| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| refractory, advanced gastro-oesophageal cancer |
| refraktäres, fortgeschrittenes Magen-Ösophagus-Karzinom |
|
| E.1.1.1 | Medical condition in easily understood language |
| advanced stomach / oesophageal cancer who have failed prior therapy |
| fortgeschrittener Magen-/Speiseröhrenkrebs, bei denen die vorherige Therapie versagt hat |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 20.1 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10062878 |
| E.1.2 | Term | Gastrooesophageal cancer |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
| To determine the effect of regorafenib in combination with nivolumab (RegoNivo) on overall survival (OS) (death from any cause) in the overall study population. |
|
| E.2.2 | Secondary objectives of the trial |
To determine the effect of RegoNivo on:
• Overall survival (death from any cause) in the Asian sub-population
• Progression free survival (PFS) (disease progression or death)
• Objective tumour response rate (OTRR) (partial or complete response (PR or CR)) according to Response Evaluation Criteria in Solid Tumours (RECIST)
version 1.1, and immune-related iRECIST
• Quality of life (QoL)(scores from participant-completed questionnaires)
• Safety (rates of adverse events) |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
1. Adults (18 years or over) with metastatic or locally recurrent gastro-oesophageal cancer which:
a. has arisen in any primary gastro-oesophageal site (oesophago-gastric junction (GOJ) or stomach); and
b. is of adenocarcinoma or undifferentiated carcinoma histology; and
c. is evaluable according to Response Evaluation Criteria in Solid Tumours (RECIST Version 1.1) by computed tomography (CT) scan performed
within 21 days prior to randomisation. A lesion in a previously irradiated area is eligible to be considered as measurable disease as long as
there is objective evidence of progression of the lesion prior to study enrolment; and
d. has failed or been intolerant to a minimum of 2 lines of prior anti-cancer therapy for recurrent/metastatic disease which must have included
at least one platinum agent and one fluoropyrimidine analogue. Note: Neoadjuvant or adjuvant chemotherapy or chemoradiotherapy will be
considered as first line treatment where people have relapsed or progressed within 6 months of completing treatment; Radiosensitising
chemotherapy given solely for this purpose concurrent with palliative radiation will not be considered as a line of treatment. Ramucirumab
monotherapy, or immunotherapy with a checkpoint inhibitor, will be considered a line of treatment.
e.HER2-positive participants must have received trastuzumab
2. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 (Appendix 1).
3. Ability to swallow oral medication.
4. Adequate bone marrow function (Platelets ≥100x109/L; Absolute Neutrophil Count (ANC) ≥1.5x109/L and Haemoglobin ≥ 9.0g/dL).
5. Adequate renal function (Creatinine clearance >50 ml/min) based on either the Cockcroft-Gault formula (Appendix 2), 24-hour urine or Glomerular Filtration Rate (GFR) scan; and serum creatinine ≤1.5 x Upper Limit of Normal (ULN).
6. Adequate liver function (Serum total bilirubin ≤1.5 x ULN, and INR ≤ 1.5 x ULN, and Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP) ≤2.5 x ULN (≤ 5 x ULN for participants with liver metastases)).
Participants being treated with an anti-coagulant, such as warfarin or heparin, will be allowed to participate provided that no prior evidence of an
underlying abnormality in these parameters exists.
7. Willing and able to comply with all study requirements, including treatment, timing, and/or nature of required assessments and follow-up.
8. Study treatment both planned and able to start within 7 days after randomisation (note: subjects randomised on a Friday should commence
treatment no earlier than the following Monday)
9. Signed, written informed consent.
|
|
| E.4 | Principal exclusion criteria |
1. Known allergy to the investigational product drug class or excipients in the regorafenib and/or nivolumab
2. Poorly-controlled hypertension (systolic blood pressure >140mmHg or diastolic pressure> 90mmHg despite optimal medical management).
3. Participants with known, uncontrolled malabsorption syndromes
4. Any prior anti-VEGF targeted therapy using small molecule VEGF TKIs (e.g. apatinib). Prior anti-VEGF targeted monoclonal antibody therapies (e.g.
bevacizumab and ramucirumab) are permitted.
5. Any prior use of more than one immune checkpoint inhibitor
6. Treatment with any previous drug therapy within 2 weeks prior to first dose of study treatment. This includes any investigational therapy.
7. Use of biological response modifiers, such as granulocyte colony stimulating factor (G-CSF), within 3 weeks prior to randomisation.
8. Concurrent treatment with strong CYP3A4 inhibitors or inducers.
9. Palliative radiotherapy, unless more than 14 days have elapsed between completion of radiation and the date of registration, and adverse events resulting from radiation have resolved to < Grade 2 according to CTCAE V5.0
10. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to randomization
11. Arterial thrombotic or ischaemic events, such as cerebrovascular accident, within 6 months prior to randomization.
12. Venous thrombotic events and pulmonary embolism within 3 months prior to randomization
13. Any haemorrhage or bleeding event ≥ Grade 3 according to CTCAE v5.0 within 4 weeks prior to randomization.
14. Non-healing wound, ulcer, or bone fracture.
15. Interstitial lung disease with ongoing signs and symptoms
16. Clinical hyperthyroidism or hypothyroidism. Note: non-clinically significant abnormal TFTs (abnormal TSH and abnormal T3 and/or abnormal T4) considered to be due to sick euthyroid syndrome is allowed.
