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    Clinical Trial Results:
    A randomized, double-blinded, phase III study of atezolizumab versus placebo in patients with late relapse of epithelial ovarian, fallopian tube, or peritoneal cancer treated by platinum-based chemotherapy and bevacizumab

    Summary
    EudraCT number
    2015-005471-24
    Trial protocol
    FR   ES   AT   DE   BE   CZ  
    Global end of trial date
    22 Feb 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    10 Apr 2025
    First version publication date
    10 Apr 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GINECO-OV236b
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02891824
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    ENGOT-ov29: ENGOT
    Sponsors
    Sponsor organisation name
    ARCAGY-GINECO
    Sponsor organisation address
    8 rue Lamennais, Paris, France, 75008
    Public contact
    Marina Gomes, projet manager, ARCAGY-GINECO, +33 184852020, contact@arcagy.org
    Scientific contact
    Marina Gomes, projet manager, ARCAGY-GINECO, +33 184852020, contact@arcagy.org
    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
    22 Feb 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    22 Feb 2024
    Global end of trial reached?
    Yes
    Global end of trial date
    22 Feb 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine the efficacy of combining atezolizumab with carboplatin-based chemotherapy and bevacizumab compared to placebo with carboplatin-based chemotherapy and bevacizumab in patients with late (platinum-sensitive) relapse of epithelial ovarian, fallopian tube, or peritoneal cancer. Co-Primary outcomes will be the Progression Free Survival (PFS1) in the ITT population and in the PD-L1 positive subpopulation (PD-L1 expression ≥ 1%). The primary endpoint measure is progression free survival (PFS1), where the date of progression is based on investigator assessment using the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1).
    Protection of trial subjects
    The study was performed in accordance with ethical principles that have their origin in the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013) and are consistent with International Conference on Harmonization (ICH)/Good Clinical Practice (GCP) and applicable regulatory requirements. Informed consent was obtained before inclusion in the study. All patients were treated with the standard of care for patients with a relapse from ovarian cancer and placebo or atezolizumab was added. Disease progression was a criterion for study end, so patients not correctly treated by the study treatment exited the study and were treated with other options.
    Background therapy
    Platinum-based chemotherapy either : - Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or - Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or - Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + placebo (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w.
    Evidence for comparator
    Atezolizumab was compared to a placebo. In both groups patients were also treated with bevacizumab and a platinum-based chemotherapy.
    Actual start date of recruitment
    28 Sep 2016
    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
    Spain: 67
    Country: Number of subjects enrolled
    Austria: 24
    Country: Number of subjects enrolled
    Belgium: 3
    Country: Number of subjects enrolled
    Czechia: 8
    Country: Number of subjects enrolled
    France: 441
    Country: Number of subjects enrolled
    Germany: 70
    Country: Number of subjects enrolled
    Israel: 1
    Worldwide total number of subjects
    614
    EEA total number of subjects
    613
    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)
    342
    From 65 to 84 years
    272
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    787 patients were included from 25/09/2016 to 04/10/2019 and 614 patients were randomized from 07/10/2016 to 15/10/2019.

    Pre-assignment
    Screening details
    787 patients were screened and 173 were excluded before randomization(n=93 for not meeting the inclusion criteria, n=27 for tumor block unavailability, n=7 for adverse events, n= 21 withdrew their consent, n= 2 were lost to follow-up and n= 23 for other reasons).

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    Atezolizumab and placebo treatment were double blinded. The study medication was labelled using a unique kit ID number, which was linked to the randomization scheme. The active and placebo kits were presented in the same packaging to ensure blinding of the study medication.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Placebo + bevacizumab & platinum-based chemotherapy The placebo arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) d) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or e) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or f) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + placebo (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate and solvent for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The fixed dose of 1200 mg (equivalent to an average body weight−based dose of 15 mg/kg) was selected based on both nonclinical studies and available clinical data. This atezolizumab/placebo 1200mg dose was delivered every 3 weeks before bevacizumab infusion and prior to the carboplatin-gemcitabine or paclitaxel regimen and in all the maintenance schedule. The atezolizumab/placebo dose was 800mg every 2 weeks when delivered with carboplatin-PLD chemotherapy.

