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Study of Dalantercept and Axitinib in Patients With Advanced Renal Cell Carcinoma

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ClinicalTrials.gov Identifier: NCT01727336
Recruitment Status : Terminated (The study was terminated by the sponsor following unblinding of the Progression Free Survival endpoint.)
First Posted : November 16, 2012
Results First Posted : May 24, 2021
Last Update Posted : September 23, 2021
Sponsor:
Information provided by (Responsible Party):
Acceleron Pharma Inc.

Tracking Information
First Submitted Date  ICMJE November 8, 2012
First Posted Date  ICMJE November 16, 2012
Results First Submitted Date  ICMJE April 28, 2021
Results First Posted Date  ICMJE May 24, 2021
Last Update Posted Date September 23, 2021
Actual Study Start Date  ICMJE December 2012
Actual Primary Completion Date June 2017   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 20, 2021)
  • Part 1: Number of Participants With Adverse Events as a Measure of Safety and Tolerability. [ Time Frame: Assessed from time of first dose to approximately 30 days after last dose. Participants were allowed to remain on treatment until documented disease progression. The time frame for Part 1 of the study was up to 21.6 months ]
    Outcome measure is intended for Part 1 of the study in order to determine recommended dose level for Part 2.
  • Part 2: Progression Free Survival (PFS). [ Time Frame: Progression free survival is defined as the time from the date of the randomization to the first documented disease progression (according to RECIST v1.1) or death due to any cause. The Time frame for Part 2 was up to 29.0 months ]
    PFS was defined as the time from randomization to the date of first documentation of disease progression based on RECIST (version 1.1) or to death due to any cause, whichever occurred first. Disease progression is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. RECIST 1.1 defines disease progression as an increase of at least a 20% in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression)
Original Primary Outcome Measures  ICMJE
 (submitted: November 12, 2012)
  • Part 1: Number of participants with Adverse Events as a measure of safety and tolerability. [ Time Frame: Assessed from time of first dose to approximately 30 days after last dose (approximately 6 months). ]
  • Part 2: Progression free survival (PFS). [ Time Frame: Progression free survival is defined as the time from the date of the randomization to the first documented disease progression (according to RECIST v1.1) or death due to any cause (approximately 6 months). ]
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: September 14, 2021)
  • Part 1: Progression Free Survival (PFS). [ Time Frame: The time frame for Part 1 of the study was up to 21.6 months ]
    PFS was defined as the time from randomization to the date of first documentation of disease progression based on RECIST (version 1.1) or to death due to any cause, whichever occurred first. Disease progression is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study.
  • Part 1: Overall Survival (OS). [The Time Frame for Part 1 of the Study Was up to 21.6 Months] [ Time Frame: Up to 21.6 months ]
    Percentage of Part 1 subjects alive at the end of Part 1 of the study. [The time frame for Part 1 of the study was up to 21.6 months]
  • Part 1: Objective Response Rate (ORR) [ Time Frame: Up to 21.6 months from randomization in Part 1 of the study ]
    Objective response rate (ORR) is defined as the number and percentage of patients who have a partial response (PR) or complete response (CR) to therapy. A CR is defined as the disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. A PR is defined as a decrease of at least a 30% in the sum of diameters of target lesions, taking as reference the baseline sum diameters. As no subjects in Part 1 experienced a CR, the ORR in Part 1 is defined by the PR
  • Part 1: Disease Control Rate (DCR) [ Time Frame: From randomization up to 21.6 months in Part 1 of the study ]
    The number and percentage of patients whose disease shrinks or remains stable. DCR is the sum of the complete, partial and stable disease rates.
  • Part 1: Duration of Response (DoR) [ Time Frame: From randomization up to 21.6 months in Part 1 of the study. ]
