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    Clinical Trial Results:
    An International, Multicenter, Open-label, Randomized, Phase 3 Study of BLU-285 vs Regorafenib in subjects with Locally Advanced Unresectable or Metastatic Gastrointestinal Stromal Tumor (GIST)

    Summary
    EudraCT number
    2017-003497-14
    Trial protocol
    GB   FR   SE   HU   DE   NL   AT   ES   BE   CZ   IT  
    Global end of trial date
    15 Sep 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    11 May 2022
    First version publication date
    11 May 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    BLU-285-1303
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03465722
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Blueprint Medicines Corporation
    Sponsor organisation address
    45 Sidney Street, Cambridge, United States, MA 02139
    Public contact
    Project Director, Global Oncology, INC Research, +44 7717348365, shaun.bedford@syneoshealth.com
    Scientific contact
    Project Director, Global Oncology, INC Research, +44 7717348365, shaun.bedford@syneoshealth.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Sep 2021
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Sep 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of this study was to demonstrate the efficacy of avapritinib based on progression-free survival (PFS) determined by central radiological assessment per (Modified) Response Evaluation Criteria in Solid Tumors (mRECIST), version 1.1 in subjects with advanced Gastrointestinal stromal tumor (GIST) following 2 or 3 regimens of prior treatment, including imatinib, compared to subjects treated with regorafenib.
    Protection of trial subjects
    This trial was designed and monitored in accordance with Sponsor procedures, which comply with the ethical principles of Good Clinical Practice (GCP) as required by the major regulatory authorities, and in accordance with the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    26 Mar 2018
    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
    Singapore: 4
    Country: Number of subjects enrolled
    United States: 133
    Country: Number of subjects enrolled
    Netherlands: 8
    Country: Number of subjects enrolled
    Poland: 19
    Country: Number of subjects enrolled
    Spain: 25
    Country: Number of subjects enrolled
    Sweden: 13
    Country: Number of subjects enrolled
    United Kingdom: 24
    Country: Number of subjects enrolled
    Austria: 1
    Country: Number of subjects enrolled
    Belgium: 2
    Country: Number of subjects enrolled
    Czechia: 4
    Country: Number of subjects enrolled
    France: 42
    Country: Number of subjects enrolled
    Germany: 35
    Country: Number of subjects enrolled
    Hungary: 3
    Country: Number of subjects enrolled
    Italy: 28
    Country: Number of subjects enrolled
    China: 74
    Country: Number of subjects enrolled
    Canada: 8
    Country: Number of subjects enrolled
    Korea, Republic of: 43
    Country: Number of subjects enrolled
    Australia: 10
    Worldwide total number of subjects
    476
    EEA total number of subjects
    180
    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)
    287
    From 65 to 84 years
    186
    85 years and over
    3

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Overall, 569 subjects were screened, of them, 476 subjects were randomized and enrolled in the study.

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Avapritinib : 300 mg PO QD
    Arm description
    Subjects received avapritinib 300 milligrams (mg) orally (PO) once daily (QD), continuously in 28-day cycles.
    Arm type
    Experimental

    Investigational medicinal product name
    Avapritinib
    Investigational medicinal product code
    BLU-285
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received avapritinib 300 milligrams (mg) orally (PO) once daily (QD), continuously in 28-day cycles.

    Arm title
    Regorafinib: 160 mg PO QD
    Arm description
    Subjects received regorafenib 160 mg PO QD, for 3 weeks out of every 4 weeks (ie. 3 weeks on/1 week off) in 28-day cycles.
    Arm type
    Active comparator

    Investigational medicinal product name
    Regorafinib 160mg PO QD
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received regorafenib 160 mg PO QD, for 3 weeks out of every 4 weeks (ie. 3 weeks on/1 week off) in 28-day cycles.

    Number of subjects in period 1
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD
    Started
    240
    236
    Completed
    0
    0
    Not completed
    240
    236
         Consent withdrawn by subject
    21
    14
         Administrative
    33
    32
         Death
    89
    87
         Lost to follow-up
    5
    3
         Sponsor decision
    91
    98
         Not treated
    1
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Avapritinib : 300 mg PO QD
    Reporting group description
    Subjects received avapritinib 300 milligrams (mg) orally (PO) once daily (QD), continuously in 28-day cycles.