    Arm title
    Atezolizumab
    Arm description
    Atezolizumab + bevacizumab & platinum-based chemotherapy The atezolizumab arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) a) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or b) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or c) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + atezolizumab (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w.
    Arm type
    Experimental

    Investigational medicinal product name
    Atezolizumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The fixed dose of 1200 mg (equivalent to an average body weight−based dose of 15 mg/kg) was selected based on both nonclinical studies and available clinical data. This atezolizumab/placebo 1200mg dose was delivered every 3 weeks before bevacizumab infusion and prior to the carboplatin-gemcitabine or paclitaxel regimen and in all the maintenance schedule. The atezolizumab/placebo dose was 800mg every 2 weeks when delivered with carboplatin-PLD chemotherapy.

    Number of subjects in period 1
    Placebo Atezolizumab
    Started
    204
    410
    Completed
    204
    410

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo + bevacizumab & platinum-based chemotherapy The placebo arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) d) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or e) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or f) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + placebo (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w.

    Reporting group title
    Atezolizumab
    Reporting group description
    Atezolizumab + bevacizumab & platinum-based chemotherapy The atezolizumab arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) a) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or b) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or c) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + atezolizumab (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w.

    Reporting group values
    Placebo Atezolizumab Total
    Number of subjects
    204 410 614
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (standard deviation)
    62.54 ( 10.82 ) 61.76 ( 10.75 ) -
    Gender categorical
    Units: Subjects
        Female
    204 410 614
        Male
    0 0 0
    ECOG
    Units: Subjects
        score of 0
    131 277 408
        score of 1
    72 131 203
        score of 2
    0 2 2
        score of 3
    0 0 0
        score of 4
    0 0 0
        NA
    1 0 1
    CA125 dosage before treatment administration
    Units: Subjects
        Anormal <100 kU/L
    48 88 136
        Anormal >=100 kU/L
    113 227 340
        Normal
    43 92 135
        NA
    0 3 3
    Blood Pressure
    Units: Subjects
        High (SBP > 140 and DPB >90)
    9 12 21
        Normal
    193 395 588
        NA
    2 3 5
    PDL1 expression
    PD-L1–positive status was defined as tumor-infiltrating immune cell (IC) PD-L1 expression on ≥1% of tumor area using the Ventana SP142 immunohistochemistry assay (Ventana Medical Systems, Tucson, AZ), as in previous atezolizumab trials (Moore et al. 2021; Schmid et al. 2018; Mittendorf et al. 2020; Miles et al. 2021).
    Units: Subjects
        Positive
    77 156 233
        Negative
    102 196 298
        Inconclusive
    25 58 83
    Primary cancer site
    Units: Subjects
        Ovary
    191 369 560
        Fallopian tube
    5 27 32
        Peritoneal
    8 14 22
    Adenocarcinoma type
    Units: Subjects
        Serous High Grade (a)
    169 346 515
        Serous Low Grade (b)
    8 32 40
        Endometrioid Grade 2/3 (c)
    11 12 23
        Endometrioid Grade 1 (d)
    0 1 1
        Clear cell
    9 8 17
        Mucinous
    0 0 0
        Undifferentiated
    4 4 8
        Other
    1 1 2
        Carcinosarcoma
    1 4 5
        Mixed tumor
    0 2 2
        Brenner
    1 0 1
    FIGO
    Units: Subjects
        Stage I
    5 18 23
        Stage II
    8 18 26
        Stage III
    117 261 378
        Stage IV
    49 73 122
        Unknown
    25 40 65
    BRCA mutation status
    Units: Subjects
        Germline or somatic mutation
    32 40 72
        Inconclusive
    54 129 183
        No mutation
    118 241 359
    Debulking surgery
    Units: Subjects
        No
    21 27 48
        Yes
    183 383 566
    Number of previous lines of treatment
    Units: Subjects
        1 line
    147 307 454
        2 lines
    56 103 159
        3 lines
    1 0 1
    Tumor size
    Units: millimetre(s)
        median (inter-quartile range (Q1-Q3))
    38.5 (24 to 68) 47 (28 to 82.75) -
    BMI
    kg/cm2
    Units: kilogram(s)/square centimetre
        median (inter-quartile range (Q1-Q3))
    24.27 (21.62 to 27.99) 24.67 (21.61 to 28.23) -
    Time between relapse before entering the sutyd and randomization
    Units: day
        median (inter-quartile range (Q1-Q3))
    57 (41 to 78) 59 (42 to 82) -