    Response duration is measured from the time measurement criteria are first met for objective response until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded on study.
  • Part 2: Progression Free Survival (PFS) for the Subset of Participants With 2 or More Lines of Prior Systemic Chemotherapy [ Time Frame: Progression free survival is defined as the time from the date of the randomization to the first documented disease progression (according to RECIST v1.1) or death due to any cause. The Time frame for Part 2 was up to 29.0 months ]
    Progression Free Survival (PFS) for the subset of participants with 2 or more lines of prior systemic chemotherapy. PFS was based upon RECIST 1.1 assessment, as described in outcome measure 2.
  • Part 2: Overall Survival. [ Time Frame: Patients to be contacted every 3 months for up to 12 months (anticipated) for survival follow-up, as well as tumor assessment scans if progression of disease has not previously been documented. The time frame for Part 2 was up to 29.0 months ]
    The number of months from the date of randomization to the date of death.
  • Part 2: Objective Response Rate. [ Time Frame: Assessed at 30 days after last dose of study drug; up to 29.0 months for Part 2 of the study ]
    Objective response rate (ORR) is defined as the number and percentage of patients who have a partial response (PR) or complete response (CR) to therapy. A CR is defined as the disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. A PR is defined as a decrease of at least a 30% in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
  • Part 2: Duration of Response [ Time Frame: Assessed at 30 days after the last dose of study drug; up to 29.0 months for Part 2 of the study. ]
    Response duration is measured from the time measurement criteria are first met for objective response until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded on study.
  • Part 2: Disease Control Rate. [ Time Frame: Assessed at 30 days after last dose of study drug. The time frame for Part 2 was up to 29.0 months ]
    The number and percentage of patients whose disease shrinks or remains stable. DCR is the sum of the complete, partial and stable disease rates.
Original Secondary Outcome Measures  ICMJE
 (submitted: November 12, 2012)
  • Part 2: Overall survival. [ Time Frame: Patients to be contacted every 3 months for up to 12 months (anticipated) for survival follow-up, as well as tumor assessment scans if progression of disease has not previously been documented. ]
  • Part 2: Time to tumor progression. [ Time Frame: Assessed at 30 days after last dose of study drug, or up to approximately 6 months from initiation of treatment. ]
  • Part 2: Objective response rate. [ Time Frame: Assessed at 30 days after last dose of study drug, or up to approximately 6 months from initiation of treatment. ]
  • Part 2: Duration of response [ Time Frame: Assessed at 30 days after last dose of study drug, or up to approximately 6 months from initiation of treatment. ]
  • Part 2: Disease control rate. [ Time Frame: Assessed at 30 days after last dose of study drug, or up to approximately 6 months from initiation of treatment for evaluable patients who meet the criteria for CR, PR or SD a minimum of 6 weeks after initiation of dosing. ]
  • Part 2: PD biomarker activities. [ Time Frame: Assessed at 30 days after the last dose of dalantercept ± 10 days. ]
Current Other Pre-specified Outcome Measures
 (submitted: September 14, 2021)
  • Part 1: Exploratory PD - Serum BMP9 [ Time Frame: From randomization up to 21.6 months in Part 1 of the study ]
    Exploratory analysis. Absolute change from baseline in serum Bone Morphogenetic Protein 9 (BMP9)
  • Part 2: PD Biomarker Activities. [ Time Frame: Assessed at 30 days after the last dose of dalantercept ± 10 days. The time frame for Part 2 was up to 29.0 months. ]
    Exploratory analysis. Absolute change from baseline in serum Bone Morphogenetic Protein 9 (BMP9)
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Study of Dalantercept and Axitinib in Patients With Advanced Renal Cell Carcinoma
Official Title  ICMJE A Phase 2 Randomized, Double-Blind Study of Dalantercept and Axitinib Compared to Placebo and Axitinib in Patients With Advanced Renal Cell Carcinoma
Brief Summary

