibrutinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Ibrutinib 840 mg, 560 mg, or 420 mg (6 x, 4 x, or 3 x 140 mg capsules, respectively) was administered PO qd with 8 ounces (approximately 240 mL) of water. The capsules were to be swallowed intact, and subjects were not to attempt to open capsules or dissolve them in water.

    Investigational medicinal product name
    Everolimus
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Everolimus 10 mg tablets were taken PO qd at the same time every day either consistently with food or consistently without food. Four × 2.5 mg tablets or 2 × 5.0 mg tablets could be substituted if 10 mg tablets were not available. Everolimus tablets were to be taken approximately 6 hours after ibrutinib capsules. Everolimus was administered in continual 21-day cycles. The first dose was delivered in the clinic on Day 1, after which subsequent dosing was usually on an outpatient basis. Everolimus was to be dispensed to subjects on Day 1 of each cycle.

    Arm title
    Gastric Adenocarcinoma
    Arm description
    Subjects were to receive ibrutinib administered PO qd in combination with docetaxel at a dose of 60 to 75 mg/sqm administered as a 60-minute IV infusion q3weeks in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Ibrutinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Ibrutinib 840 mg, 560 mg, or 420 mg (6 x, 4 x, or 3 x 140 mg capsules, respectively) was administered PO qd with 8 ounces (approximately 240 mL) of water. The capsules were to be swallowed intact, and subjects were not to attempt to open capsules or dissolve them in water.

    Investigational medicinal product name
    Docetaxel
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Docetaxel was administered as a 60-minute infusion (±10 minutes) at a dose of 60 to 75 mg/sqm, given continually in 21-day cycles. Following the first dose of docetaxel combination therapy (on Cycle 1 Day 1), subjects were to remain in the clinic for 2 hours after completion of administration in order to assess any acute toxicity. On days when ibrutinib was to be administered, ibrutinib was to be taken in the clinic approximately 30 minutes prior to commencement of IV drug delivery. If an episode of febrile neutropenia, prolonged neutropenia, or neutropenic infection occurred despite use of granulocyte-colony stimulating factor, the docetaxel dose was to be reduced from 75 to 60 mg/sqm.

    Arm title
    Colorectal Adenocarcinoma
    Arm description
    Subjects were to receive ibrutinib administered PO qd in combination with cetuximab at a dose of 400 mg/sqm administered initially as a 120-minute IV infusion, then weekly 250 mg/sqm IV over 60 minutes in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Ibrutinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Ibrutinib 840 mg, 560 mg, or 420 mg (6 x, 4 x, or 3 x 140 mg capsules, respectively) was administered PO qd with 8 ounces (approximately 240 mL) of water. The capsules were to be swallowed intact, and subjects were not to attempt to open capsules or dissolve them in water.

    Investigational medicinal product name
    Cetuximab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The recommended initial dose of cetuximab was 400 mg/sqm administered as a 120-minute IV infusion. The recommended subsequent weekly dose (all other infusions) was 250 mg/sqm infused over 60 minutes. On days when ibrutinib was to be administered, ibrutinib was to be taken in the clinic approximately 30 minutes prior to commencement of IV drug delivery.

    Number of subjects in period 1
    Renal cell carcinoma Gastric Adenocarcinoma Colorectal Adenocarcinoma
    Started
    42
    46
    58
    Completed
    27
    32
    42
    Not completed
    15
    14
    16
         Consent withdrawn by subject
    2
    4
    5
         Physician decision
    -
    2
    1
         Adverse event, non-fatal
    13
    8
    9
         Death
    -
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Renal cell carcinoma
    Reporting group description
    Subjects were to receive ibrutinib PO qd in combination with everolimus (6 hours after ibrutinib) at a dose of 10 mg PO qd in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Reporting group title
    Gastric Adenocarcinoma
    Reporting group description
    Subjects were to receive ibrutinib administered PO qd in combination with docetaxel at a dose of 60 to 75 mg/sqm administered as a 60-minute IV infusion q3weeks in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Reporting group title
    Colorectal Adenocarcinoma
    Reporting group description
    Subjects were to receive ibrutinib administered PO qd in combination with cetuximab at a dose of 400 mg/sqm administered initially as a 120-minute IV infusion, then weekly 250 mg/sqm IV over 60 minutes in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Reporting group values
    Renal cell carcinoma Gastric Adenocarcinoma Colorectal Adenocarcinoma Total
    Number of subjects
    42 46 58 146
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    24 33 31 88
        From 65-84 years
    18 13 27 58
    Age continuous
    Units: years
        median (full range (min-max))
    62 (40 to 81) 58 (35 to 77) 62 (32 to 81) -
    Gender categorical
    Units: Subjects
        Female
    9 12 28 49
        Male
    33 34 30 97
    Subject analysis sets

