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Efficacy and Safety of RAD001 in Patients Aged 18 and Over With Angiomyolipoma Associated With Either Tuberous Sclerosis Complex (TSC) or Sporadic Lymphangioleiomyomatosis (LAM) (EXIST-2)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Novartis ( Novartis Pharmaceuticals )
ClinicalTrials.gov Identifier:
NCT00790400
First received: November 10, 2008
Last updated: January 3, 2017
Last verified: January 2017
Results First Received: May 23, 2012  
Study Type: Interventional
Study Design: Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor);   Primary Purpose: Treatment
Conditions: Tuberous Sclerosis Complex (TSC)
Lymphangioleiomyomatosis (LAM)
Interventions: Drug: Everolimus (RAD001)
Drug: Everolimus Placebo

  Participant Flow
  Hide Participant Flow

Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
A multicenter trial conducted at 24 sites in 11 countries. As the primary analysis of the core phase of the study favored everolimus over placebo, an open-label extension phase started: patients randomized in placebo were offered to switch on everolimus and those still receiving everolimus at the end of the core phase could continue the treatment.

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
The trial had a 2:1 randomization in favor of the everolimus arm. 118 patients were randomized to the core phase of the study. 112 patients received everolimus during core and/or extension phase.

Reporting Groups
  Description
Everolimus Study drug was given by continuous oral daily dosing of two 5 mg tablets.
Placebo Placebo was given by continuous oral daily dosing of two 5 mg tablets.

Participant Flow for 2 periods

Period 1:   Double-blind Period (Core Phase)
    Everolimus   Placebo
STARTED   79   39 
COMPLETED   72 [1]   26 [2] 
NOT COMPLETED   7   13 
Protocol Violation                1                0 
Progressive disease                0                9 
Adverse Event                2                4 
Abnormal lab value (s)                1                0 
Withdrawal by Subject                1                0 
Administrative problems                1                0 
Death                1                0 
[1] Completed = Completed the Core phase & moved to Extension phase
[2] Completed = 1st received Placebo in the Core phase, switched to Everolimus in Extension phase

Period 2:   Everolimus Period (Core or Extension)
    Everolimus   Placebo
STARTED   112 [1]   0 [2] 
COMPLETED   83 [3]   0 
NOT COMPLETED   29   0 
Adverse Event                9                0 
Abnormal lab value (s)                1                0 
Withdrawal by Subject                7                0 
Lost to Follow-up                1                0 
Administrative problems                2                0 
Death                1                0 
Disease progression                5                0 
Protocol Violation                1                0 
New treatment                2                0 
[1] 112 pts had Everolimus during core and/or extension (6 from placebo did not switch to Eve. in ext.)
[2] Placebo randomized patients who switched to Everolimus are reported in "Everolimus" arm.
[3] Treatment duration completed as per protocol



  Baseline Characteristics
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Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
Everolimus Study drug was given by continuous oral daily dosing of two 5 mg tablets.
Placebo Placebo was given by continuous oral daily dosing of two 5 mg tablets.
Total Total of all reporting groups

Baseline Measures
   Everolimus   Placebo   Total 
Overall Participants Analyzed 
[Units: Participants]
 79   39   118 
Age 
[Units: Years]
Mean (Standard Deviation)
 32.5  (10.37)   31.0  (9.64)   32.0  (10.12) 
Age, Customized 
[Units: Participants]
     
<30 years   35   20   55 
≥ 30 years   44   19   63 
Gender 
[Units: Participants]
Count of Participants
     
Female      52  65.8%      26  66.7%      78  66.1% 
Male      27  34.2%      13  33.3%      40  33.9% 


  Outcome Measures
  Show All Outcome Measures

1.  Primary:   Angiomyolipoma Response Rate as Per Central Radiology Review   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to 5.7 years ]

2.  Secondary:   Time to Angiomyolipoma Progression as Per Central Radiology Review   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to about 5.7 years ]
  Hide Outcome Measure 2

Measure Type Secondary
Measure Title Time to Angiomyolipoma Progression as Per Central Radiology Review
Measure Description

Time to angiomyolipoma progression (TTAP) is defined as time from date of randomization to date of first documented angiomyolipoma progression. Angiomyolipoma progression was defined as one or more of the following: Increase from nadir of ≥ 25% in angiomyolipoma volume to value greater than baseline; the appearance of a new angiomyolipoma ≥ 1.0 cm in longest diameter; an increase from nadir of 20% or more in the volume of either kidney to a value greater than baseline; angiomyolipoma-related bleeding grade ≥ 2.

For the everolimus (core/extension periods) treatment group, the time to angiomyolipoma progression is defined starting from the start of everolimus. The baseline means the latest value on or before starting everolimus.

Time Frame From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to about 5.7 years  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Full Analysis Set (FAS) is defined according to the Intention-to-Treat principle and consists of all randomized patients.

Reporting Groups
  Description
Everolimus Randomized (Core Period) Study drug was given by continuous oral daily dosing of two 5 mg tablets.
Placebo Randomized (Core Period) Placebo was given by continuous oral daily dosing of two 5 mg tablets.
Everolimus (Core and/or Extension Period) Patients initially randomized in everolimus and patients initially randomized in placebo but who crossed-over to everolimus during extension.

Measured Values
   Everolimus Randomized (Core Period)   Placebo Randomized (Core Period)   Everolimus (Core and/or Extension Period) 
Participants Analyzed 
[Units: Participants]
 79   39   112 
Time to Angiomyolipoma Progression as Per Central Radiology Review 
[Units: Months]
Median (95% Confidence Interval)
 NA [1]   11.37 [2] 
 (11.07 to N/A) 
 NA [3] 
[1] Median not reached since too few number of patients with progressions (n=3).
[2] Upper limit not estimable due to few number of patients at this time point.
[3] Median not reached since too few number of patients with progressions (n=16)

No statistical analysis provided for Time to Angiomyolipoma Progression as Per Central Radiology Review



3.  Secondary:   Skin Lesion Response Rate as Per Investigator (Only Patients With at Least One Skin Lesion at Baseline)   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to 5.7 years ]
  Hide Outcome Measure 3

Measure Type Secondary
Measure Title Skin Lesion Response Rate as Per Investigator (Only Patients With at Least One Skin Lesion at Baseline)
Measure Description Skin lesion response rate in the double-blind period was determined only among patients with at least one skin lesion at baseline, and is the percentage of this group of patients with a best overall skin lesion response on the Physician’s Global Assessment of Clinical Condition (PGA) of either complete clinical response (CCR) or partial response (PR). A complete clinical response (CCR) requires a grading of 0 indicating the absence of disease (histological confirmation is not required). Grades 1, 2, and 3 constitute partial response, indicating improvement of at least 50 percent, but less than 100 percent improvement. For the everolimus (core/extension periods) treatment group, the baseline means the latest value on or before starting everolimus.
Time Frame From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to 5.7 years  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Full Analysis Set (FAS) is defined according to the Intention-to-Treat principle and consists of all randomized patients. Only patients with at least one skin lesion at baseline are included in the analysis.

Reporting Groups
  Description
Everolimus Randomized (Core Period) Study drug was given by continuous oral daily dosing of two 5 mg tablets.
Placebo Randomized (Core Period) Placebo was given by continuous oral daily dosing of two 5 mg tablets.
Everolimus (Core and/or Extension Period) Patients initially randomized in everolimus and patients initially randomized in placebo but who crossed-over to everolimus during extension.

Measured Values
   Everolimus Randomized (Core Period)   Placebo Randomized (Core Period)   Everolimus (Core and/or Extension Period) 
Participants Analyzed 
[Units: Participants]
 77   37   112 
Skin Lesion Response Rate as Per Investigator (Only Patients With at Least One Skin Lesion at Baseline) 
[Units: Percentage of participants]
Number (95% Confidence Interval)
 26 
 (16.6 to 37.2) 
 0 
 (0.0 to 9.5) 
 68.2 
 (58.5 to 76.9) 

No statistical analysis provided for Skin Lesion Response Rate as Per Investigator (Only Patients With at Least One Skin Lesion at Baseline)



4.  Secondary:   Percentage of Participants With Renal Impairment   [ Time Frame: Day 1 up to 28 days after end of treatment ]

5.  Secondary:   Change From Baseline in Plasma Angiogenic Molecules - Vascular Endothelial Growth Factor (VEGF) Marker   [ Time Frame: 4 weeks, 12 weeks, 24 weeks, 36 weeks 48 weeks, 60 weeks, 72 weeks ]

6.  Secondary:   Everolimus Trough Concentrations (Cmin)   [ Time Frame: Prior to dosing at weeks 2, 4, 12, 24, 48 ]

7.  Secondary:   Everolimus Blood Concentrations (C2h) at 2 Hours Post-dose   [ Time Frame: 2 hours post-dose administration at Weeks 2, 4, 12, 24, 48 ]

8.  Secondary:   Time to Angiomyolipoma Response - Only Everolimus Patients With Angiomyolipoma Response   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to 5.7 years ]

9.  Secondary:   Duration of Angiomyolipoma Response - Only Everolimus Patients With Angiomyolipoma Response   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to about 5.7 years ]

10.  Secondary:   Duration of Skin Lesion Response - Only Everolimus Patients With Best Overall Skin Lesion Response of Complete Clinical Response (CCR) or Partial Response (PR)   [ Time Frame: From date of randomization until the earliest date of first documented AML progression, date of further anti-AML medication (including open-label Everolimus)/surgery or up to about 5.7 years ]


  Serious Adverse Events


  Other Adverse Events


  Limitations and Caveats
  Hide Limitations and Caveats

Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
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