The purpose of Part 1 of this study is to evaluate the safety and tolerability of dalantercept in combination with axitinib in patients with advanced renal cell carcinoma (RCC) to determine the recommended dose level of dalantercept in combination with axitinib for Part 2.

The purpose of Part 2 of this study is to determine whether treatment with dalantercept in combination with axitinib prolongs progression free survival (PFS) compared to axitinib alone in patients with advanced renal cell carcinoma (RCC).

Detailed Description

In Part 1 of the study, groups of subjects received escalating doses of dalantercept; 0.6, 0.9 and 1.2 mg/kg in sequential groups. All subjects received concurrent axitinib 5 mg PO BID. A total of 29 subjects were enrolled i Part 1 of the study.

In Part 2, dalantercept at 0.9 mg/kg once every 3 weeks plus axitinib 5 mg PO BID was compared to placebo plus axitinib 5 mg PO BID. A total of 131 subjects were enrolled in Part 2 for a total of 160 in the study

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: Randomized
Intervention Model: Sequential Assignment
Intervention Model Description:
Part 1 of the study involved a dose escalation phase to select a dose for Part 2 of the study. In Part 1, a total of 29 subjects escalated through 3 dose levels of dalantercept: 0.6, 0.9 and 1.2 mg/kg once every 3 weeks. In Part 2, dalantercept (0.9 mg/kg once every 3 weeks) plus axitinib 5 mg PO BID) was compared with placebo plus axitinib 5 mg PO BID. Part 2 enrolled 131 subjects for a total of 160 subjects in the study
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Condition  ICMJE Advanced Renal Cell Carcinoma
Intervention  ICMJE
  • Drug: Dalantercept and axitinib
    Other Name: ACE-041, Inlyta
  • Drug: Placebo and axitinib
    Other Name: Inlyta
Study Arms  ICMJE
  • Experimental: Dalantercept 0.9 mg/kg plus axitinib
    Subcutaneous (SC) injection of dalantercept 0.9 mg/kg once every 3 weeks and oral axitinib 5 mg BID for continuous dosing.
    Intervention: Drug: Dalantercept and axitinib
  • Placebo Comparator: Placebo plus axitinib
    Subcutaneous injection of normal saline once every 3 weeks and oral axitinib 5 mg BID for continuous dosing
    Intervention: Drug: Placebo and axitinib
  • Experimental: Dalantercept 0.6 mg/kg
    Part 1 dose escalation arm 0.6 mg/kg dalantercept once every 3 weeks
    Intervention: Drug: Dalantercept and axitinib
  • Experimental: Dalantercept 0.9 mg/kg
    Part 1 dose escalation arm 0.9 mg/kg dalantercept once every 3 weeks
    Intervention: Drug: Dalantercept and axitinib
  • Experimental: Dalantercept 1.2 mg/kg
    Part 1 dose escalation arm 1.2 mg/kg dalantercept once every 3 weeks
    Intervention: Drug: Dalantercept and axitinib
  • Experimental: Dalantercept 1.5 mg/kg
    Part 1 dose escalation arm 1.5 mg/kg dalantercept once every 3 weeks
    Intervention: Drug: Dalantercept and axitinib
Publications * Voss MH, Bhatt RS, Vogelzang NJ, Fishman M, Alter RS, Rini BI, Beck JT, Joshi M, Hauke R, Atkins MB, Burgess E, Logan TF, Shaffer D, Parikh R, Moazzam N, Zhang X, Glasser C, Sherman ML, Plimack ER. A phase 2, randomized trial evaluating the combination of dalantercept plus axitinib in patients with advanced clear cell renal cell carcinoma. Cancer. 2019 Jul 15;125(14):2400-2408. doi: 10.1002/cncr.32061. Epub 2019 Apr 5.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Terminated
Actual Enrollment  ICMJE
 (submitted: May 20, 2021)
160
Original Estimated Enrollment  ICMJE
 (submitted: November 12, 2012)
156
Actual Study Completion Date  ICMJE November 2017
Actual Primary Completion Date June 2017   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Key Inclusion Criteria:

  • Histologically confirmed, advanced, predominantly clear cell renal cell carcinoma (RCC).
  • Part 1: Progression of disease following up to three lines of prior therapy, including at least one approved VEGF receptor tyrosine kinase inhibitor for RCC. Adjuvant therapy is permitted as one line of prior therapy.
  • Part 2: Progression of disease following one VEGF pathway inhibitor for RCC (e.g. sunitinib, pazopanib, sorafenib, bevacizumab, tivozanib, or cabozantinib) inclusive of adjuvant therapy if there was documented disease progression during treatment. Patients may have received one additional line of an approved mTOR kinase inhibitor (e.g. everolimus, temsirolimus). Prior exposure to investigational and/or approved anticancer immune therapies is permitted.
  • A minimum of 1 week since the last dose of prior therapy (a minimum of 4 weeks since anticancer immune therapy or bevacizumab +/- interferon).
  • Measurable disease that is evaluable by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Life expectancy of at least 12 weeks.
  • Clinical laboratory values within acceptable ranges within 72 hours prior to study day 1.