    Subject analysis set title
    Analysis set 1: Phase 1 RCC subjects not treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Covering subjects in the Phase 1 RCC cohort treated with 560 mg ibrutinib instead of 840 mg ibrutinib (RP2D) in combination with everolimus.

    Subject analysis set title
    Analysis Set 2: Phase 1 CRC subjects not treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Covering subjects in the Phase 1 CRC cohort treated with 560 mg ibrutinib instead of 840 mg ibrutinib (RP2D) in combination with cetuximab.

    Subject analysis set title
    Analysis Set 3: All RCC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All RCC subjects in Phase 1 and Phase 2 treated with the RP2D of 840 mg ibrutinib.

    Subject analysis set title
    Analysis Set 4: All GC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All GC subjects in Phase 1 and Phase 2 treated with the RP2D of 560 mg ibrutinib.

    Subject analysis set title
    Analysis Set 5: All CRC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All CRC subjects in Phase 1 and Phase 2 treated with the RP2D of 840 mg ibrutinib.

    Subject analysis sets values
    Analysis set 1: Phase 1 RCC subjects not treated with RP2D Analysis Set 2: Phase 1 CRC subjects not treated with RP2D Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects
    3
    8
    39
    46
    50
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    1
    6
    23
    33
    25
        From 65-84 years
    2
    2
    16
    13
    25
    Age continuous
    Units: years
        median (full range (min-max))
    67 (61 to 72)
    54.5 (35 to 77)
    62 (40 to 81)
    58 (35 to 77)
    64 (32 to 81)
    Gender categorical
    Units: Subjects
        Female
    1
    7
    8
    12
    21
        Male
    2
    1
    31
    34
    29

    End points

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    End points reporting groups
    Reporting group title
    Renal cell carcinoma
    Reporting group description
    Subjects were to receive ibrutinib PO qd in combination with everolimus (6 hours after ibrutinib) at a dose of 10 mg PO qd in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Reporting group title
    Gastric Adenocarcinoma
    Reporting group description
    Subjects were to receive ibrutinib administered PO qd in combination with docetaxel at a dose of 60 to 75 mg/sqm administered as a 60-minute IV infusion q3weeks in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Reporting group title
    Colorectal Adenocarcinoma
    Reporting group description
    Subjects were to receive ibrutinib administered PO qd in combination with cetuximab at a dose of 400 mg/sqm administered initially as a 120-minute IV infusion, then weekly 250 mg/sqm IV over 60 minutes in 21-day cycles until unacceptable toxicity or disease progression occurred. If one component of the regimen was discontinued prior to RECIST 1.1 determined disease progression, the other component was to be continued until disease progression or unacceptable toxicity.

    Subject analysis set title
    Analysis set 1: Phase 1 RCC subjects not treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Covering subjects in the Phase 1 RCC cohort treated with 560 mg ibrutinib instead of 840 mg ibrutinib (RP2D) in combination with everolimus.

    Subject analysis set title
    Analysis Set 2: Phase 1 CRC subjects not treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Covering subjects in the Phase 1 CRC cohort treated with 560 mg ibrutinib instead of 840 mg ibrutinib (RP2D) in combination with cetuximab.

    Subject analysis set title
    Analysis Set 3: All RCC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All RCC subjects in Phase 1 and Phase 2 treated with the RP2D of 840 mg ibrutinib.

