Back to resultsCORAL XT - Open-label Extension Trial of the CORAL Trial (CORAL XT)
Primary Purpose
Pain, Neoplasms, Chronic Pain
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Cebranopadol
Sponsored by
About this trial
This is an interventional treatment trial for Pain focused on measuring cancer-related pain, cebranopadol
Eligibility Criteria
Inclusion Criteria:
- Informed consent signed indicating that the participant understands the purpose of and procedures required for the trial and is willing to participate in the trial.
- Participants must be at least 18 years of age at the Enrollment Visit.
- Women of childbearing potential must have a negative pregnancy test at enrollment and must not be lactating at the Enrollment Visit.
- Participants must be willing to use medically acceptable and highly effective methods of birth control.
- Participants who have completed treatment in KF6005/07 and are still in need of around-the-clock pain analgesia with strong opioids.
Exclusion Criteria:
- The participant has a clinically significant disease or condition other than cancer which in the investigator's opinion may affect efficacy or safety assessments.
- Known to or suspected of not being able to comply with the protocol and the use of cebranopadol.
- Participants taking forbidden concomitant medications or not being able to follow the rules of use of concomitant treatment.
- History of torsade de pointes and/or presence of risk factors for torsade de pointes (e.g., heart failure, hypokalemia, bradycardia).
- Concurrent participation in another trial (except participation in KF6005/07) or planning to be enrolled in another clinical trial (i.e., administration of experimental treatment in another clinical trial) during the course of this trial, or previous participation in this trial.
- Employees of the sponsor, investigator, or trial site or family members of the employees, sponsor, or investigator.
Sites / Locations
- AT004
- BE001
- BG001
- BG008
- BG003
- BG004
- DK006
- DK004
- DE008
- DE010
- HU011
- PL012
- PL014
- PL003
- PL010
- RO002
- RS003
- RS002
- RS005
- SK004
- SK001
- SK005
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Cebranopadol
Arm Description
Cebranopadol 200 µg to 1000 µg per taken taken once a day in the morning. Allowed dose levels in the Maintenance Phase were 200, 400, 600, 800, or 1000 µg per day.
Outcomes
Primary Outcome Measures
Number of Participants With Treatment Emergent Adverse Event (TEAEs)
The safety of cebranopadol was assessed by the number of participants with treatment emergent adverse events (TEAEs). A TEAE was any adverse event that occurred after the first administration of investigational medicinal product (IMP), i.e., cebranopadol in this study. In addition, pretreatment adverse events which worsened during the treatment period were also considered TEAEs.
Secondary Outcome Measures
Intensity of Treatment Emergent Adverse Events
A Treatment Emergent Adverse Event (TEAE) was defined as any Adverse Event (AE) that occurred on or after the first intake of cebranopadol or a pretreatment AE which worsened during the treatment period. TEAEs were classified by the investigator as falling into 1 of 3 categories:
Mild: Signs and symptoms that can be easily tolerated. Symptoms can be ignored and disappear when the participant is distracted.
Moderate: Symptoms cause discomfort but are tolerable; they cannot be ignored and affect concentration.
Severe: Symptoms which affect usual daily activity.
For TEAE where the intensity changed over time, the maximum intensity observed during the whole duration of the adverse event was documented.
Changes From Baseline in the Average Pain Intensity in the Last Week During the Treatment Period
Participants were asked "Please rate your pain by selecting the one number that best describes your pain on average during the last week." and scored their average pain intensity during the last week of the treatment period on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine". The absolute change from baseline for the average pain intensity during the last week was determined for all participants that scored their pain intensities. A mean value for all participants was calculated.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02031432
Brief Title
CORAL XT - Open-label Extension Trial of the CORAL Trial
Acronym
CORAL XT
Official Title
An Open-label, Multi-site Trial to Describe the Safety and Tolerability of Oral Cebranopadol Administered for 26 Weeks in Subjects With Cancer-related Pain Who Have Completed Treatment in the KF6005/07 Trial
Study Type
Interventional
2. Study Status
Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
December 18, 2013 (Actual)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
May 3, 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Tris Pharma, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this trial was to find out how well cebranopadol is tolerated and how often, and which, adverse reactions occur when it is taken every day for a longer period of time. In addition, information was collected how cebranopadol affects pain and well-being in patients suffering from cancer-related pain.