Key Exclusion Criteria:

  • Clinically significant organ/system disease unrelated to RCC that in the judgment of the investigator should preclude treatment with dalantercept or axitinib.
  • Clinically significant cardiovascular risk.
  • Known CNS metastases or leptomeningeal disease:

For Part 1, patients with CNS metastases treated with whole brain radiotherapy, gamma knife, and/or surgery who are considered stable by CNS imaging and are not being treated with corticosteroids 6 weeks prior to study day 1 may be enrolled.

For Part 2, patients with CNS metastases treated stereotactic radio-surgery (SRS), and/or surgery who are considered stable by CNS imaging for at least 2 months prior to enrollment and are not being treated with corticosteroids 6 weeks prior to study day 1 may be enrolled.

  • Any active malignancy, other than RCC, for which chemotherapy or other anti-cancer therapy is indicated. Patients with adequately treated non-melanoma skin cancer, in situ cancer, or other cancer from which the subject has been disease-free for at least 3 years will be permitted.
  • Any lesion invading or having encasement ≥ 180 degrees around the wall of a major blood vessel as assessed by computed tomography (CT) scan and/or magnetic resonance imaging (MRI).
  • Radiotherapy within 2 weeks prior to study day 1.
  • Lack of recovery from toxic effects of previous treatment for RCC ≤ grade 1 with the exception of alopecia, unless stabilized under adequate medical control.
  • Patients undergoing renal dialysis.
  • Major surgery within 4 weeks prior to study day 1 (patients must have recovered completely from any previous surgery prior to study day 1).
  • Any active infection requiring antibiotic therapy within 2 weeks of study day 1.
  • Anti-coagulation therapy. Aspirin, other anti-platelet agents, and low molecular weight heparin are permitted unless the investigator deems the patient is at a significant risk for bleeding.
  • Current use or anticipated inability to avoid potent CYP3A4/5 inhibitors or inducers (please refer to the Inlyta® [axitinib] prescribing information) during participation in the study.
  • Peripheral edema requiring medical intervention within 2 weeks prior to study day 1.
  • Bleeding diathesis including clinically significant platelet disorders or active hemoptysis (defined as bright red blood of ≥ 1/2 teaspoon [2.5 mL] in any 24 hour period) within 6 months prior to study day 1. For clinically significant epistaxis within 4 weeks prior to study day 1, no risk of further bleeding must be clearly documented.
  • Known history of hereditary hemorrhagic telangiectasia (HHT).
  • Known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infections or positive human immunodeficiency virus (HIV) antibody results. Patients with sustained virologic response to HCV treatment or immunity to HBV from prior infection without cirrhosis may be included.
  • History of severe (defined as ≥ grade 3, using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0 [NCI-CTCAE] v4 current active minor version) allergic or anaphylactic reaction or hypersensitivity to recombinant proteins or excipients (10 mM Tris buffered saline) in the investigational agent.
  • Any prior treatment with dalantercept or any other agent targeting ALK1 pathway.
  • Any prior treatment with axitinib.
  • A morbidity (per the prescribing information) that would require starting a patient at a reduced dose of axitinib.
  • Treatment with another investigational drug (with the exception of anticancer immune therapy) or device, or approved therapy for investigational use, within 5 times the half-life of the drug or within 3 weeks prior to study day 1 if the half life is not known.
  • Pregnant or lactating female patients.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT01727336
Other Study ID Numbers  ICMJE A041-04
ACE-041 ( Other Identifier: Acceleron Pharma Inc. )
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Acceleron Pharma Inc.
Study Sponsor  ICMJE Acceleron Pharma Inc.
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Acceleron Pharma Inc.
Verification Date September 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP