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    Clinical Trial Results:
    A phase II study of Platinum-doublet chemotherapy in combination with nivolumab as first-line treatment, in subjects with unresectable, locally advanced or metastatic G3 Neuroendocrine Neoplasms (NENs) of the gastroenteropancreatic (GEP) tract or of unknown (UK) origin.

    Summary
    EudraCT number
    2019-001546-18
    Trial protocol
    ES  
    Global end of trial date
    09 Jun 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    18 Oct 2024
    First version publication date
    18 Oct 2024
    Other versions
    Summary report(s)
    NICE-NEC Scientific Manuscript

    Trial information

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    Trial identification
    Sponsor protocol code
    GETNE-T1913
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03980925
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    CA209-73D: BMS protocol identification number
    Sponsors
    Sponsor organisation name
    Grupo Español de Tumores Neuroendocrinos y Endocrinos
    Sponsor organisation address
    C/ Balmes 243, Escalera A, 5º1ª, Barcelona, Spain, 08006
    Public contact
    Federico Nepote, MFAR Clinical Research, 34 93 434 44 12, investigacion@mfar.net
    Scientific contact
    Federico Nepote, MFAR Clinical Research, 34 93 434 44 12, investigacion@mfar.net
    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
    09 Nov 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    09 Jun 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    09 Jun 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine the overall survival patients with advanced G3 NENs treated with nivolumab + platinum-based chemotherapy.
    Protection of trial subjects
    The eligibility criteria were designed to only include patients who can receive the experimental treatment without unacceptable toxicities, according to clinical data available at the moment. The protocol was approved by an independent ethics committee and study was performed according to Declaration of Helsinki and GCPs.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    02 Sep 2019
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 37
    Worldwide total number of subjects
    37
    EEA total number of subjects
    37
    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)
    37
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    37 patients were recruited between 4/11/2019 and 26/01/2021 in a total of 12 sites in Spain

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    38 [1]
    Number of subjects completed
    37

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Protocol deviation: 1
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: One patient was not eligible
    Period 1
    Period 1 title
    Overall study period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Not blinded

    Arms
    Arm title
    Nivolumab + platinum-doublet chemotherapy
    Arm description
    1. Induction Phase: Nivolumab 360 mg IV plus Carboplatin IV (AUC=5) plus Etoposide 10mg/m2/day on days 1-3D, all every 3 weeks up to 6 cycles followed by Nivolumab 480mg for 24 months or until PD, death or toxicity. Order of administration: Nivolumab, Carboplatin, Etoposide 2. Maintenance Phase Nivolumab 480 mg IV will be administered every 4 weeks (±3 days) for 2 years.
    Arm type
    Experimental

    Investigational medicinal product name
    Nivolumab Solution for Injection
    Investigational medicinal product code
    Other name
    BMS-936558-01
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    1. Induction Phase: Nivolumab 360 mg IV first day all every 3 weeks up to 6 cycles followed by Nivolumab 480mg for 24 months or until PD, death or toxicity. 2. Maintenance Phase Nivolumab 480 mg IV will be administered every 4 weeks (±3 days) for 2 years.

    Investigational medicinal product name
    Carboplatin Solution for injection
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Carboplatin IV infusion first day all every 3 weeks up to 6 cycles

    Investigational medicinal product name
    Etoposide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Etoposide 100 mg/m2/day IV infusion on days 1-3D, all every 3 weeks up to 6 cycles

    Number of subjects in period 1
    Nivolumab + platinum-doublet chemotherapy
    Started
    37
    Completed
    37

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall study period
    Reporting group description
    -

    Reporting group values
    Overall study period Total
    Number of subjects
    37 37
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Age at registration
    Units: years
        median (full range (min-max))
    61 (28 to 84) -
    Gender categorical
    Units: Subjects
        Female
    12 12
        Male
    25 25
    ECOG
    Eastern Cooperative Oncology Group scale
    Units: Subjects
        ECOG 0
    11 11
        ECOG 1
    22 22
        ECOG 2
    4 4
    Stage at diagnosis
    Units: Subjects
        Stage I
    1 1
        Stage III
    1 1
        Stage IV
    35 35
    Differentiation
    Units: Subjects
        NET
    12 12
        NEC
    25 25
    Ki 67
    Units: Subjects
        21 - 55%
    12 12
        > 55%
    25 25
    Primary site
    Units: Subjects
        Esophageal
    2 2
        Gastric
    6 6
        Pancreatic
    14 14
        Colonic
    4 4
        Rectal
    2 2
        Small intestine
    2 2
        Other
    2 2
        Unknown
    5 5
    Metastatic sites number
    Units: Subjects
        = 1
    10 10
        ≥ 2
    27 27
    Previous surgery
    Units: Subjects
        Yes
    6 6
        No
    30 30
        Unknown
    1 1
    CgA
    Chromogranin A. Definitions: upper limit of normal (ULN)
    Units: Subjects
        < 2x ULN
    7 7
        ≥ 2x ULN
    27 27
        Unknown
    3 3
    Enolase
    Definitions: upper limit of normal (ULN)
    Units: Subjects
        < 2x ULN
    13 13
        ≥ 2x ULN
    21 21
        Unknown
    3 3
    LDH
    Definitions: upper limit of normal (ULN)
    Units: Subjects
        > 2x ULN
    9 9
        ≤ 2x ULN
    28 28

    End points

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    End points reporting groups
    Reporting group title
    Nivolumab + platinum-doublet chemotherapy
    Reporting group description
    1. Induction Phase: Nivolumab 360 mg IV plus Carboplatin IV (AUC=5) plus Etoposide 10mg/m2/day on days 1-3D, all every 3 weeks up to 6 cycles followed by Nivolumab 480mg for 24 months or until PD, death or toxicity. Order of administration: Nivolumab, Carboplatin, Etoposide 2. Maintenance Phase Nivolumab 480 mg IV will be administered every 4 weeks (±3 days) for 2 years.