17.Persistent proteinuria of ≥ Grade 3 according to CTCAE v5.0 (equivalent to > 3.5g of protein over 24 hour measured on either a random specimen or 24 hour collection.
18. Uncontrolled metastatic disease to the central nervous system. To be eligible, known CNS metastases should have been treated with surgery and/or radiotherapy and the patient should have been receiving a stable dose of steroids for at least 2 weeks prior to randomization, with no deterioration in neurological symptoms during this time.
19. History of another malignancy within 2 years prior to randomization. Participants with the following are eligible for this study:
a. curatively treated cervical carcinoma in situ,
b. non-melanomatous carcinoma of the skin,
c. superficial bladder tumours (T1a [Non-invasive tumour], and Tis [Carcinoma in situ]),
d. treated thyroid papillary cancer
20. Any significant active infection, including chronic active hepatitis B, hepatitis C, or HIV. Testing for these is not mandatory unless clinically indicated. Participants with known Hepatitis B/C infection will be allowed to participate providing evidence of viral suppression has been documented and the patient remains on appropriate anti-viral therapy.
21. Patients with acute coronary syndrome (including myocardial infarction and unstable angina), and with a history of coronary angioplasty or stent placement performed within 6 months before enrolment
22. Patients with a ≥ grade 3 active infection according to CTCAE version 5.0
23. Patients with concurrent autoimmune disease, or a history of chronic or recurrent autoimmune disease
24. Patients who require systemic corticosteroids (excluding temporary usage for tests, prophylactic administration for allergic reactions, or to
alleviate swelling associated with radiotherapy; if used as replacement therapy e.g. ≤ 10 mg prednisolone or dexamethasone ≤ 2 mg per day) or immunosuppressants, or who have received such a therapy < 14 days prior to randomisation
25. Patients with a seizure disorder who require pharmacotherapy
26. Serious medical or psychiatric condition(s) that might limit the ability of the patient to comply with the protocol.
27. Pregnancy, lactation, or inadequate contraception. Women must be post-menopausal infertile, or use a reliable means of contraception. Women
of childbearing potential must have a negative pregnancy test done within 7 days prior to randomization. Men must have been surgically sterilized
or use a barrier method of contraception.
28. Patients with prior organ allograft or allogeneic bone marrow transplantation.
|
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| Overall survival (OS) (death from any cause) in the overall study population |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| Assuming the study is not terminated early, the final analysis is planned to be undertaken once the required number of events have occurred (380 deaths from 450 patients) |
|
| E.5.2 | Secondary end point(s) |
• Overall survival (death from any cause) in the Asian sub-population
• Progression free survival (PFS) (disease progression or death)
• Objective tumour response rate (OTRR) (partial or complete response (PR or CR)) according to Response Evaluation Criteria in Solid Tumours (RECIST)
version 1.1, and immune-related iRECIST
• Quality of life (QoL) (scores from participant-completed questionnaires)
• Safety (rates of adverse events)
Translational Research:
• prognostic and predictive biomarkers (tissue and circulating) for study endpoints (relating to survival, response and safety)
• regorafenib PK in patient populations from different geographical regions (PK levels) |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| Assuming the study is not terminated early, the final analysis is planned to be undertaken once the required number of events have occurred (380 deaths from 450 patients) |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | Yes |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
| E.7.4 | Therapeutic use (Phase IV) | No |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | Yes |
| E.8.1.6 | Cross over | No |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | No |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | Yes |
| E.8.2.3.1 | Comparator description |
| Standard Chemotherapy (taxane (paclitaxel or docetaxel), irinotecan, oral trifluridine/tipiracil) |
|
| E.8.2.4 | Number of treatment arms in the trial | 2 |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 39 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
| New Zealand |
| Taiwan |
| Australia |
| Austria |
| Belgium |
| France |
| Germany |
| Italy |
| Japan |
| Korea, Republic of |
| Spain |
| United States |
|
| E.8.7 | Trial has a data monitoring committee | Yes |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of this study is defined as the date when the last patient, last visit (LPLV) occurs, i.e. when all enrolled patients have either died, withdrawn consent, are lost to follow up, or have been followed up for 12 months since the last study patient is enrolled, whichever occurs first. After follow-up, the data cleaning process will be finalized, and database will be closed.
|
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 3 |
| E.8.9.1 | In the Member State concerned months | |
| E.8.9.1 | In the Member State concerned days | |
| E.8.9.2 | In all countries concerned by the trial years | 5 |
Print