    Subject analysis set title
    Analysis Set 4: All GC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All GC subjects in Phase 1 and Phase 2 treated with the RP2D of 560 mg ibrutinib.

    Subject analysis set title
    Analysis Set 5: All CRC subjects treated with RP2D
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All CRC subjects in Phase 1 and Phase 2 treated with the RP2D of 840 mg ibrutinib.

    Primary: Progression Free Survival (PFS)

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    End point title
    Progression Free Survival (PFS) [1]
    End point description
    PFS was defined as the time from the date of first dose of study treatment to the date of first documentation of progressive disease or date of death from any cause, whichever occurs first, regardless of the use of subsequent anti-cancer treatment. PFS was primary endpoint in the RCC arm and secondary endpoint in the GC and CRC arms. The evaluations are based on the efficacy evaluable population treated with the RP2D.
    End point type
    Primary
    End point timeframe
    Results were collected on an ongoing basis with a median time on study in the RCC arm of 37.4/22.5 mo (Phase 1 incl. RP2D dose/Phase 2), in the GC arm of 25.3 /11.1 mo (Phase 1/Phase 2), and in the CRC arm of 34.1/22.1 mo (Phase 1 incl. PR2D dose/Phase 2)
    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: As this is a Phase 1/2 open label study with 6 different cohorts covering different indications, no comparisons were applicable and therefore no statistical analyses have been performed.
    End point values
    Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects analysed
    36 [2]
    39 [3]
    47 [4]
    Units: months
        number (confidence interval 90%)
    5.6 (3.9 to 7.5)
    4.0 (2.7 to 4.2)
    5.4 (4.1 to 5.8)
    Notes
    [2] - Efficacy Evaluable Population
    [3] - Efficacy Evaluable Population
    [4] - Efficacy Evaluable Population
    No statistical analyses for this end point

    Primary: Overall Response Rate (ORR)

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    End point title
    Overall Response Rate (ORR) [5]
    End point description
    ORR was defined as the proportion of subjects achieving complete response (CR) or partial response (PR) with confirmation based on the best overall response (BOR) per RECIST 1.1 guidelines recorded since date of first dose of study treatment until first documentation of progressive disease or initiation of subsequent anti-cancer treatment, whichever occurs first. Confirmation of CR or PR required two consecutive assessments that are at least 28 days apart. ORR was primary endpoint in the GC and CRC arms and secondary endpoint in the RCC arm. The evaluations are based on the efficacy evaluable population treated with the RP2D.
    End point type
    Primary
    End point timeframe
    Results were collected on an ongoing basis with a median time on study in the RCC arm of 37.4/22.5 mo (Phase 1 incl. RP2D dose/Phase 2), in the GC arm of 25.3 /11.1 mo (Phase 1/Phase 2), and in the CRC arm of 34.1/22.1 mo (Phase 1 incl. PR2D dose/Phase 2)
    Notes
    [5] - 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: As this is a Phase 1/2 open label study with 6 different cohorts covering different indications, no comparisons were applicable and therefore no statistical analyses have been performed.
    End point values
    Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects analysed
    36 [6]
    39 [7]
    47 [8]
    Units: percent
        number (confidence interval 90%)
    2.8 (0.1 to 12.5)
    17.9 (8.7 to 31.1)
    14.9 (7.2 to 26.2)
    Notes
    [6] - Efficacy Evaluable Population
    [7] - Efficacy Evaluable Population
    [8] - Efficacy Evaluable Population
    No statistical analyses for this end point

    Secondary: Disease Control Rate (DCR)

