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    Clinical Trial Results:
    A Phase II, Multicenter, Randomized Study To Compare The Efficacy Of Venetoclax Plus Fulvestrant Versus Fulvestrant In Women With Estrogen Receptor-Positive, HER2-Negative Locally Advanced Or Metastatic Breast Cancer Who Experienced Disease Recurrence Or Progression During Or After CDK4/6 Inhibitor Therapy

    Summary
    EudraCT number
    2017-005118-74
    Trial protocol
    GB   DE  
    Global end of trial date

    Results information
    Results version number
    v2(current)
    This version publication date
    14 Oct 2021
    First version publication date
    05 Aug 2021
    Other versions
    v1
    Version creation reason

    Trial information

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    Trial identification
    Sponsor protocol code
    WO40181
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03584009
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH4070
    Public contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, +41 616878333, global.trial_information@roche.com
    Scientific contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, +41 616878333, global.trial_information@roche.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    05 Aug 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    05 Aug 2020
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    To evaluate and compare the efficacy of Venetoclax in combination with Fulvestrant versus Fulvestrant in Women with Estrogen Receptor-Positive, HER2-Negative locally advanced or Metastatic Breast Cancer
    Protection of trial subjects
    All study subjects were required to sign an Informed Consent Form
    Background therapy
    Subjects must not have received more than two prior lines of hormonal therapy in the locally advanced or metastatic setting. In addition, at least one line of treatment must be a CDK4/6i AND subjects must have experienced disease recurrence or progression during or after CDK4/6i therapy, which must have been administered for a minimum of 8 weeks prior to progression.
    Evidence for comparator
    -
    Actual start date of recruitment
    06 Sep 2018
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Efficacy
    Long term follow-up duration
    2 Years
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 23
    Country: Number of subjects enrolled
    Canada: 24
    Country: Number of subjects enrolled
    Germany: 14
    Country: Number of subjects enrolled
    United Kingdom: 13
    Country: Number of subjects enrolled
    United States: 29
    Worldwide total number of subjects
    103
    EEA total number of subjects
    14
    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)
    72
    From 65 to 84 years
    30
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 38 centers in 5 countries.

    Pre-assignment
    Screening details
    A total of 103 subjects were randomized in this study. Of these, 101 subjects received at least one dose of any study drug.

    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
    Venetoclax + Fulvestrant
    Arm description
    Subjects were administered Venetoclax 800mg orally once daily (QD) and Fulvestrant 500mg intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).
    Arm type
    Experimental

    Investigational medicinal product name
    Fulvestrant
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for injection
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Fulvestrant was administered intramuscularly (IM) at a dose of 500mg (on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Investigational medicinal product name
    Venetoclax
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Venetoclax was administered orally once daily (QD) at a dose of 800mg.

    Arm title
    Fulvestrant
    Arm description
    Subjects were administered Fulvestrant 500mg only intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).
    Arm type
    Active comparator

    Investigational medicinal product name
    Fulvestrant
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for injection
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Fulvestrant was administered intramuscularly (IM) at a dose of 500mg (on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Number of subjects in period 1
    Venetoclax + Fulvestrant Fulvestrant
    Started
    51
    52
    Completed
    0
    0
    Not completed
    51
    52
         Death
    18
    9
         Physician decision
    1
    1
         Ongoing in study
    29
    40
         Consent withdrawn by subject
    3
    1
         Lost to follow-up
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Venetoclax + Fulvestrant
    Reporting group description
    Subjects were administered Venetoclax 800mg orally once daily (QD) and Fulvestrant 500mg intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Reporting group title
    Fulvestrant
    Reporting group description
    Subjects were administered Fulvestrant 500mg only intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Reporting group values
    Venetoclax + Fulvestrant Fulvestrant Total
    Number of subjects
    51 52 103
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    38 34 72
        From 65-84 years
    12 18 30
        85 years and over
    1 0 1
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    57.4 ± 10.6 58.8 ± 11.7 -
    Sex: Female, Male
    Units: Participants
        Female
    51 52 103
        Male
    0 0 0
    Race/Ethnicity, Customized
    Units: Subjects
        Hispanic or Latino
    1 3 4
        Not Hispanic or Latino
    47 46 93
        Not Reported
    3 3 6
    Race/Ethnicity, Customized
    Units: Subjects
        Asian
    6 3 9
        Black or African American
    3 2 5
        White
    40 46 86
        Multiple
    1 0 1
        Unknown
    1 1 2