Detailed Description
The trial consisted of 3 phases: Titration Phase, Maintenance Phase, and Follow-Up. The total duration of the trial was approximately 28 weeks for each individual participant, including the Follow-up. The participants received cebranopadol for a maximum of approximately 26 weeks.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pain, Neoplasms, Chronic Pain
Keywords
cancer-related pain, cebranopadol
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
76 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Cebranopadol
Arm Type
Experimental
Arm Description
Cebranopadol 200 µg to 1000 µg per taken taken once a day in the morning.
Allowed dose levels in the Maintenance Phase were 200, 400, 600, 800, or 1000 µg per day.
Intervention Type
Drug
Intervention Name(s)
Cebranopadol
Other Intervention Name(s)
GRT6005
Intervention Description
Film-coated tablet; strengths: 200, 400, or 600 µg
Primary Outcome Measure Information:
Title
Number of Participants With Treatment Emergent Adverse Event (TEAEs)
Description
The safety of cebranopadol was assessed by the number of participants with treatment emergent adverse events (TEAEs). A TEAE was any adverse event that occurred after the first administration of investigational medicinal product (IMP), i.e., cebranopadol in this study. In addition, pretreatment adverse events which worsened during the treatment period were also considered TEAEs.
Time Frame
Up to 28 weeks (26 weeks of cebranopadol treatment and 2 weeks follow up after the last dose)
Secondary Outcome Measure Information:
Title
Intensity of Treatment Emergent Adverse Events
Description
A Treatment Emergent Adverse Event (TEAE) was defined as any Adverse Event (AE) that occurred on or after the first intake of cebranopadol or a pretreatment AE which worsened during the treatment period. TEAEs were classified by the investigator as falling into 1 of 3 categories:
Mild: Signs and symptoms that can be easily tolerated. Symptoms can be ignored and disappear when the participant is distracted.
Moderate: Symptoms cause discomfort but are tolerable; they cannot be ignored and affect concentration.
Severe: Symptoms which affect usual daily activity.
For TEAE where the intensity changed over time, the maximum intensity observed during the whole duration of the adverse event was documented.
Time Frame
Up to 28 weeks (26 weeks of cebranopadol treatment and 2 weeks follow-up after the last dose)
Title
Changes From Baseline in the Average Pain Intensity in the Last Week During the Treatment Period
Description
Participants were asked "Please rate your pain by selecting the one number that best describes your pain on average during the last week." and scored their average pain intensity during the last week of the treatment period on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine". The absolute change from baseline for the average pain intensity during the last week was determined for all participants that scored their pain intensities. A mean value for all participants was calculated.
Time Frame
Baseline Visit (Day 1) to End of Treatment Visit (up to 26 weeks).
Other Pre-specified Outcome Measures:
Title
Outcome of Treatment Emergent Adverse Events (TEAE)
Description
The outcome of a TEAE was classified into 1 of the following 6 categories by the investigator, i.e.
Recovered/Resolved.
Recovered/Resolved with sequelae.
Fatal
Recovering/Resolving.
Not recovered/Not resolved.
Unknown (e.g., because the participant is lost to follow up).
Time Frame
Baseline (Day 2) to End of trial (i.e., up to Week 28)
Title
Time to Onset of Treatment Emergent Adverse Events (TEAEs)
Description
The median time, in days, from the start of the open-label cebranopadol treatment to the start day of the treatment emergent adverse event (TEAE).
Time Frame
Baseline (Day 2) to End of trial (up to Week 28)
Title
Duration of Treatment Emergent Adverse Events (TEAEs)
Description
An adverse event is any untoward medical occurrence attributed to cebranopadol. Duration of Adverse Event was calculated as stop date minus start date plus 1 for non-missing and partial dates.
Time Frame
Baseline (Day 2) to End of trial (up to Week 28)
Title
Causal Relationship of Treatment Emergent Adverse Events (TEAEs)
Description
The causality of TEAEs was assessed by the investigator as falling into 1 of the following 7 categories: Conditional/Unclassified, Unassessable/Unclassifiable, Not related, Unlikely, Possible, Probable/likely, or Certain. The numbers of TEAEs per category are presented.