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    End point title
    Disease Control Rate (DCR)
    End point description
    DCR was defined as the proportion of subjects achieving CR, PR, or stable disease of length ≥ 6 weeks based on the BOR per RECIST 1.1 guidelines recorded since date of first dose of study treatment until first documentation of progressive disease or initiation of subsequent anti-cancer treatment, whichever occurs first. Confirmation of CR or PR was not required. The evaluations are based on the efficacy evaluable population treated with the RP2D.
    End point type
    Secondary
    End point timeframe
    Results were collected on an ongoing basis with a median time on study in the RCC arm of 37.4/22.5 mo (Phase 1 incl. RP2D dose/Phase 2), in the GC arm of 25.3 /11.1 mo (Phase 1/Phase 2), and in the CRC arm of 34.1/22.1 mo (Phase 1 incl. PR2D dose/Phase 2)
    End point values
    Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects analysed
    36 [9]
    39 [10]
    47 [11]
    Units: percent
        number (confidence interval 90%)
    80.6 (66.6 to 90.5)
    74.4 (60.4 to 85.4)
    83.0 (71.4 to 91.2)
    Notes
    [9] - Efficacy Evaluable Population
    [10] - Efficacy Evaluable Population
    [11] - Efficacy Evaluable Population
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    OS was defined as the time from the date of first dose of study treatment to the date of death from any cause. The evaluations are based on the efficacy evaluable population treated with the RP2D.
    End point type
    Secondary
    End point timeframe
    Results were collected on an ongoing basis with a median time on study in the RCC arm of 37.4/22.5 mo (Phase 1 incl. RP2D dose/Phase 2), in the GC arm of 25.3 /11.1 mo (Phase 1/Phase 2), and in the CRC arm of 34.1/22.1 mo (Phase 1 incl. PR2D dose/Phase 2)
    End point values
    Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects analysed
    36 [12]
    39 [13]
    47 [14]
    Units: months
        number (confidence interval 90%)
    21.0 (13.1 to 25.3)
    7.3 (5.5 to 9.6)
    15.0 (10.5 to 17.2)
    Notes
    [12] - Efficacy Evaluable Population
    [13] - Efficacy Evaluable Population
    [14] - Efficacy Evaluable Population
    No statistical analyses for this end point

    Secondary: Duration of Response (DOR)

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    End point title
    Duration of Response (DOR)
    End point description
    DOR was defined for confirmed responders (PR or better) as the time from the date of initial response (PR or better) to the date of first documentation of progressive disease or death, whichever occurs first, regardless of use of subsequent anti-cancer treatment. Confirmed responders without documentation of progressive disease or death or with unknown status at the data extract were censored at the last adequate post-baseline disease assessment showing no evidence of progressive disease.
    End point type
    Secondary
    End point timeframe
    Results were collected on an ongoing basis with a median time on study in the RCC arm of 37.4/22.5 mo (Phase 1 incl. RP2D dose/Phase 2), in the GC arm of 25.3 /11.1 mo (Phase 1/Phase 2), and in the CRC arm of 34.1/22.1 mo (Phase 1 incl. PR2D dose/Phase 2)
    End point values
    Analysis Set 3: All RCC subjects treated with RP2D Analysis Set 4: All GC subjects treated with RP2D Analysis Set 5: All CRC subjects treated with RP2D
    Number of subjects analysed
    1
    7
    7
    Units: months
        number (confidence interval 90%)
    3.1 (3.1 to 3.1)
    5.5 (3.0 to 18.0)
    11.1 (4.2 to 12.5)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose of study drug up to 30 days after the last dose of study drug or the day before initiation of subsequent anti-cancer treatment, whichever comes first.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.1
    Reporting groups
    Reporting group title
    Subjects treated with RP2D
    Reporting group description
    Safety is reported here for all subjects treated with the RP2D regardless of the indication. Safety of subjects treated with lower doses in the Phase I part of the study are not reported due to the low number of subjects,