    Reporting group title
    Regorafinib: 160 mg PO QD
    Reporting group description
    Subjects received regorafenib 160 mg PO QD, for 3 weeks out of every 4 weeks (ie. 3 weeks on/1 week off) in 28-day cycles.

    Reporting group values
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD Total
    Number of subjects
    240 236 476
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    61.1 ( 10.96 ) 61.0 ( 10.74 ) -
    Gender categorical
    Units: Subjects
        Female
    78 80 158
        Male
    162 156 318
    Race
    Units: Subjects
        American Indian or Alaska Native
    0 0 0
        Asian
    64 64 128
        Native Hawaiian or Other Pacific Islander
    1 1 2
        Black or African American
    9 5 14
        White
    139 143 282
        More than one race
    0 0 0
        Unknown or Not Reported
    27 23 50
    Body Mass Index (BMI)
    Both height and weight measurements are needed for body mass index calculation. Some subjects had missing height and/or weight measurements. Only subjects with both a height and a weight measurement are included in the body mass index calculation.
    Units: Kilogram per meter square
        arithmetic mean (standard deviation)
    25.50 ( 5.563 ) 24.69 ( 5.163 ) -

    End points

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    End points reporting groups
    Reporting group title
    Avapritinib : 300 mg PO QD
    Reporting group description
    Subjects received avapritinib 300 milligrams (mg) orally (PO) once daily (QD), continuously in 28-day cycles.

    Reporting group title
    Regorafinib: 160 mg PO QD
    Reporting group description
    Subjects received regorafenib 160 mg PO QD, for 3 weeks out of every 4 weeks (ie. 3 weeks on/1 week off) in 28-day cycles.

    Primary: Efficacy of Avapritinib Based on Progression-free Survival (PFS) Determined by Central Radiological Assessment Per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), Version 1.1

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    End point title
    Efficacy of Avapritinib Based on Progression-free Survival (PFS) Determined by Central Radiological Assessment Per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), Version 1.1
    End point description
    To demonstrate the efficacy of avapritinib based on progression-free survival (PFS) determined by central radiological assessment per modified Response Evaluation Criteria in Solid Tumors (mRECIST), version 1.1 in subjects with advanced GIST following 2 or 3 regimens of prior treatment with a tyrosine kinase inhibitor (TKI), including imatinib, compared to subjects treated with regorafenib. A progressively growing tumor must meet the following criteria: a) the target lesions must be greater or equal to 2cm in size and be a new GIST active lesion or b) the target lesions must be expanding on at least 2 sequential imaging studies. Intent-to-treat population that included all subject randomized to study.
    End point type
    Primary
    End point timeframe
    24 Months
    End point values
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD
    Number of subjects analysed
    240
    236
    Units: Months
        median (confidence interval 95%)
    4.2 (3.7 to 5.6)
    5.6 (3.8 to 7.2)
    Statistical analysis title
    stratified log-rank test
    Statistical analysis description
    A stratified log-rank test was performed to compare the progression free survival of avapritinib versus regorafenib. The nominal 2-sided p-value was 0.055, indicating there was no significant difference between the two treatments in extending patients' progression free survival.
    Comparison groups
    Avapritinib : 300 mg PO QD v Regorafinib: 160 mg PO QD
    Number of subjects included in analysis
    476
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.055
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.247
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.992
         upper limit
    1.5666

    Secondary: Objective Response Rate (ORR) Determined by Central Radiology Assessment Per mRECIST, Version 1.1

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    End point title
    Objective Response Rate (ORR) Determined by Central Radiology Assessment Per mRECIST, Version 1.1
    End point description
    To evaluate objective response rate (ORR) determined by central radiology assessment per mRECIST, version 1.1 in subjects with advanced GIST treated with avapritinib compared to subjects treated with regorafenib. A complete response (CR) per modified Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) is defined as complete disappearance of all target lesions. A partial response (PR) is defined as at least 30% decrease in the sum of diameters of target lesions taking as reference the baseline sum of diameters. Overall Response (OR) = CR + PR. Intent-to-treat population that included all subject randomized to study.
    End point type
    Secondary
    End point timeframe
    24 Months
    End point values
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD
    Number of subjects analysed
    240
    236
    Units: Subjects
        Responder
    41
    17
        Non-Responder
    199
    219
    No statistical analyses for this end point