    End points

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    End points reporting groups
    Reporting group title
    Venetoclax + Fulvestrant
    Reporting group description
    Subjects were administered Venetoclax 800mg orally once daily (QD) and Fulvestrant 500mg intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Reporting group title
    Fulvestrant
    Reporting group description
    Subjects were administered Fulvestrant 500mg only intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Primary: Clinical benefit defined as Complete Response (CR), Partial Response (PR) or Stable Disease (SD) lasting >= 24 weeks, as determined by the Investigator according to RECIST v1.1

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    End point title
    Clinical benefit defined as Complete Response (CR), Partial Response (PR) or Stable Disease (SD) lasting >= 24 weeks, as determined by the Investigator according to RECIST v1.1
    End point description
    Clinical Benefit was defined as Complete Response, Partial Response, or Stable Disease lasting more than equal to 24 weeks from randomization in subjects with measurable disease at baseline, as determined by the investigator according to Response Evaluation Criteria In Solid Tumors Criteria (RECIST) v1.1. Per RECIST v1.1 for target lesions assessed by CT or MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the diameters of target lesions; Stable Disease (SD), neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for Disease Progression (PD), taking as reference the smallest sum on study.
    End point type
    Primary
    End point timeframe
    Randomization through till 6 months after the last subject is enrolled into the study (up to approximately 23 months).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    51
    51
    Units: Percentage of Subjects
        number (confidence interval 95%)
    11.8 (4.44 to 23.87)
    13.7 (5.70 to 26.26)
    Statistical analysis title
    (Venetoclax + Fulvestrant) vs Fulvestrant
    Comparison groups
    Fulvestrant v Venetoclax + Fulvestrant
    Number of subjects included in analysis
    102
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7286 [1]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Risk difference (RD)
    Point estimate
    -1.96
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -16.86
         upper limit
    12.94
    Notes
    [1] - P-value is based on Stratified Analysis (Stratified by BCL2 status (High vs Low) and Lines of Therapy (2 vs 1)).

    Secondary: Progression Free Survival (PFS)

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    End point title
    Progression Free Survival (PFS)
    End point description
    PFS was defined as the time from randomization to the first occurrence of disease progression (as determined by the investigator according to RECIST v1.1) or death from any cause, whichever occurs first.
    End point type
    Secondary
    End point timeframe
    Randomization through till 6 months after the last subject is enrolled into the study (up to approximately 23 months).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    51
    52
    Units: Months
        median (confidence interval 95%)
    2.69 (1.94 to 3.71)
    1.94 (1.84 to 3.55)
    Statistical analysis title
    (Venetoclax + Fulvestrant) vs Fulvestrant
    Comparison groups
    Venetoclax + Fulvestrant v Fulvestrant
    Number of subjects included in analysis
    103
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7853 [2]
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.94
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.61
         upper limit
    1.45
    Notes
    [2] - P-value is based on Stratified Analysis (Stratified by BCL2 status (High vs Low) and Lines of Therapy (2 vs 1)).