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo + bevacizumab & platinum-based chemotherapy The placebo arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) d) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or e) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + placebo (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w or f) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + placebo (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + placebo (1200mg, d1) q3w.

    Reporting group title
    Atezolizumab
    Reporting group description
    Atezolizumab + bevacizumab & platinum-based chemotherapy The atezolizumab arm included one of 3 following regimens up to investigator choice (chosen prior to randomization) a) Carboplatin (AUC = 4, d1) combined with gemcitabine (1000 mg/m2, d1 & d8) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles q3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or b) Carboplatin (AUC = 5, d1) combined with paclitaxel (175 mg/m², d1) and bevacizumab (15mg/kg, d1) + atezolizumab (1200mg, d1) x 6 cycles every 3wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w or c) Carboplatin (AUC = 5, d1) combined with pegylated liposomal doxorubicin (PLD) (30 mg/m², d1) and bevacizumab (10mg/kg, d1 & 15) + atezolizumab (800mg, d1& 15) x 6 cycles every 4wk followed by maintenance with bevacizumab (15 mg/kg, d1) + atezolizumab (1200mg, d1) q3w.

    Subject analysis set title
    PD-L1 positive Placebo
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    PD-L1 expression was assessed by immunochemistry on immune cells of the tumor de novo biopsy obtained before entry in ATALANTE. PD-L1 positivity was defined as ≥1% of immune cells (ICs) expressing PD-L1 which was referred to IC1/2/3 according to PD-L1 scoring algorithm.

    Subject analysis set title
    PD-L1 positive Atzolizumab
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    PD-L1 expression was assessed by immunochemistry on immune cells of the tumor de novo biopsy obtained before entry in ATALANTE. PD-L1 positivity was defined as ≥1% of immune cells (ICs) expressing PD-L1 which was referred to IC1/2/3 according to PD-L1 scoring algorithm.

    Primary: Progression free survival

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    End point title
    Progression free survival
    End point description
    The co-primary endpoints were not reached and therefore the statistics for the secondary endpoints are not detailed here.
    End point type
    Primary
    End point timeframe
    Progression free survival was assessed over the entire duration of the study from 25/09/2016 to 15/10/2023.
    End point values
    Placebo Atezolizumab PD-L1 positive Placebo PD-L1 positive Atzolizumab
    Number of subjects analysed
    204
    410
    77
    156
    Units: month
        median (confidence interval 95%)
    11.27 (11.04 to 13.50)
    13.60 (12.32 to 14.29)
    13.08 (11.40 to 16.49)
    15.24 (13.14 to 17.02)
    Statistical analysis title
    Cox model results in ITT population
    Comparison groups
    Placebo v Atezolizumab
    Number of subjects included in analysis
    614
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.035
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    0.98
    Statistical analysis title
    Cox model in PD-L1 positive population
    Comparison groups
    PD-L1 positive Placebo v PD-L1 positive Atzolizumab
    Number of subjects included in analysis
    233
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.4
    Method
    Cox model
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.88
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.65
         upper limit
    1.18

    Secondary: Treatment exposure

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    End point title
    Treatment exposure
    End point description
    End point type
    Secondary
    End point timeframe
    From start of trial until date of data cut-off (10/15/2023)
    End point values
    Placebo Atezolizumab
    Number of subjects analysed
    202
    407
    Units: month
        median (inter-quartile range (Q1-Q3))
    11.2 (8.41 to 16.74)
    11.33 (7.06 to 18.28)
    No statistical analyses for this end point