    Secondary: Overall Survival (OS) in Subjects With Advanced GIST Treated With Avapritinib Compared to subjects Treated With Regorafenib

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    End point title
    Overall Survival (OS) in Subjects With Advanced GIST Treated With Avapritinib Compared to subjects Treated With Regorafenib
    End point description
    To evaluate overall survival (OS) in subjects with advanced GIST treated with avapritinib compared to subjects treated with regorafenib. Here, "99999" indicates upper bound of the confidence interval is not estimable by the Kaplan-Meier analysis due to the short follow-up time. Intent-to-treat population that included all subject randomized to study. Since the primary endpoint of statiscally significant in PFS was not met subjects are not being followed for OS.
    End point type
    Secondary
    End point timeframe
    24 Months
    End point values
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD
    Number of subjects analysed
    240
    236
    Units: Months
        median (confidence interval 95%)
    19.2 (19.2 to 99999)
    17.4 (15.8 to 99999)
    No statistical analyses for this end point

    Secondary: European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-30). Change in Individual Scores in subjects With Advanced GIST Treated With Avapritinib Compared to subjects Treated With Regorafenib

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    End point title
    European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-30). Change in Individual Scores in subjects With Advanced GIST Treated With Avapritinib Compared to subjects Treated With Regorafenib
    End point description
    The Global Health Status Score is derived from question 29 and 30 on the EORTC-QLQ-C30 tool. The change in score was assessed between baseline and week 12 in subjects treated with advanced GIST treated with avapritinib compared to subjects treated with regorafenib. The Global Health Status Score score range is 0 to 100 with a higher score indicating better global health status. A positive change indicates improvement in global health status. Intent-to-treat population with both a baseline and a week 12 measurements.
    End point type
    Secondary
    End point timeframe
    Difference between baseline and week 12 of treatment
    End point values
    Avapritinib : 300 mg PO QD Regorafinib: 160 mg PO QD
    Number of subjects analysed
    123 [1]
    138 [2]
    Units: scores on a scale
        median (standard deviation)
    -5.7 ( 24.29 )
    -4.4 ( 20.74 )
    Notes
    [1] - “Subject Analysed” signifies those subjects who were evaluable at specified time points.
    [2] - “Subject Analysed” signifies those subjects who were evaluable at specified time points.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the date of first study drug administration to 30 days after last study drug administration, approximately 6 months
    Adverse event reporting additional description
    The total number of at risk subjects includes subjects that were randomized to treatment and received at least one dose of treatment. Subjects that were randomized by did not receive treatment were excluded from the safety analysis.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Avapritinib: 300 mg PO QD
    Reporting group description
    Avapritinib: Avapritinib tablets for oral administration. Avapritinib will be dosed at 300 mg once daily, continuously.

    Reporting group title
    Regorafinib: 160 mg PO QD
    Reporting group description
    Regorafenib tablets for oral administration. Regorafenib will be dosed at 160 mg once daily for 3 weeks out of every 4 weeks (ie. 3 weeks on/1 week off).