    Secondary: Objective Response (OR)

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    End point title
    Objective Response (OR)
    End point description
    OR was defined as Complete Response (CR) or Partial response (PR), in subjects with measurable disease at baseline as determined by the investigator according to RECIST v1.1.
    End point type
    Secondary
    End point timeframe
    Randomization through till 6 months after the last subject is enrolled into the study (up to approximately 23 months).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    51
    51
    Units: Percentage of Subjects
        number (confidence interval 95%)
    3.9 (0.48 to 13.46)
    5.9 (1.23 to 16.24)
    Statistical analysis title
    (Venetoclax + Fulvestrant) vs Fulvestrant
    Comparison groups
    Venetoclax + Fulvestrant v Fulvestrant
    Number of subjects included in analysis
    102
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.5978 [3]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Risk difference (RD)
    Point estimate
    -1.96
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -12.29
         upper limit
    8.37
    Notes
    [3] - P-value is based on Stratified Analysis (Stratified by BCL2 status (High vs Low) and Lines of Therapy (2 vs 1)).

    Secondary: Duration of Response (DOR)

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    End point title
    Duration of Response (DOR)
    End point description
    DOR was defined as the time from the first occurrence of a documented objective response to the time of the first documented disease progression (as determined by the investigator according to RECIST v1.1) or death from any cause, whichever occurs first. 9999 = Not Estimable.
    End point type
    Secondary
    End point timeframe
    Time from first occurrence of a documented objective response to the first documented disease progression or death from any cause, whichever occurs first, until 6 months after the last subject is enrolled in the study (up to approximately 23 months).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    2
    3
    Units: Months
        median (confidence interval 95%)
    9999 (9999 to 9999)
    3.61 (1.94 to 9999)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    Overall Survival (OS) is defined as the time from randomization to death due to any cause. Data collection is still ongoing and the results will be disclosed within 1 year from the Study Completion Date.
    End point type
    Secondary
    End point timeframe
    Randomization to death from any cause, through till the end of the study (2 years after the last subject is enrolled)
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    0 [4]
    0 [5]
    Units: Months
        median (confidence interval 95%)
    ( to )
    ( to )
    Notes
    [4] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    [5] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Adverse Events (AEs)

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    End point title
    Percentage of Subjects with Adverse Events (AEs)
    End point description
    An Adverse Event (AE) is any untoward medical occurrence in a subject administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An Adverse Event can therefore be any unfavorable and unintended sign (including abnormal laboratory values or abnormal clinical test results), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Preexisting conditions which worsen during a study are also considered as Adverse Events. Data collection is still ongoing and the results will be disclosed within 1 year from the Study Completion Date.
    End point type
    Secondary
    End point timeframe
    Baseline up until 28 days after the last dose of study drug (venetoclax or fulvestrant, whichever is later) (up to approximately 23 months).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    0 [6]
    0 [7]
    Units: Percentage of Subjects
    Notes
    [6] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    [7] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    No statistical analyses for this end point

    Secondary: Plasma Concentrations of Venetoclax at specified timepoints

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    End point title
    Plasma Concentrations of Venetoclax at specified timepoints
    End point description
    The PK analyses includes tabulation of plasma concentration data and summarisation of plasma concentrations by visits with subjects grouped according to treatment received. Descriptive summary statistics for the Arithmetic Mean and Standard Deviation are presented below. Data collection is still ongoing and the results will be disclosed within 1 year from the Study Completion Date.
    End point type
    Secondary
    End point timeframe
    At pre-defined intervals from Cycle 1, Day 1, through till the end of treatment (2 years after the last subject is enrolled).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    0 [8]
    0 [9]
    Units: μg/mL
        arithmetic mean (standard deviation)
    ±
    ±
    Notes
    [8] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    [9] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    No statistical analyses for this end point