    Secondary: Overall survival

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    End point title
    Overall survival
    End point description
    End point type
    Secondary
    End point timeframe
    Over the whole duration of the study.
    End point values
    Placebo Atezolizumab PD-L1 positive Placebo PD-L1 positive Atzolizumab
    Number of subjects analysed
    204
    410
    77
    156
    Units: percent
        number (confidence interval 95%)
    30.62 (27.79 to 33.15)
    35.75 (32.89 to 41.00)
    33.68 (30.62 to 50.76)
    42.97 (38.05 to 50.23)
    Statistical analysis title
    Cox model results in ITT population
    Statistical analysis description
    The proportional hazard assumption was tested using Likelihood ratio test on time-dependent coefficient. The test statistic for the likelihood ratio test between the time independent and time dependent models was 1.422. With one degree of freedom, the corresponding p value is equal to 0.233, therefore the time dependent coefficient is non-significant. Based on this result, an adjusted Cox model without time varying effect of treatment was used for the analysis on the ITT population.
    Comparison groups
    Placebo v Atezolizumab
    Number of subjects included in analysis
    614
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    0.98
    Statistical analysis title
    Cox model results in PD-L1 positive population
    Comparison groups
    PD-L1 positive Placebo v PD-L1 positive Atzolizumab
    Number of subjects included in analysis
    233
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.84
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.6
         upper limit
    1.17

    Secondary: Time to first subsequent therapy

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    End point title
    Time to first subsequent therapy
    End point description
    End point type
    Secondary
    End point timeframe
    Over the whole duration of the trial
    End point values
    Placebo Atezolizumab PD-L1 positive Placebo PD-L1 positive Atzolizumab
    Number of subjects analysed
    204
    410
    77
    156
    Units: month
        median (confidence interval 95%)
    12.42 (11.83 to 14.42)
    14.36 (13.67 to 15.64)
    14.16 (12.02 to 18.43)
    17.12 (14.36 to 19.98)
    Statistical analysis title
    Cox model results in ITT population
    Comparison groups
    Placebo v Atezolizumab
    Number of subjects included in analysis
    614
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    0.99
    Statistical analysis title
    Cox model in PD-L1 positive population
    Comparison groups
    PD-L1 positive Placebo v PD-L1 positive Atzolizumab
    Number of subjects included in analysis
    233
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.89
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.66
         upper limit
    1.19

    Secondary: Time to second subsequent therapy

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    End point title
    Time to second subsequent therapy
    End point description
    End point type
    Secondary
    End point timeframe
    Endpoint was assessed over the entire duration of the study from 25/09/2016 to 15/10/2023.
    End point values
    Placebo Atezolizumab PD-L1 positive Placebo PD-L1 positive Atzolizumab
    Number of subjects analysed
    204
    410
    77
    156
    Units: month
        median (confidence interval 95%)
    20.99 (18.63 to 23.75)
    23.72 (22.60 to 25.72)
    25.26 (21.62 to 31.18)
    27.14 (24.61 to 33.08)
    Statistical analysis title
    Cox model results in ITT population
    Comparison groups
    Placebo v Atezolizumab
    Number of subjects included in analysis
    614
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    0.99
    Statistical analysis title
    Cox model in PD-L1 positive population
    Comparison groups
    PD-L1 positive Placebo v PD-L1 positive Atzolizumab
    Number of subjects included in analysis
    233
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.97
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.71
         upper limit
    1.32