Time Frame
Baseline (Day 2) to End of trial (up to Week 28)
Title
Countermeasures Taken for Treatment Emergent Adverse Events (TEAEs)
Description
The countermeasure of a Treatment Emergent Adverse Event (TEAE) was classified by the investigator as being a study medication-related countermeasure and based on non-study medication countermeasures.
Non-study medication related countermeasures were categorized as being one of the following: No countermeasure given; A newly started medication or change in dose or route of application of a concomitant medication due to the AE; Other countermeasures, e.g., physical therapy, surgery.
Study medication-related countermeasures were categorized as being one of the following: Dose not changed; Dose reduced; Drug interrupted; Trial discontinuation.
Absolute numbers are per category reported.
Time Frame
Baseline (Day 2) to End of trial (up to Week 28)
Title
Number of Participants With Treatment Emergent Adverse Events (TEAEs) Related to Cebranopadol
Description
Only participants with TEAEs which were assessed by the investigator as falling into one of the 3 categories of causality (Possible, Probable/likely, or Certain) were summarized. The initial breakdown planned based on intensity, outcome, time to onset, duration, and countermeasures was not performed and is therefore not reported.
Time Frame
Baseline (Day 2) to End of trial (up to Week 28)
Title
Columbia-Suicide Severity Rating Scale (C-SSRS) Scores
Description
The C-SSRS was administered by a clinician who had been certified to administer the C-SSRS at each visit. Suicidal ideation is classified on a 5-item scale (where 1 = Wish to be dead, 2 = Non-specific active suicidal thoughts, 3 = Active Suicidal Ideation with any methods (not plan) without intent to act, 4 = Active Suicidal Ideation with some intent to act, without specific plan, 5 = Active suicidal ideation with a specific plan and intent). The number of participants with suicidal ideation at baseline is presented below for categories with at least 1 participant.
Time Frame
Baseline (Day 1) to End of trial (up to Week 28)
Title
Mean Scores of Chronic Pain Sleep Inventory (CPSI) and Changes From Baseline
Description
The CPSI was completed by the participants. It measures 5 items, all on a 100-mm visual analog scale:
Participant's assessment of Sleep Problem Index subscores and need for sleep medication (the lower the score the better): (1) Trouble falling asleep (0 = never; 100 = always); (2) Needing sleep medication to help fall asleep (0 = never, 100 = always); (3) Awakened by pain during the night (0 = never, 100 = always); and (4) Awakened by pain in the morning (0 = never, 100 = always). The Sleep Problem Index is the sum of items (1), (3), and (4) with a maximum score of 100 indicating maximum sleep problems.
Participant's assessment of the Overall Quality of Sleep (the higher the score the better): (5) Overall quality of sleep (0 = very poor, 100 = excellent).
Time Frame
Baseline (Day 1); End of Treatment (up to Week 26)
Title
Weekly Means of Daily Average Pain Intensity During the First Month of Treatment
Description
Participants were asked: "Please rate your pain by selecting the one number that best describes your pain on average during the last 24 hours." every day in the morning during the first month of treatment (comprising Titration Weeks 1 and 2 and Maintenance Weeks 1 and 2). They scored their pain intensity on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine". The weekly mean value of the 24-hour average pain intensity was calculated as a mean score of these daily entries of average pain intensity for each week.
Time Frame
Baseline (Day 1); Titration Weeks 1 and 2; Maintenance Weeks 1 and 2
Title
Worst Pain Intensity in the Last Week of Treatment (Week 26)
Description
Participants were asked: "Please rate your pain by selecting the one number that best describes your pain at its worst during the last week." at some of the visits during the treatment period. They scored their pain intensity on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine". The mean scores of the worst pain intensity were calculated for all participants. Results for baseline and Week 26 are presented.
Time Frame
Baseline (Day 1); End of Treatment (Week 26)
Title
Weekly Average Number of Breakthrough Pain Episodes
Description
The number of episodes of breakthrough pain during the past week was planned to be collected. However, for some participants, the intensity of breakthrough pain for the past week has been collected instead of the incidence of breakthrough pain events. Since the values of the intensity of breakthrough pain were much higher (maximum of up to 99) than the frequency of pain events, the mean is skewed and cannot be interpreted. The median for the weekly average number of breakthrough pain episodes is less influenced by these values and is reported below.