    Secondary: Plasma Concentrations of Fulvestrant at specified timepoints

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    End point title
    Plasma Concentrations of Fulvestrant at specified timepoints
    End point description
    The PK analyses includes tabulation of plasma concentration data and summarisation of plasma concentrations by visits with subjects grouped according to treatment received. Descriptive summary statistics for the Arithmetic Mean and Standard Deviation are presented below. Data collection is still ongoing and the results will be disclosed within 1 year from the Study Completion Date.
    End point type
    Secondary
    End point timeframe
    At pre-defined intervals from Cycle 1, Day 1, through till the end of treatment (2 years after the last subject is enrolled).
    End point values
    Venetoclax + Fulvestrant Fulvestrant
    Number of subjects analysed
    0 [10]
    0 [11]
    Units: μg/mL
        arithmetic mean (standard deviation)
    ±
    ±
    Notes
    [10] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    [11] - Data for this Endpoint will only be reported within 1 year from the Final Study Completion Date.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up until 28 days after the last dose of study drug (venetoclax or fulvestrant, whichever is later) (up to approximately 23 months).
    Adverse event reporting additional description
    The 1 additional death in the Ven + Fulv arm compared to in the Subject Disposition section, relates to a subject who had withdrawn consent from the study and later died. Their death was reported in public records.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.0
    Reporting groups
    Reporting group title
    Venetoclax + Fulvestrant
    Reporting group description
    Subjects were administered Venetoclax 800mg orally once daily (QD) and Fulvestrant 500mg intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Reporting group title
    Fulvestrant
    Reporting group description
    Subjects were administered Fulvestrant 500mg only intramuscularly (IM) on Day 1 and 15 of Cycle 1 and Day 1 of subsequent cycles (Cycle length = 28 days).

    Serious adverse events
    Venetoclax + Fulvestrant Fulvestrant
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 50 (8.00%)
    1 / 51 (1.96%)
         number of deaths (all causes)
    19
    9
         number of deaths resulting from adverse events
    Investigations
    Ejection fraction decreased
         subjects affected / exposed
    1 / 50 (2.00%)
    0 / 51 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    0 / 50 (0.00%)
    1 / 51 (1.96%)
         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
    Pyrexia
         subjects affected / exposed
    1 / 50 (2.00%)
    0 / 51 (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
    Flank pain
         subjects affected / exposed
    0 / 50 (0.00%)
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 50 (2.00%)
    0 / 51 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 50 (2.00%)
    0 / 51 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Venetoclax + Fulvestrant Fulvestrant
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    45 / 50 (90.00%)
    34 / 51 (66.67%)
    Vascular disorders
    Hot flush
         subjects affected / exposed
    1 / 50 (2.00%)
    9 / 51 (17.65%)
         occurrences all number
    1
    9
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    4 / 50 (8.00%)
    0 / 51 (0.00%)
         occurrences all number
    4
    0
    Fatigue
         subjects affected / exposed
    18 / 50 (36.00%)
    8 / 51 (15.69%)
         occurrences all number
    20
    8
    Injection site pain
         subjects affected / exposed
    0 / 50 (0.00%)
    9 / 51 (17.65%)
         occurrences all number
    0
    12
    Oedema peripheral
         subjects affected / exposed
    4 / 50 (8.00%)
    1 / 51 (1.96%)
         occurrences all number
    6
    1
    Injection site reaction
         subjects affected / exposed
    6 / 50 (12.00%)
    6 / 51 (11.76%)
         occurrences all number
    7
    7
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    8 / 50 (16.00%)
    4 / 51 (7.84%)
         occurrences all number
    8
    4
    Injury, poisoning and procedural complications
    Injection related reaction
         subjects affected / exposed
    5 / 50 (10.00%)
    4 / 51 (7.84%)
         occurrences all number
    9
    4
    Investigations
    Blood alkaline phosphatase increased
         subjects affected / exposed
    2 / 50 (4.00%)
    4 / 51 (7.84%)
         occurrences all number
    2
    4
    Aspartate aminotransferase increased
         subjects affected / exposed
    4 / 50 (8.00%)
    3 / 51 (5.88%)
         occurrences all number
    4
    3
    Alanine aminotransferase increased
         subjects affected / exposed
    3 / 50 (6.00%)
    4 / 51 (7.84%)
         occurrences all number
    3
    4
    Blood creatine phosphokinase increased
         subjects affected / exposed
    4 / 50 (8.00%)
    2 / 51 (3.92%)
         occurrences all number
    4
    2
    Weight decreased
         subjects affected / exposed
    3 / 50 (6.00%)
    0 / 51 (0.00%)
         occurrences all number
    3
    0
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    3 / 50 (6.00%)
    1 / 51 (1.96%)
         occurrences all number
    3
    1
    Anaemia
         subjects affected / exposed
    2 / 50 (4.00%)
    3 / 51 (5.88%)
         occurrences all number
    2
    3
    Lymphopenia
         subjects affected / exposed
    7 / 50 (14.00%)
    0 / 51 (0.00%)
         occurrences all number
    7
    0
    Neutropenia
         subjects affected / exposed
    8 / 50 (16.00%)
    0 / 51 (0.00%)
         occurrences all number
    11
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    5 / 50 (10.00%)
    3 / 51 (5.88%)
         occurrences all number
    5
    3
    Cough
         subjects affected / exposed
    8 / 50 (16.00%)
    4 / 51 (7.84%)
         occurrences all number
    9
    4
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    5 / 50 (10.00%)
    2 / 51 (3.92%)
         occurrences all number
    5
    2
    Headache
         subjects affected / exposed
    7 / 50 (14.00%)
    8 / 51 (15.69%)
         occurrences all number
    8
    8
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    4 / 50 (8.00%)
    1 / 51 (1.96%)
         occurrences all number
    4
    1
    Abdominal distension
         subjects affected / exposed
    5 / 50 (10.00%)
    1 / 51 (1.96%)
         occurrences all number
    5
    1
    Abdominal pain
         subjects affected / exposed
    4 / 50 (8.00%)
    0 / 51 (0.00%)
         occurrences all number
    4
    0
    Dry mouth
         subjects affected / exposed
    4 / 50 (8.00%)
    0 / 51 (0.00%)
         occurrences all number
    4
    0
    Diarrhoea
         subjects affected / exposed
    27 / 50 (54.00%)
    5 / 51 (9.80%)
         occurrences all number
    37
    6
    Constipation
         subjects affected / exposed
    8 / 50 (16.00%)
    2 / 51 (3.92%)
         occurrences all number
    8
    2
    Vomiting
         subjects affected / exposed
    15 / 50 (30.00%)
    1 / 51 (1.96%)
         occurrences all number
    23
    1
    Nausea
         subjects affected / exposed
    32 / 50 (64.00%)
    9 / 51 (17.65%)
         occurrences all number
    40
    10
    Hepatobiliary disorders
    Hepatic pain
         subjects affected / exposed
    3 / 50 (6.00%)
    0 / 51 (0.00%)
         occurrences all number
    3
    0
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    4 / 50 (8.00%)
    1 / 51 (1.96%)
         occurrences all number
    5
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    3 / 50 (6.00%)
    5 / 51 (9.80%)
         occurrences all number
    3
    6
    Arthralgia
         subjects affected / exposed
    5 / 50 (10.00%)
    6 / 51 (11.76%)
         occurrences all number
    5
    8
    Musculoskeletal chest pain
         subjects affected / exposed
    1 / 50 (2.00%)
    8 / 51 (15.69%)
         occurrences all number
    2
    9
    Pain in extremity
         subjects affected / exposed
    4 / 50 (8.00%)
    1 / 51 (1.96%)
         occurrences all number
    4
    2
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    9 / 50 (18.00%)
    2 / 51 (3.92%)
         occurrences all number
    9
    2
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 50 (6.00%)
    1 / 51 (1.96%)
         occurrences all number
    3
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    19 Sep 2018
    Primarily to provide clarifications and to ensure consistency across sections.

    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.
    Primary and secondary efficacy endpoints have been updated to report 95% confidence interval (CI) for Clinical Benefit estimate and 95% CI for the Cox proportional hazards model for PFS, following reporting conventions.
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