    Serious adverse events
    Subjects treated with RP2D
    Total subjects affected by serious adverse events
         subjects affected / exposed
    62 / 135 (45.93%)
         number of deaths (all causes)
    88
         number of deaths resulting from adverse events
    7
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Adenocarcinoma gastric
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Colorectal adenocarcinoma
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastric cancer
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metastases to central nervous system
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metastases to spine
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal cell carcinoma
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Tumour haemorrhage
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Aortic stenosis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Pleurodesis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    4 / 135 (2.96%)
         occurrences causally related to treatment / all
    2 / 5
         deaths causally related to treatment / all
    0 / 0
    Generalised oedema
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Chest pain
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Multiple organ dysfunction syndrome
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    3 / 135 (2.22%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Haemoptysis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Pneumonia aspiration
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Respiratory failure
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Gun shot wound
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Transient ischaemic attack
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral infarction
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral ischaemia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Headache
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Presyncope
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Radiculopathy
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences causally related to treatment / all
    8 / 14
         deaths causally related to treatment / all
    0 / 0
    Neutropenia
         subjects affected / exposed
    4 / 135 (2.96%)
         occurrences causally related to treatment / all
    3 / 6
         deaths causally related to treatment / all
    0 / 0
    Anaemia
         subjects affected / exposed
    3 / 135 (2.22%)
         occurrences causally related to treatment / all
    4 / 5
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    4 / 135 (2.96%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    3 / 135 (2.22%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Ileus
         subjects affected / exposed
    3 / 135 (2.22%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Stomatitis
         subjects affected / exposed
    3 / 135 (2.22%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Ascites
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Melaena
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal motility disorder
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haematemesis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Nausea
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Obstruction gastric
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Haematuria
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Renal Failure
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal pain
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Neck mass
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences causally related to treatment / all
    1 / 9
         deaths causally related to treatment / all
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    5 / 135 (3.70%)
         occurrences causally related to treatment / all
    4 / 5
         deaths causally related to treatment / all
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Appendicitis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Atypical pneumonia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Biliary tract infection
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Clostridium difficile infection
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterococcal bacteraemia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Herpes simplex
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningitis aseptic
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Paronychia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Staphylococcal infection
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Dehydration
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Diabetic ketoacidosis
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperphosphataemia
         subjects affected / exposed
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Subjects treated with RP2D
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    132 / 135 (97.78%)
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    52 / 135 (38.52%)
         occurrences all number
    120
    Asthenia
         subjects affected / exposed
    35 / 135 (25.93%)
         occurrences all number
    91
    Oedema peripheral
         subjects affected / exposed
    21 / 135 (15.56%)
         occurrences all number
    29
    Pyrexia
         subjects affected / exposed
    21 / 135 (15.56%)
         occurrences all number
    27
    Chills
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    10
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
         subjects affected / exposed
    37 / 135 (27.41%)
         occurrences all number
    54
    Cough
         subjects affected / exposed
    24 / 135 (17.78%)
         occurrences all number
    37
    Dyspnoea
         subjects affected / exposed
    12 / 135 (8.89%)
         occurrences all number
    25
    Oropharyngeal pain
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    13
    Haemoptysis
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    10
    Productive cough
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    10
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    14
    Investigations
    Weight decreased
         subjects affected / exposed
    17 / 135 (12.59%)
         occurrences all number
    21
    Platelet count decreased
         subjects affected / exposed
    14 / 135 (10.37%)
         occurrences all number
    19
    Aspartate aminotransferase increased
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    12
    Neutrophil count decreased
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    24
    Blood creatinine increased
         subjects affected / exposed
    10 / 135 (7.41%)
         occurrences all number
    24
    White blood cell count decreased
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    18
    Alanine aminotransferase increased
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    9
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    22 / 135 (16.30%)
         occurrences all number
    28
    Headache
         subjects affected / exposed
    12 / 135 (8.89%)
         occurrences all number
    16
    Peripheral sensory neuropathy
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    16
    Neurotoxicity
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    21
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    51 / 135 (37.78%)
         occurrences all number
    160
    Thrombocytopenia
         subjects affected / exposed
    24 / 135 (17.78%)
         occurrences all number
    55
    Neutropenia
         subjects affected / exposed
    18 / 135 (13.33%)
         occurrences all number
    46
    Eye disorders
    Dry eye
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    10
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    70 / 135 (51.85%)
         occurrences all number
    148
    Stomatitis
         subjects affected / exposed
    68 / 135 (50.37%)
         occurrences all number
    154
    Nausea
         subjects affected / exposed
    46 / 135 (34.07%)
         occurrences all number
    82
    Vomiting
         subjects affected / exposed
    34 / 135 (25.19%)
         occurrences all number
    55
    Constipation
         subjects affected / exposed
    23 / 135 (17.04%)
         occurrences all number
    26
    Abdominal pain
         subjects affected / exposed
    18 / 135 (13.33%)
         occurrences all number
    27
    Dyspepsia
         subjects affected / exposed
    17 / 135 (12.59%)
         occurrences all number
    20
    Abdominal pain upper
         subjects affected / exposed
    13 / 135 (9.63%)
         occurrences all number
    19
    Dry mouth
         subjects affected / exposed
    10 / 135 (7.41%)
         occurrences all number
    22
    Dysphagia
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    9
    Skin and subcutaneous tissue disorders
    Dermatitis acneiform
         subjects affected / exposed
    48 / 135 (35.56%)
         occurrences all number
    160
    Pruritus
         subjects affected / exposed
    30 / 135 (22.22%)
         occurrences all number
    42
    Dry skin
         subjects affected / exposed
    27 / 135 (20.00%)
         occurrences all number
    45
    Rash maculo-papular
         subjects affected / exposed
    19 / 135 (14.07%)
         occurrences all number
    71
    Alopecia
         subjects affected / exposed
    17 / 135 (12.59%)
         occurrences all number
    20
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    16 / 135 (11.85%)
         occurrences all number
    38
    Petechiae
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    17
    Rash erythematous
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    12
    Rash
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    10
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    18
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    16 / 135 (11.85%)
         occurrences all number
    27
    Back pain
         subjects affected / exposed
    13 / 135 (9.63%)
         occurrences all number
    14
    Myalgia
         subjects affected / exposed
    12 / 135 (8.89%)
         occurrences all number
    16
    Pain in extremity
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    14
    Musculoskeletal pain
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    8
    Infections and infestations
    Paronychia
         subjects affected / exposed
    29 / 135 (21.48%)
         occurrences all number
    54
    Urinary tract infection
         subjects affected / exposed
    11 / 135 (8.15%)
         occurrences all number
    13
    Conjunctivitis
         subjects affected / exposed
    9 / 135 (6.67%)
         occurrences all number
    13
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    50 / 135 (37.04%)
         occurrences all number
    92
    Hypokalaemia
         subjects affected / exposed
    18 / 135 (13.33%)
         occurrences all number
    33
    Hypomagnesaemia
         subjects affected / exposed
    16 / 135 (11.85%)
         occurrences all number
    35
    Dehydration
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    9
    Hypocalcaemia
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    14
    Hypophosphataemia
         subjects affected / exposed
    8 / 135 (5.93%)
         occurrences all number
    12
    Hyperglycaemia
         subjects affected / exposed
    7 / 135 (5.19%)
         occurrences all number
    21

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Feb 2016
    • New starting dose of 560 mg for ibrutinib • Dose escalation clinical trial design for Phase 1b • Revised inclusion criteria for CRC cohort • Revised eligibility criteria for subjects with platelet counts above 100 × 109/L to match relevant labelling • Revise eligibility criteria for hemoglobin • Revised DLT criteria • Refined DLT evaluable population • Updated Pharmacodynamics Collection Schedule • Updated protocol template language to align with most current Investigator’s Brochure
    25 Jan 2019
    • Cohort 5 (single agent ibrutinib) was added to the study • Summary of Clinical Safety section was updated to align with the current ibrutinib Investigator’s Brochure (version 12.0) • Summary of Clinical Data section was updated to provide safety data from the interim analysis of Study 1128 • Rationale in Specific Solid Tumors section was updated to include information on UC and GC solid tumors • Dosing Rationale section was updated to include the rationale for the 560 mg and 840 mg starting doses (for UC and Cohorts 2 and 5) • The study objectives were updated to include the primary objectives in Phase 1b and Phase 2 and the secondary objectives in Phase 2 for Cohort 5 • Background information on safety and efficacy of ibrutinib monotherapy in previously treated UC and combination therapy in previously treated UC and GC was added to the Overview of Study Design • Updates were made to the permitted concomitant medications • Updates were made to minor surgical procedures to include information pertinent to UC Cohort 5

    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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