    Serious adverse events
    Avapritinib: 300 mg PO QD Regorafinib: 160 mg PO QD
    Total subjects affected by serious adverse events
         subjects affected / exposed
    106 / 239 (44.35%)
    91 / 234 (38.89%)
         number of deaths (all causes)
    14
    13
         number of deaths resulting from adverse events
    13
    13
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasm progression
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Tumour haemorrhage
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Adenocarcinoma of colon
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast cancer
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malignant ascites
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malignant neoplasm progression
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    Metastases to liver
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour necrosis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Basal cell carcinoma
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal stromal tumour
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Liver carcinoma ruptured
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour fistulisation
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour pain
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritoneal sarcoma
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour compression
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 239 (0.00%)
    3 / 234 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypotension
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Disease progression
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 2
    0 / 2
    Face oedema
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Generalised oedema
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Multi-organ failure
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    Pyrexia
         subjects affected / exposed
    4 / 239 (1.67%)
    7 / 234 (2.99%)
         occurrences causally related to treatment / all
    1 / 4
    4 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chest pain
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    2 / 239 (0.84%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    3 / 239 (1.26%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Hernia perforation
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperthermia
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Inflammation
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 239 (0.00%)
    3 / 234 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Condition aggravated
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Malaise
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Anaphylactic reaction
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Drug hypersensitivity
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Uterine haemorrhage
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Benign prostatic hyperplasia
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    3 / 239 (1.26%)
    5 / 234 (2.14%)
         occurrences causally related to treatment / all
    0 / 3
    3 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory distress
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Respiratory failure
         subjects affected / exposed
    1 / 239 (0.42%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Bronchitis chronic
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Epistaxis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Insomnia
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Major depression
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Amylase increased
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood bilirubin increased
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Spinal fracture
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Accidental overdose
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anastomotic stenosis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound dehiscence
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure congestive
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocarditis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Acute coronary syndrome
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ventricular arrhythmia
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cognitive disorder
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Coma
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Facial paresis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    VIIth nerve paralysis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemolytic uraemic syndrome
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    27 / 239 (11.30%)
    7 / 234 (2.99%)
         occurrences causally related to treatment / all
    15 / 27
    3 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Retinal vein occlusion
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    5 / 239 (2.09%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 5
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    6 / 239 (2.51%)
    5 / 234 (2.14%)
         occurrences causally related to treatment / all
    3 / 6
    3 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    5 / 239 (2.09%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    1 / 5
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    4 / 239 (1.67%)
    5 / 234 (2.14%)
         occurrences causally related to treatment / all
    0 / 4
    4 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastric haemorrhage
         subjects affected / exposed
    4 / 239 (1.67%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    1 / 4
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal distension
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intra-abdominal haemorrhage
         subjects affected / exposed
    3 / 239 (1.26%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    13 / 239 (5.44%)
    11 / 234 (4.70%)
         occurrences causally related to treatment / all
    1 / 13
    0 / 11
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Lower gastrointestinal haemorrhage
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diverticular perforation
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Duodenitis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastritis
         subjects affected / exposed
    1 / 239 (0.42%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal fistula
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    2 / 239 (0.84%)
    3 / 234 (1.28%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Intestinal perforation
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Oesophagitis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anal fistula
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastric ulcer
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal toxicity
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Inguinal hernia strangulated
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Large intestinal obstruction
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritoneal haemorrhage
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Small intestine ulcer
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    2 / 239 (0.84%)
    3 / 234 (1.28%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastric mucosal lesion
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal haemorrhage
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatic haemorrhage
         subjects affected / exposed
    3 / 239 (1.26%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Jaundice
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Portal hypertension
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholangitis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bile duct stenosis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Drug-induced liver injury
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic failure
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Hepatic pain
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatotoxicity
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperbilirubinaemia
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic function abnormal
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Purpura
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rash morbilliform
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin toxicity
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    4 / 239 (1.67%)
    4 / 234 (1.71%)
         occurrences causally related to treatment / all
    2 / 4
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Autoimmune nephritis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Calculus urinary
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nephrolithiasis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    3 / 239 (1.26%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spinal pain
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Arthritis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal pain
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    5 / 239 (2.09%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bacteraemia
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 239 (0.84%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lung infection
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rhinovirus infection
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 239 (0.42%)
    3 / 234 (1.28%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diverticulitis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Enteritis infectious
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hypokalaemia
         subjects affected / exposed
    2 / 239 (0.84%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypophosphataemia
         subjects affected / exposed
    2 / 239 (0.84%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Decreased appetite
         subjects affected / exposed
    1 / 239 (0.42%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dehydration
         subjects affected / exposed
    1 / 239 (0.42%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    1 / 239 (0.42%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diabetes mellitus
         subjects affected / exposed
    0 / 239 (0.00%)
    2 / 234 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Failure to thrive
         subjects affected / exposed
    0 / 239 (0.00%)
    1 / 234 (0.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 12
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    hypoglycaemia
         subjects affected / exposed
    2 / 239 (0.84%)
    0 / 234 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Avapritinib: 300 mg PO QD Regorafinib: 160 mg PO QD
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    218 / 239 (91.21%)
    224 / 234 (95.73%)
    Investigations
    Blood alkaline phosphatase increased
         subjects affected / exposed
    6 / 239 (2.51%)
    13 / 234 (5.56%)
         occurrences all number
    6
    13
    White blood cell count decreased
         subjects affected / exposed
    42 / 239 (17.57%)
    7 / 234 (2.99%)
         occurrences all number
    42
    7
    Aspartate aminotransferase increased
         subjects affected / exposed
    33 / 239 (13.81%)
    33 / 234 (14.10%)
         occurrences all number
    33
    33
    Weight decreased
         subjects affected / exposed
    24 / 239 (10.04%)
    53 / 234 (22.65%)
         occurrences all number
    24
    53
    Blood creatinine increased
         subjects affected / exposed
    21 / 239 (8.79%)
    12 / 234 (5.13%)
         occurrences all number
    21
    12
    Weight increased
         subjects affected / exposed
    18 / 239 (7.53%)
    4 / 234 (1.71%)
         occurrences all number
    18
    4
    Alanine aminotransferase increased
         subjects affected / exposed
    15 / 239 (6.28%)
    29 / 234 (12.39%)
         occurrences all number
    15
    29
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    32 / 239 (13.39%)
    19 / 234 (8.12%)
         occurrences all number
    32
    19
    Dysgeusia
         subjects affected / exposed
    20 / 239 (8.37%)
    11 / 234 (4.70%)
         occurrences all number
    20
    11
    Memory impairment
         subjects affected / exposed
    31 / 239 (12.97%)
    5 / 234 (2.14%)
         occurrences all number
    31
    5
    Headache
         subjects affected / exposed
    29 / 239 (12.13%)
    43 / 234 (18.38%)
         occurrences all number
    29
    43
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    55 / 239 (23.01%)
    13 / 234 (5.56%)
         occurrences all number
    55
    13
    Mucosal inflammation
         subjects affected / exposed
    3 / 239 (1.26%)
    28 / 234 (11.97%)
         occurrences all number
    3
    28
    Eye disorders
    Periorbital oedema
         subjects affected / exposed
    68 / 239 (28.45%)
    0 / 234 (0.00%)
         occurrences all number
    68
    0
    Lacrimation increased
         subjects affected / exposed
    45 / 239 (18.83%)
    0 / 234 (0.00%)
         occurrences all number
    45
    0
    Eyelid oedema
         subjects affected / exposed
    35 / 239 (14.64%)
    0 / 234 (0.00%)
         occurrences all number
    35
    0
    Gastrointestinal disorders
    Dyspepsia
         subjects affected / exposed
    21 / 239 (8.79%)
    16 / 234 (6.84%)
         occurrences all number
    21
    16
    Gastrooesophageal reflux disease
         subjects affected / exposed
    16 / 239 (6.69%)
    7 / 234 (2.99%)
         occurrences all number
    16
    7
    Dry mouth
         subjects affected / exposed
    7 / 239 (2.93%)
    15 / 234 (6.41%)
         occurrences all number
    7
    15
    Stomatitis
         subjects affected / exposed
    7 / 239 (2.93%)
    40 / 234 (17.09%)
         occurrences all number
    7
    40
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    17 / 239 (7.11%)
    13 / 234 (5.56%)
         occurrences all number
    17
    13
    Dysphonia
         subjects affected / exposed
    8 / 239 (3.35%)
    71 / 234 (30.34%)
         occurrences all number
    8
    71
    Skin and subcutaneous tissue disorders
    Hair colour changes
         subjects affected / exposed
    33 / 239 (13.81%)
    2 / 234 (0.85%)
         occurrences all number
    33
    2
    Alopecia
         subjects affected / exposed
    24 / 239 (10.04%)
    38 / 234 (16.24%)
         occurrences all number
    24
    38
    Dry skin
         subjects affected / exposed
    10 / 239 (4.18%)
    18 / 234 (7.69%)
         occurrences all number
    10
    18
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    4 / 239 (1.67%)
    143 / 234 (61.11%)
         occurrences all number
    4
    143
    Rash maculo-papular
         subjects affected / exposed
    7 / 239 (2.93%)
    14 / 234 (5.98%)
         occurrences all number
    7
    14
    Pruritus
         subjects affected / exposed
    11 / 239 (4.60%)
    15 / 234 (6.41%)
         occurrences all number
    11
    15
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    12 / 239 (5.02%)
    3 / 234 (1.28%)
         occurrences all number
    12
    3
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    9 / 239 (3.77%)
    16 / 234 (6.84%)
         occurrences all number
    9
    16
    Myalgia
         subjects affected / exposed
    7 / 239 (2.93%)
    22 / 234 (9.40%)
         occurrences all number
    7
    22
    Muscle spasms
         subjects affected / exposed
    6 / 239 (2.51%)
    25 / 234 (10.68%)
         occurrences all number
    6
    25
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    12 / 239 (5.02%)
    0 / 234 (0.00%)
         occurrences all number
    12
    0
    Metabolism and nutrition disorders
    Hypoalbuminaemia
         subjects affected / exposed
    12 / 239 (5.02%)
    16 / 234 (6.84%)
         occurrences all number
    12
    16
    Hypocalcaemia
         subjects affected / exposed
    15 / 239 (6.28%)
    11 / 234 (4.70%)
         occurrences all number
    15
    11
    Hypomagnesaemia
         subjects affected / exposed
    11 / 239 (4.60%)
    12 / 234 (5.13%)
         occurrences all number
    11
    12