Time Frame
Baseline (Day 1); End of Treatment (Week 26)
Title
Mean Scores of Neuropathic Pain Symptom Inventory (NPSI)
Description
Participants with neuropathic pain (determined by the completion of the DN4 [Douleur Neuropathique] questionnaire at enrollment) rated their symptoms of neuropathic pain using the NPSI. Ten out of 12 questions (Q1-3, 5, 6, 8-12) are answered on an 11-point numerical scale (NRS) ranging from 0 (no symptom present) to 10 (worst imaginable).
The NPSI Total Score was calculated as the sum of the 10 single items scored on the 11-point NRS divided by 100. The mean score is reported on a scale of 0 (no neuropathic pain components present) to 1 (all neuropathic pain components have the maximum imaginable intensity).
Time Frame
Baseline (Day 1); Weeks 2, 6, 14, 18; End of Treatment (up to Week 26)
Title
EuroQol-5 Dimension (EQ-5D) Health Status Index Outcome
Description
Participants answered 5 questions on the 5 dimensions of the EuroQol-5 Dimension Health Questionnaire: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each question has 3 possible answers reflecting 3 levels of impact on the quality of life. Each dimension was assessed on a 3-point ordinal scale (1=no problems, 2=some problems, 3=extreme problems). The responses to the 5 EQ-5D dimensions were scored using a utility-weighted algorithm to derive an EQ-5D Health Status Index score between 0 to 1 (with 1 indicating "full health" and 0 representing "dead"). The higher the values (the closer the value is to 1), the better the health status.
Time Frame
Baseline (Day 1); End of Treatment (up to Week 26)
Title
EuroQol-5 Dimension (EQ-5D) Health Questionnaire - Visual Analog Scale (VAS)
Description
The EuroQoL-5D Health State Visual Analog Scale (VAS) is a participant-rated scale where a single value is ticked for "Your own health state today" on a scale from 0 (worst imaginable health state) to 100 (best imaginable health state); higher scores indicate a better health state.
Time Frame
Baseline (Day 1); End of Treatment (up to Week 26)
Title
Patient Global Impression of Change (PGIC)
Description
In the PGIC, participants indicates the perceived change over the treatment period compared to their condition prior to the start of treatment. Participants are requested to choose 1 of 7 categories. Scores range from "very much improved" to "very much worse". The frequency of responses per category are provided.
Time Frame
Baseline (Day 1); End of Treatment (up to Week 26)
Title
Clinical Global Impression of Change (CGIC)
Description
For the CGIC assessment, the clinician indicates the perceived change in the patient's condition over the treatment period as compared to the patient's condition prior to the start of treatment. The clinician is requested to choose 1 of 7 categories. Categories range from "very much improved" to "very much worse".
Time Frame
Baseline (Day 1); End of Treatment Visit (up to Week 26)
Title
Use of On-demand Opioid Analgesic Medication
Description
Participants reported the opioid type and amount of an opioid in mg/day used to relieve their breakthrough pain over the time period in the study. The average number of units of on-demand opioid medication administered during the previous day (reported on Day 3) and during the last 3 days (reported at all other visits) were documented. The number of units of on-demand opioid medication administered during the Treatment Period is summarized descriptively over the treatment period.
Time Frame
From Day 3 to End of Treatment (up to Week 26) (13 time points)
Title
Mean Equipotency Ratio of Morphine Sulfate Prolonged Release Compared to Cebranopadol.
Description
For those participants, who received morphine prolonged release in the CORAL trial (KF6005/07, NCT01964378) and were, thus, switched from morphine prolonged release to cebranopadol in the CORAL XT trial, the equianalgesic doses of morphine prolonged release and cebranopadol was identified.
Time Frame
Baseline (Day 1); End of first month of treatment
Title
Mean Eastern Cooperative Oncology Group Performance Status (ECOG) Scores
Description
The investigator scores the ECOG performance status for a participant on a 6-point categorical scale as follows:
0 indicates that a participant is "fully active, able to carry on all pre-disease performance without restriction."
1 indicates that a participant is "restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work."
2 indicates that a participant is "ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours."
3 indicates that a participant is "capable of only limited selfcare, confined to bed or chair more than 50% of waking hours."
4 indicates that a participant is "completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair."
5 indicates that a participant is "dead". Mean ECOG performance status scores are calculated for the number of participants with data available.
Time Frame
From Baseline (Day 1) through to End of treatment (up to Week 26) (9 time points)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Informed consent signed indicating that the participant understands the purpose of and procedures required for the trial and is willing to participate in the trial.
Participants must be at least 18 years of age at the Enrollment Visit.
Women of childbearing potential must have a negative pregnancy test at enrollment and must not be lactating at the Enrollment Visit.
Participants must be willing to use medically acceptable and highly effective methods of birth control.
Participants who have completed treatment in KF6005/07 and are still in need of around-the-clock pain analgesia with strong opioids.
Exclusion Criteria:
The participant has a clinically significant disease or condition other than cancer which in the investigator's opinion may affect efficacy or safety assessments.
Known to or suspected of not being able to comply with the protocol and the use of cebranopadol.
Participants taking forbidden concomitant medications or not being able to follow the rules of use of concomitant treatment.
History of torsade de pointes and/or presence of risk factors for torsade de pointes (e.g., heart failure, hypokalemia, bradycardia).
Concurrent participation in another trial (except participation in KF6005/07) or planning to be enrolled in another clinical trial (i.e., administration of experimental treatment in another clinical trial) during the course of this trial, or previous participation in this trial.
Employees of the sponsor, investigator, or trial site or family members of the employees, sponsor, or investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Director Clinical Trials
Organizational Affiliation
Grünenthal GmbH
Official's Role
Study Director
Facility Information:
Facility Name
AT004
City
Vienna
ZIP/Postal Code
1090
Country
Austria
Facility Name
BE001
City
Sint-Niklaas
ZIP/Postal Code
9100
Country
Belgium
Facility Name
BG001
City
Shumen
ZIP/Postal Code
9700
Country
Bulgaria
Facility Name
BG008
City
Sofia
ZIP/Postal Code
1330
Country
Bulgaria
Facility Name
BG003
City
Sofia
ZIP/Postal Code
1407
Country
Bulgaria
Facility Name
BG004
City
Sofia
ZIP/Postal Code
1407
Country
Bulgaria
Facility Name
DK006
City
Aalborg
ZIP/Postal Code
9000
Country
Denmark
Facility Name
DK004
City
Herlev
ZIP/Postal Code
2730
Country
Denmark
Facility Name
DE008
City
Böhlen
ZIP/Postal Code
4564
Country
Germany
Facility Name
DE010
City
Munich
ZIP/Postal Code
81377
Country
Germany
Facility Name
HU011
City
Nyiregyhaza
ZIP/Postal Code
4400
Country
Hungary
Facility Name
PL012
City
Będzin
ZIP/Postal Code
42-500
Country
Poland
Facility Name
PL014
City
Dąbrowa Górnicza
ZIP/Postal Code
41-300
Country
Poland
Facility Name
PL003
City
Gdansk
ZIP/Postal Code
80-208
Country
Poland
Facility Name
PL010
City
Gliwice
ZIP/Postal Code
44-100
Country
Poland
Facility Name
RO002
City
Cluj-Napoca
ZIP/Postal Code
400015
Country
Romania
Facility Name
RS003
City
Belgrade
ZIP/Postal Code
11000
Country
Serbia
Facility Name
RS002
City
Sremska Kamenica
ZIP/Postal Code
21204
Country
Serbia
Facility Name
RS005
City
Zrenjanin
ZIP/Postal Code
23000
Country
Serbia
Facility Name
SK004
City
Bratislava
ZIP/Postal Code
851 07
Country
Slovakia
Facility Name
SK001
City
Presov
ZIP/Postal Code
08001
Country
Slovakia
Facility Name
SK005
City
Pruské
ZIP/Postal Code
018 52
Country
Slovakia
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
31152783
Citation
Koch ED, Kapanadze S, Eerdekens MH, Kralidis G, Letal J, Sabatschus I, Ahmedzai SH. Cebranopadol, a Novel First-in-Class Analgesic Drug Candidate: First Experience With Cancer-Related Pain for up to 26 Weeks. J Pain Symptom Manage. 2019 Sep;58(3):390-399. doi: 10.1016/j.jpainsymman.2019.05.012. Epub 2019 May 30.
Results Reference
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CORAL XT - Open-label Extension Trial of the CORAL Trial
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