    Secondary: Time to RECIST progression or CA125 deterioration

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    End point title
    Time to RECIST progression or CA125 deterioration
    End point description
    End point type
    Secondary
    End point timeframe
    Was assessed over the entire duration of the study from 25/09/2016 to 15/10/2023.
    End point values
    Placebo Atezolizumab PD-L1 positive Placebo PD-L1 positive Atzolizumab
    Number of subjects analysed
    204
    410
    77
    156
    Units: month
        median (confidence interval 95%)
    10.81 (10.38 to 11.17)
    11.56 (11.07 to 12.88)
    11.17 (10.64 to 12.45)
    13.70 (12.62 to 16.39)
    Statistical analysis title
    Cox model results in ITT population
    Comparison groups
    Placebo v Atezolizumab
    Number of subjects included in analysis
    614
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.67
         upper limit
    0.95
    Statistical analysis title
    Cox model in PD-L1 positive population
    Comparison groups
    PD-L1 positive Placebo v PD-L1 positive Atzolizumab
    Number of subjects included in analysis
    233
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.73
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.55
         upper limit
    0.98

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events will be collected from time of signature of informed consent, throughout the treatment period and up to and including the 30-day follow-up period.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26
    Reporting groups
    Reporting group title
    Safety population
    Reporting group description
    The safety was described on the safety set population (N=609), including only patients who had at least one dose of study treatment. 5 patients (3 in the atezolizumab group and 2 in the placebo group) did not start bevacizumab nor atezolizumab after randomization.

    Serious adverse events
    Safety population
    Total subjects affected by serious adverse events
         subjects affected / exposed
    444 / 609 (72.91%)
         number of deaths (all causes)
    443
         number of deaths resulting from adverse events
    19
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute megakaryocytic leukaemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Acute myeloid leukaemia
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    2 / 3
    Adrenal metastases
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Breast cancer
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cancer pain
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lymphangitis carcinomatosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myelodysplastic syndrome
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    Paraneoplastic syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Aortic stenosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypertension
         subjects affected / exposed
    190 / 609 (31.20%)
         occurrences causally related to treatment / all
    173 / 190
         deaths causally related to treatment / all
    0 / 0
    Hematoma
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombosis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Embolism
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haematoma
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malignant hypertension
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Phlebitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Venous thrombosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Intervertebral disc operation
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary catheter insertion
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Stomatitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Asthenia
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Catheter infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Death
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Drug intolerance
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    10 / 609 (1.64%)
         occurrences causally related to treatment / all
    4 / 10
         deaths causally related to treatment / all
    0 / 0
    Inflammation
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza like illness
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mucositis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Multi organ failure
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pain
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    8 / 609 (1.31%)
         occurrences causally related to treatment / all
    1 / 8
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    7 / 609 (1.15%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Anaphylactic reaction
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Anaphylactic shock
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Drug hypersensitivity
         subjects affected / exposed
    7 / 609 (1.15%)
         occurrences causally related to treatment / all
    5 / 7
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Rectovaginal fistula
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute pulmonary oedema
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Dyspnea
         subjects affected / exposed
    5 / 609 (0.82%)
         occurrences causally related to treatment / all
    1 / 5
         deaths causally related to treatment / all
    0 / 0
    Embolism pulmonary
         subjects affected / exposed
    19 / 609 (3.12%)
         occurrences causally related to treatment / all
    12 / 19
         deaths causally related to treatment / all
    1 / 2
    Laryngeal spasm
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    4 / 4
         deaths causally related to treatment / all
    0 / 0
    Lung disorder
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Pulmonary infarction
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    Alkaline phosphatase increased
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    7 / 609 (1.15%)
         occurrences causally related to treatment / all
    6 / 7
         deaths causally related to treatment / all
    0 / 0
    CSF white blood cell count decreased
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    GGT increased
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Left ventricular ejection fraction decreased
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    10 / 609 (1.64%)
         occurrences causally related to treatment / all
    2 / 10
         deaths causally related to treatment / all
    0 / 0
    Renal biopsy
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transaminases increased
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    White blood cell decreased
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Cat bite
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye burns
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fracture vertebral
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hip fracture
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infusion related reaction
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Intraoperative hemorrhage
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Post biopsy bleeding
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Procedural pneumothorax
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tendon achilles rupture
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Congenital, familial and genetic disorders
    Aplasia
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Acute coronary syndrome
         subjects affected / exposed
    5 / 609 (0.82%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Acute heart failure
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Cardiac disorder
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac dysfunction
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Cardiac failure
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Coronary artery stenosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    Myocarditis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Non ST segment elevation myocardial infarction
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Palpitations
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cephalgia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral ischaemia
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Cerebral venous thrombosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Dizziness
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Encephalopathy
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Epileptic seizure
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Headache aggravated
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hemorrhagic stroke
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Hypercapnic coma
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Cerebrovascular accident
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Ischemic stroke
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningismus
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningorrhagia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Neurologic disorder NOS
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Posterior reversible encephalopathy syndrome
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Stroke
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Transient ischemic attack
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Tremor
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Loss of consciousness
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    10 / 609 (1.64%)
         occurrences causally related to treatment / all
    2 / 10
         deaths causally related to treatment / all
    0 / 0
    Aplasia bone marrow
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Febrile aplasia
         subjects affected / exposed
    8 / 609 (1.31%)
         occurrences causally related to treatment / all
    2 / 8
         deaths causally related to treatment / all
    0 / 1
    Evans syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    30 / 609 (4.93%)
         occurrences causally related to treatment / all
    6 / 30
         deaths causally related to treatment / all
    0 / 0
    Hemolytic anemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperviscosity syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune thrombocytopenic purpura
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Neutropenia
         subjects affected / exposed
    42 / 609 (6.90%)
         occurrences causally related to treatment / all
    10 / 42
         deaths causally related to treatment / all
    0 / 0
    Pancytopenia
         subjects affected / exposed
    17 / 609 (2.79%)
         occurrences causally related to treatment / all
    8 / 17
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    68 / 609 (11.17%)
         occurrences causally related to treatment / all
    12 / 68
         deaths causally related to treatment / all
    0 / 0
    Thrombotic microangiopathy
         subjects affected / exposed
    9 / 609 (1.48%)
         occurrences causally related to treatment / all
    9 / 9
         deaths causally related to treatment / all
    0 / 0
    Thrombotic thrombocytopenic purpura
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Splenic haematoma
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bone marrow failure
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Eosinophilia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ear and labyrinth disorders
    Labyrinthine hydrops
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Blurred vision
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Posterior vitreous detachment
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Retinal bleeding
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Uveitis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Vitreous hemorrhage
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal hernia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    8 / 609 (1.31%)
         occurrences causally related to treatment / all
    1 / 8
         deaths causally related to treatment / all
    0 / 0
    Acute abdomen
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Autoimmune colitis
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    4 / 4
         deaths causally related to treatment / all
    0 / 0
    Autoimmune pancreatitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bloody stool
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bowel perforation
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    1 / 1
    Colitis
         subjects affected / exposed
    7 / 609 (1.15%)
         occurrences causally related to treatment / all
    7 / 7
         deaths causally related to treatment / all
    0 / 0
    Colonic fistula
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Constipation
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal motility disorder
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    22 / 609 (3.61%)
         occurrences causally related to treatment / all
    15 / 22
         deaths causally related to treatment / all
    0 / 0
    Duodenal ulcer
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterocutaneous fistula
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Epigastric pain
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal fistula
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Glossitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Haematemesis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hemorrhoids
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hernial eventration
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ileus
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    11 / 609 (1.81%)
         occurrences causally related to treatment / all
    1 / 11
         deaths causally related to treatment / all
    0 / 0
    Intestinal perforation
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    Intestinal subobstruction
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mechanical ileus
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Melaena
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nausea
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Perforation gastrointestinal
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Rectal pain
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Rectal perforation
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reflux oesophagitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Small bowel obstruction
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Small intestinal perforation
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Stagnation of intestinal contents
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Subileus
         subjects affected / exposed
    11 / 609 (1.81%)
         occurrences causally related to treatment / all
    3 / 11
         deaths causally related to treatment / all
    0 / 0
    Subocclusive syndrome
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Upper gastrointestinal hemorrhage
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    11 / 609 (1.81%)
         occurrences causally related to treatment / all
    5 / 10
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Acute cholecystitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Autoimmune hepatitis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Bile duct stenosis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Biliary colic
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Calculus biliary
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cholestasis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatic cytolysis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gallbladder rupture
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatic failure
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatitis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Liver disorder
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatitis acute
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatocellular injury
         subjects affected / exposed
    5 / 609 (0.82%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Cutaneous lupus erythematosus
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Dermatitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dermatitis bullous
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dermatomyositis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Drug eruption
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Erythroderma
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Exanthema
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gallbladder perforation
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hidradenitis suppurativa
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Itching and rash
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Leg ulcer
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Macular rash
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Maculopapular rash
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Palmar-plantar erythrodysesthesia syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin rash
         subjects affected / exposed
    21 / 609 (3.45%)
         occurrences causally related to treatment / all
    19 / 21
         deaths causally related to treatment / all
    0 / 0
    Skin toxicity
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Stevens-Johnson syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney failure
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Proteinuria
         subjects affected / exposed
    22 / 609 (3.61%)
         occurrences causally related to treatment / all
    19 / 22
         deaths causally related to treatment / all
    0 / 0
    Acute renal insufficiency
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute renal failure
         subjects affected / exposed
    5 / 609 (0.82%)
         occurrences causally related to treatment / all
    2 / 5
         deaths causally related to treatment / all
    0 / 0
    Glomerulonephritis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Macroscopic haematuria
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Nephrotic syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pelvicaliectasis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal failure
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal insufficiency
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal impairment
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Adrenal insufficiency
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Autoimmune thyroid disorder
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Autoimmune thyroiditis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Hyperthyroidism
         subjects affected / exposed
    15 / 609 (2.46%)
         occurrences causally related to treatment / all
    12 / 15
         deaths causally related to treatment / all
    0 / 0
    Hypophysitis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Hypothyroidism
         subjects affected / exposed
    72 / 609 (11.82%)
         occurrences causally related to treatment / all
    70 / 72
         deaths causally related to treatment / all
    0 / 0
    Panhypopituitarism
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Thyroiditis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Bone pain
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Joint pain
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Myalgia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myositis
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    4 / 4
         deaths causally related to treatment / all
    0 / 0
    Rhizomelic pseudopolyarthritis
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Abscess
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Abscess dental
         subjects affected / exposed
    5 / 609 (0.82%)
         occurrences causally related to treatment / all
    3 / 5
         deaths causally related to treatment / all
    0 / 0
    Abscess gum
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Anal abscess
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Acute upper respiratory tract infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Ascites infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Aspergillosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bacterial sepsis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    CMV infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    6 / 609 (0.99%)
         occurrences causally related to treatment / all
    3 / 6
         deaths causally related to treatment / all
    0 / 0
    COVID-19
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diverticulitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Encephalitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterococcus faecalis infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Erysipelas
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Escherichia sepsis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Escherichia urinary tract infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Flu syndrome
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infected lymphocele
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Influenza A virus infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    H1N1 influenza
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Groin abscess
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Papulopustular rash
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pelvic abscess
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Perianal abscess
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Periorbital cellulitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Peritoneal infection
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Peritonitis
         subjects affected / exposed
    3 / 609 (0.49%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    1 / 1
    Pyelitis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    10 / 609 (1.64%)
         occurrences causally related to treatment / all
    0 / 10
         deaths causally related to treatment / all
    0 / 0
    Respiratory infection
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    4 / 609 (0.66%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Septic arthritis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Septicaemia due to Escherichia coli (E. coli)
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Stoma site infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tooth abscess
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory infection
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary infection
         subjects affected / exposed
    8 / 609 (1.31%)
         occurrences causally related to treatment / all
    1 / 8
         deaths causally related to treatment / all
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vertebral abscess
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Arthritis bacterial
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteonecrosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Diabetes
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Diabetes with ketoacidosis
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Electrolyte disturbance
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperamylasemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypercalcemia
         subjects affected / exposed
    2 / 609 (0.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypercreatininaemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperkalemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperlipasemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypokalemia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatremia
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatremia aggravated
         subjects affected / exposed
    1 / 609 (0.16%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    Safety population
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    609 / 609 (100.00%)
    Vascular disorders
    HYPERTENSION
         subjects affected / exposed
    231 / 609 (37.93%)
         occurrences all number
    451
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    353 / 609 (57.96%)
         occurrences all number
    1042
    NEUTROPENIA
         subjects affected / exposed
    354 / 609 (58.13%)
         occurrences all number
    1166
    THROMBOCYTOPENIA
         subjects affected / exposed
    304 / 609 (49.92%)
         occurrences all number
    1026
    LEUKOPENIA
         subjects affected / exposed
    133 / 609 (21.84%)
         occurrences all number
    416
    General disorders and administration site conditions
    ASTHENIA
         subjects affected / exposed
    327 / 609 (53.69%)
         occurrences all number
    817
    FATIGUE
         subjects affected / exposed
    175 / 609 (28.74%)
         occurrences all number
    377
    Gastrointestinal disorders
    NAUSEA
         subjects affected / exposed
    382 / 609 (62.73%)
         occurrences all number
    852
    DIARRHOEA
         subjects affected / exposed
    239 / 609 (39.24%)
         occurrences all number
    476
    CONSTIPATION
         subjects affected / exposed
    237 / 609 (38.92%)
         occurrences all number
    411
    Respiratory, thoracic and mediastinal disorders
    EPISTAXIS
         subjects affected / exposed
    226 / 609 (37.11%)
         occurrences all number
    326
    Renal and urinary disorders
    PROTEINURIA
         subjects affected / exposed
    184 / 609 (30.21%)
         occurrences all number
    480

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    04 Jul 2016
    Modified protocol to include clarifications of subject selection criteria. Clarification of exploratory objectives. Amended of stratification factor. Clarifications of the use of corticosteroids. Clarifications of the collection of auto-immune disease. Amended management of bevacizumab and atezolizumab specific adverse event. Modification of the frequency of questionnaires collection. Added of data sharing.
    20 Oct 2016
    Amended management of atezolizumab specific adverse event.
    07 Apr 2017
    Modified protocol to add secondary objective. Modification of statistical analysis. Clarification of inclusion criteria.
    18 Dec 2017
    Amended management of atezolizumab specific adverse events. Clarification of exclusion criteria.
    26 Nov 2018
    Increase of the number of patients (from 405 to 600), update of the study calendar, addition of a co-primary outcome, update of secondary objectives, modification of statistical methods and sample size determination, modification of the management of atezolizumab specific adverse events (addition of renal events) and suppression of PRO sub-study.
    17 May 2019
    Change of sponsor’s address and phone number, precision regarding study treatment duration, precision of estimated date of end of study, addition of a secondary objective (PK and ADA analysis), addition of an exploratory objective, modification of statistical part, addition of a possible Blinded Independent Scan Review, precision regarding the necessity of the additional CT scan after detection of disease progression, modification of the management of atezolizumab specific adverse events (addition of immune-related Myositis), clarification regarding the unblinded treatment, clarification to make the difference between patient study treatment withdrawal and patient study withdrawal, clarification of the definition of SAE, list of AESI updated.
    04 May 2020
    Amended management of atezolizumab specific adverse events, list of AESI of atezolizumab updated.
    06 Nov 2020
    Modifications of statistical part and amended management of atezolizumab specific adverse events
    08 Mar 2021
    Amended management of atezolizumab specific adverse events (MAS/HLH added).
    26 Nov 2021
    Addition of secondary objective (PFS1 and OS will be evaluated according to PD-L1 and/or CD8 status) with related modifications in the chapters of Translational Research, statistical analysis and references. Alignment of the statistical test for the co-primary efficacy endpoint with Statistical Analysis Plan. Replacement of new GCIG logo and correction of minor typo. Update of the Trial Manager name.

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/37643382
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