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    31 Jan 2018
    • BLU-285 was updated to the newly approved generic name, avapritinib, and the stratification of subjects by mutation status was updated from Platelet-derived growth factor receptor alpha (PDGFRA) vs V-Kit Hardy-Zuckerman 4 Feline Sarcoma Viral Oncogene Homolog (KIT) to PDGFRA D842V mutation present or absent. • Study Objectives, Study Endpoints, and related sections of the Study Summary were updated and reorganized in response to feedback from the FDA. • Study Conduct, related sections of the Study Summary, and all other related sections of the protocol were updated to clarify the circumstances where avapritinib doses could be escalated from 300 mg QD to 400 mg QD, to specify that a washout period was required for Subjects who switched from treatment with regorafenib to treatment with avapritinib, and to provide additional details for avapritinib dose reductions and re-escalations.
    02 Aug 2018
    • Inclusion criterion, the subjects with ECOG PS of 2 were no longer to be included. • The Subjects with arterial thrombotic or embolic events within 6 months or venous thrombotic events within 14 days before randomization were excluded. • Exclude subjects with a brain aneurysm if it had not been removed or repaired. • Exclude subjects with known hypersensitivity to avapritinib, regorafenib, or the excipients in either study drug as a precautionary measure.
    20 Jun 2019
    Key modifications made to the protocol as a part of Amendment 3, are summarized below. • The planned interim analysis was removed in order to provide more mature PFS and OS data at the time of primary analysis of efficacy. This also allowed enrollment of an adequate number of patients in Asia. • The EORTC-QLQ-C30 physical functioning, pain, role functioning, and appetite loss scores were moved from key secondary to secondary objectives and endpoints and were no longer in the hierarchy of the sequential testing scheme. • Removed from the exploratory objectives and corresponding endpoints the correlation of clinical efficacy with other cancer-relevant gene mutant allele fractions and mutant allele fractions measured in ctDNA • Removed the option of escalating the avapritinib dose to 400 mg QD based on analyses of safety showing earlier onset and higher-grade AEs at 400 mg dose versus 300 mg dose. • Added in Section, Prohibited Concomitant Therapy, that patients who experienced centrally confirmed disease progression but subsequently underwent radiation therapy or surgery may continue to receive study treatment with avapritinib, if the treating investigator considered it to be in the patient’s best medical interest. • Added brain imaging assessments at Week 12 (± 1 week) and Week 24 (± 1 week), and instructions to repeat as clinically indicated, ie, for unexpected neurologic AEs, in response to feedback from regulatory authorities. • Updated language used for AE and SAE definitions, recording, and reporting. • Removed the requirement that patients underwent at least 1 postbaseline tumor assessment by independent radiology reviewers to be included in the per-protocol population.

    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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