    Primary: 12-month Overall Survival rate

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    End point title
    12-month Overall Survival rate [1]
    End point description
    End point type
    Primary
    End point timeframe
    12 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The NICE-NEC trial is a singñe arm trial. Staistical comparison was not applicable
    End point values
    Number of subjects analysed
    Units: %
        number (confidence interval 95%)
    No statistical analyses for this end point

    Secondary: Objective response rate (ORR)

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    End point title
    Objective response rate (ORR)
    End point description
    End point type
    Secondary
    End point timeframe
    30 months
    End point values
    Number of subjects analysed
    Units: %
        number (not applicable)
    No statistical analyses for this end point

    Secondary: Progression-free Survival

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    End point title
    Progression-free Survival
    End point description
    End point type
    Secondary
    End point timeframe
    30 months
    End point values
    Number of subjects analysed
    Units: month
        median (confidence interval 95%)
    No statistical analyses for this end point

    Secondary: Duration of response

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    End point title
    Duration of response
    End point description
    End point type
    Secondary
    End point timeframe
    30 months
    End point values
    Number of subjects analysed
    Units: month
        median (confidence interval 95%)
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    End point type
    Secondary
    End point timeframe
    overall study
    End point values
    Number of subjects analysed
    Units: month
        median (confidence interval 95%)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    30 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    NCI CTCAE
    Dictionary version
    5.0
    Reporting groups
    Reporting group title
    Nivolumab + platinum-doublet chemotherapy
    Reporting group description
    1. Induction Phase: Nivolumab 360 mg IV plus Carboplatin IV (AUC=5) plus Etoposide 10mg/m2/day on days 1-3D, all every 3 weeks up to 6 cycles followed by Nivolumab 480mg for 24 months or until PD, death or toxicity. Order of administration: Nivolumab, Carboplatin, Etoposide 2. Maintenance Phase Nivolumab 480 mg IV will be administered every 4 weeks (±3 days) for 2 years.

    Serious adverse events
    Nivolumab + platinum-doublet chemotherapy
    Total subjects affected by serious adverse events
         subjects affected / exposed
    18 / 37 (48.65%)
         number of deaths (all causes)
    25
         number of deaths resulting from adverse events
    4
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Alkaline phosphatase increased
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Inguinal hernia
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cognitive disturbance
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dysarthria
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences causally related to treatment / all
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Fever
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General clinical deterioration
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Multi-organ failure
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bowel subocclusion
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhea
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Esophageal hemorrhage
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Esophageal mucositis
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Nausea
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Upper gastrointestinal hemorrhage
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune-mediated nephritis
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary tract obstruction
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Confusion
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Bone pain
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bacteremia
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Covid-19
         subjects affected / exposed
    4 / 37 (10.81%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Hepatic infection
         subjects affected / exposed
    1 / 37 (2.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Nivolumab + platinum-doublet chemotherapy
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    37 / 37 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumor pain
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    General disorders and administration site conditions
    Edema limbs
         subjects affected / exposed
    4 / 37 (10.81%)
         occurrences all number
    4
    Fatigue
         subjects affected / exposed
    29 / 37 (78.38%)
         occurrences all number
    29
    Fever
         subjects affected / exposed
    7 / 37 (18.92%)
         occurrences all number
    7
    General disorders and administration site conditions
         subjects affected / exposed
    5 / 37 (13.51%)
         occurrences all number
    5
    Pain
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Aspartate aminotransferase increased
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Dysgeusia
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Headache
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Peripheral sensory neuropathy
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    18 / 37 (48.65%)
         occurrences all number
    18
    Febrile neutropenia
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Neutrophil count decreased
         subjects affected / exposed
    21 / 37 (56.76%)
         occurrences all number
    21
    Platelet count decreased
         subjects affected / exposed
    9 / 37 (24.32%)
         occurrences all number
    9
    White blood cell decreased
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    4 / 37 (10.81%)
         occurrences all number
    4
    Constipation
         subjects affected / exposed
    9 / 37 (24.32%)
         occurrences all number
    9
    Diarrhea
         subjects affected / exposed
    14 / 37 (37.84%)
         occurrences all number
    14
    Gastrointestinal disorders
         subjects affected / exposed
    7 / 37 (18.92%)
         occurrences all number
    7
    Mucositis oral
         subjects affected / exposed
    7 / 37 (18.92%)
         occurrences all number
    7
    Nausea
         subjects affected / exposed
    19 / 37 (51.35%)
         occurrences all number
    19
    Vomiting
         subjects affected / exposed
    9 / 37 (24.32%)
         occurrences all number
    9
    Hepatobiliary disorders
    Hepatobiliary disorders
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    12 / 37 (32.43%)
         occurrences all number
    12
    Dry skin
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Pruritus
         subjects affected / exposed
    6 / 37 (16.22%)
         occurrences all number
    6
    Rash acneiform
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Renal and urinary disorders
    Renal and urinary disorders
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Endocrine disorders
    Endocrine disorders
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Hyperthyroidism
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Hypothyroidism
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    3 / 37 (8.11%)
         occurrences all number
    3
    Back pain
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorder
         subjects affected / exposed
    4 / 37 (10.81%)
         occurrences all number
    4
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    10 / 37 (27.03%)
         occurrences all number
    10
    Hypomagnesemia
         subjects affected / exposed
    2 / 37 (5.41%)
         occurrences all number
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Dec 2019
    Investigator Brochure amendment
    27 Nov 2020
    Investigator Brochure amendment
    01 Feb 2022
    Investigator Brochure amendment

    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
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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