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Bioequivalence Study Bevacizumab Biosimilar (BEVZ92) Versus Bevacizumab (AVASTIN®) in First-line Treatment mCRC Patients

Primary Purpose

Metastatic Colorectal Cancer (mCRC)

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Bevacizumab biosimilar (BEVZ92)
Avastin® (bevacizumab, reference product)
Sponsored by
mAbxience Research S.L.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Colorectal Cancer (mCRC) focused on measuring colorectal cancer, metastatic, first-line treatment, comparability

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patient must not have had prior chemotherapy for advanced or metastatic disease. Patients could have received adjuvant chemotherapy or adjuvant chemo-radiotherapy.
  2. Patient with mCRC for whom bio-chemotherapy is indicated.
  3. Patients must have at least one measurable non-irradiated site of disease according to RECIST (version 1.1) criteria. If the patient has had previous irradiation of the marker lesion(s), there must be evidence of progression since the radiation.
  4. Minimum of 4 weeks since any major surgery, completion of radiation, or completion of all prior systemic anticancer therapy
  5. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.
  6. Adequate bone marrow function
  7. Adequate liver function defined within specific parameters
  8. Adequate renal function defined within specific parameters
  9. Adequate coagulation parameters defined within specific parameters
  10. Negative pregnancy test for females of a childbearing potential.
  11. Use of an effective form of contraception during the study (for subjects of childbearing potential and their partners).
  12. Life expectation ≥ 3 months

Exclusion Criteria:

  1. Prior treatment for advanced or metastatic colorectal cancer.
  2. Prior treatment with an anti-angiogenesis agent, in either the neoadjuvant or adjuvant setting.
  3. Concurrent use of investigational anti-neoplastic agents (including up to 4 weeks prior to enrolment).
  4. History of any other malignancy unless the malignancy is in complete remission and the patient has been off all therapy for that malignancy for at least 5 years.
  5. Chronic treatment with systemic steroids or other immunosuppressive agents; topical or inhaled corticosteroids are allowed.
  6. Scheduled immunization with attenuated live vaccines during study period or within 1 week prior to study entry.
  7. Uncontrolled brain or lepto-meningeal metastases, including patients who continue to require glucocorticoids for brain or lepto-meningeal metastases.
  8. Patients with active bleeding or history of bleeding diathesis on oral anti-vitamin K medication (except low dose coumadin) within the past 6 month prior to randomization or coagulopathy.
  9. Patients with history of cerebral vascular accident, transient ischemic attack, or subarachnoid haemorrhage within the past 6 month prior to randomization.
  10. Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study
  11. Patients with serious non-healing wound, ulcer, bone fracture, or with a major surgical procedure, or significant traumatic injury within 4 weeks prior to randomization
  12. Patients with clinical symptoms or signs of gastrointestinal obstruction that require parenteral hydration and/or nutrition.
  13. Patients with history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months prior to randomization.
  14. Patients with history of hypersensitivity to any of the study drugs or ingredients.

Sites / Locations

  • Hospital de Gastroenterologia "Dr. Carlos Bonorino Udaondo"
  • Instituto Oncológico de Rosario
  • Fundaçáo Pio XII - Hospital do Cancer de Barretos
  • Hospital Caridade
  • Hospital Sao Lucas da Pucrs
  • Centro de Pesquisa do Instituto Brasileiro de Controle do Câncer - IBCC
  • Hosp. A.C Camargo
  • Instituto do Cancer del estado de S. Paulo (ICEPS )
  • M S Patel Cancer Centre- Shree Krishna Hospital
  • Sri Ramachandra Hospital
  • Tata Hospital
  • Central India Canter Research Institute
  • Curie Manavta Cancer Center
  • Regional Cancer Center & Medical College
  • Centro Oncológico Clara Campal
  • Dnipropetrovsk City Multiple-discipline Clinical Hospital №4
  • Kharkiv Regional Clinical Oncology Center
  • Danylo Halytskiy Lviv National Medical University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Bevacizumab biosimilar (BEVZ92)

Avastin® (bevacizumab, ref. product)

Arm Description

Bevacizumab 25 mg/mL (strength: 100 mg/4 mL).

Bevacizumab 25mg/ml (strength: 100mg/4ml)

Outcomes

Primary Outcome Measures

Area Under the Concentration-versus-time Curve (AUC) at Cycle 1 (AUC0-336h) of BEVZ92 and Avastin®
To compare the pharmacokinetic (PK) profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated AUC calculated from start of the first infusion until start of the second infusion (i.e. at Cycle 1; AUC0-336h) For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% confidence interval (CI) of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.
AUC at Steady State (AUCss) of BEVZ92 and Avastin®
To compare the PK profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated area under the concentration-versus-time curve calculated over a dosage interval at steady state (i.e. at Cycle 7; AUCss). For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% CI of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.

Secondary Outcome Measures

Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Reported With BEVZ92 and Avastin®
Compare the safety profile by means of the frequency and severity of TEAEs and SAEs reported in each treatment arm.
Anti-Drug Antibody (ADA) of BEVZ92 and Avastin®
Immunogenicity profile by means of measurement of ADA developed de novo (seroconversion) after cycle 5, cycle 8, and 12 months after first drug administration (pre-dose).
Objective Response Rate (ORR) of BEVZ92 and Avastin®
To compare efficacy in terms of ORR between arms. Clinical and radiological tumor assessments were performed according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 using computed tomography (CT) or magnetic resonance imaging (MRI) scans. Objective response (OR) is defined as a best overall response of partial response (PR) or complete response (CR) as defined by RECIST v1.1. All participants who did not meet the criteria for CR or PR by the end of the study were considered non-responders.
Cmax,sd of BEVZ92 and Avastin®
Secondary PK endpoints included the Cmax calculated at Cycle 1 (Cmax,sd )
Progression-free Survival (PFS) of BEVZ92 and Avastin®
Compare PFS between the randomized treatment arms. Progression-free survival (PFS) was defined as the time from the randomization date to the date of disease progression using RECIST v1.1, or death. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions plus 5 mm absolute increase, and/or unequivocal progression of known non-target lesion, and/or the appearance of new lesions".
Cmax,ss of BEVZ92 and Avastin®
Secondary PK endpoints included the Cmax calculated at Cycle 7 (Cmax, ss )
Ctrough,sd of BEVZ92 and Avastin®
Secondary PK endpoints included the Ctrough calculated at Cycle 1 (Ctrough,sd )
Ctrough,ss of BEVZ92 and Avastin®
Secondary PK endpoints included the Ctrough calculated at Cycle 7 (Ctrough,ss)
Elimination Half-life (t1/2) of BEVZ92 and Avastin®
Secondary PK endpoints included the t1/2 calculated at Cycle 7
Elimination Rate Constant (Kel) of BEVZ92 and Avastin®
Secondary PK endpoints included the Kel calculated at Cycle 7 (Ctrough,ss)
Volume of Distribution (Vd) of BEVZ92 and Avastin®
Secondary PK endpoints included the Vd calculated at Cycle 7

Full Information

First Posted
February 14, 2014
Last Updated
July 19, 2019
Sponsor
mAbxience Research S.L.
Collaborators
Laboratorio Elea Phoenix S.A., Libbs Farmacêutica LTDA
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1. Study Identification

Unique Protocol Identification Number
NCT02069704
Brief Title
Bioequivalence Study Bevacizumab Biosimilar (BEVZ92) Versus Bevacizumab (AVASTIN®) in First-line Treatment mCRC Patients
Official Title
Open Label Randomized Bioequivalence Study to Evaluate the Pharmacokinetic and Safety Profile of Bevacizumab Biosimilar (BEVZ92) vs Bevacizumab (AVASTIN®), Both With FOLFOX or FOLFIRI, in First-line Treatment for mCRC Patients
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
October 29, 2014 (Actual)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
June 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
mAbxience Research S.L.
Collaborators
Laboratorio Elea Phoenix S.A., Libbs Farmacêutica LTDA

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multicenter, open label, randomized bioequivalence study of BEVZ92 (bevacizumab biosimilar) and Avastin® with 2 parallel arms to compare the pharmacokinetic (PK) profile of BEVZ92 and Avastin® in combination with FOLFOX (any) or FOLFIRI chemotherapy. FOLFOX (any) or FOLFIRI will be chosen as per investigator criteria based on the hospital standard of care.
Detailed Description
Planned enrolment duration: 12 months. Pre-treatment period (included in enrolment period): 1 month. Treatment period: Patients will continue treatment until disease progression or unacceptable toxicity, or withdrawal of consent.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Cancer (mCRC)
Keywords
colorectal cancer, metastatic, first-line treatment, comparability

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
142 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bevacizumab biosimilar (BEVZ92)
Arm Type
Experimental
Arm Description
Bevacizumab 25 mg/mL (strength: 100 mg/4 mL).
Arm Title
Avastin® (bevacizumab, ref. product)
Arm Type
Active Comparator
Arm Description
Bevacizumab 25mg/ml (strength: 100mg/4ml)
Intervention Type
Drug
Intervention Name(s)
Bevacizumab biosimilar (BEVZ92)
Other Intervention Name(s)
FOLFOX = Folinic acid + Fluorouracil + Oxaliplatin, FOLFIRI = Folinic acid + Fluorouracil + Irinotecan
Intervention Description
Active ingredient Bevacizumab 25 mg/mL (strength = 100 mg/4 mL). 30-minute* IV infusion (5 mg/kg) every 2 weeks, prior to chemotherapy (Folfox any or Folfiri). FOLFIRI = Folinic Acid + Fluorouracil + Irinotecan FOLFOX = Folinic Acid + Fluorouracil + Oxaliplatin Treatment will continue until disease progression, unacceptable toxicity, patient withdraws consent or death (whichever occurs first). *The first infusion will be given over 90 minutes. If it is well tolerated, the second infusion can be given over 60 minutes. If it is well tolerated, subsequent infusions can be given over 30 minutes. The FOLFOX (any) or FOLFIRI regimen will be chosen as per investigator's criteria based on the hospital standard of care.
Intervention Type
Drug
Intervention Name(s)
Avastin® (bevacizumab, reference product)
Other Intervention Name(s)
FOLFOX = Folinic acid + Fluorouracil + Oxaliplatin, FOLFIRI = Folinic acid + Fluorouracil + Irinotecan
Intervention Description
Active ingredient: Bevacizumab 25 mg/mL (strength: 100 mg/4 mL). 30-minute* IV infusion (5 mg/kg) every 2 weeks, prior to administration of chemotherapy. Treatment will continue until disease progression, unacceptable toxicity, patient withdraws consent or death (whichever occurs first). *The first infusion will be given over 90 minutes. If the first infusion is well tolerated, the second infusion can be given over 60 minutes. If this infusion is well tolerated, subsequent infusions can be given over 30 minutes. The FOLFOX (any) or FOLFIRI regimen will be chosen as per investigator's criteria based on the hospital standard of care.
Primary Outcome Measure Information:
Title
Area Under the Concentration-versus-time Curve (AUC) at Cycle 1 (AUC0-336h) of BEVZ92 and Avastin®
Description
To compare the pharmacokinetic (PK) profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated AUC calculated from start of the first infusion until start of the second infusion (i.e. at Cycle 1; AUC0-336h) For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% confidence interval (CI) of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.
Time Frame
AUC0-336 hrs: 0 to 336 hours after start of the first infusion
Title
AUC at Steady State (AUCss) of BEVZ92 and Avastin®
Description
To compare the PK profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated area under the concentration-versus-time curve calculated over a dosage interval at steady state (i.e. at Cycle 7; AUCss). For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% CI of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.
Time Frame
AUCss: 0 to 336 hours after the administration of Cycle 7 infusion (Week 13).
Secondary Outcome Measure Information:
Title
Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Reported With BEVZ92 and Avastin®
Description
Compare the safety profile by means of the frequency and severity of TEAEs and SAEs reported in each treatment arm.
Time Frame
From first study dose and up to 30 days after the end of study treatment for each patient, for an average of 11 months
Title
Anti-Drug Antibody (ADA) of BEVZ92 and Avastin®
Description
Immunogenicity profile by means of measurement of ADA developed de novo (seroconversion) after cycle 5, cycle 8, and 12 months after first drug administration (pre-dose).
Time Frame
At baseline, and on Day 1 (pre-dose) of Cycles: 1, 5 and 8, and 12 months after first drug administration
Title
Objective Response Rate (ORR) of BEVZ92 and Avastin®
Description
To compare efficacy in terms of ORR between arms. Clinical and radiological tumor assessments were performed according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 using computed tomography (CT) or magnetic resonance imaging (MRI) scans. Objective response (OR) is defined as a best overall response of partial response (PR) or complete response (CR) as defined by RECIST v1.1. All participants who did not meet the criteria for CR or PR by the end of the study were considered non-responders.
Time Frame
Every four weeks. Up to 48 weeks
Title
Cmax,sd of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Cmax calculated at Cycle 1 (Cmax,sd )
Time Frame
Cmax, sd: 0 to 336 hours after start of the first infusion.
Title
Progression-free Survival (PFS) of BEVZ92 and Avastin®
Description
Compare PFS between the randomized treatment arms. Progression-free survival (PFS) was defined as the time from the randomization date to the date of disease progression using RECIST v1.1, or death. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions plus 5 mm absolute increase, and/or unequivocal progression of known non-target lesion, and/or the appearance of new lesions".
Time Frame
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 weeks.
Title
Cmax,ss of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Cmax calculated at Cycle 7 (Cmax, ss )
Time Frame
Cmax, ss: 0 to 336 hours post-dose after the administration of Cycle 7 infusion (Week 13)
Title
Ctrough,sd of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Ctrough calculated at Cycle 1 (Ctrough,sd )
Time Frame
Ctrough, sd: 0 to 336 hours after start of the first infusion.
Title
Ctrough,ss of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Ctrough calculated at Cycle 7 (Ctrough,ss)
Time Frame
Ctrough, ss: 0 to 336 hours after the administration of the Cycle 7 infusion.
Title
Elimination Half-life (t1/2) of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the t1/2 calculated at Cycle 7
Time Frame
t1/2: 0 to 336 hours after the administration of the Cycle 7 infusion.
Title
Elimination Rate Constant (Kel) of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Kel calculated at Cycle 7 (Ctrough,ss)
Time Frame
Kel: 0 to 336 hours after the administration of the Cycle 7 infusion.
Title
Volume of Distribution (Vd) of BEVZ92 and Avastin®
Description
Secondary PK endpoints included the Vd calculated at Cycle 7
Time Frame
Vd: 0 to 336 hours after the administration of the Cycle 7 infusion.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must not have had prior chemotherapy for advanced or metastatic disease. Patients could have received adjuvant chemotherapy or adjuvant chemo-radiotherapy. Patient with mCRC for whom bio-chemotherapy is indicated. Patients must have at least one measurable non-irradiated site of disease according to RECIST (version 1.1) criteria. If the patient has had previous irradiation of the marker lesion(s), there must be evidence of progression since the radiation. Minimum of 4 weeks since any major surgery, completion of radiation, or completion of all prior systemic anticancer therapy Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Adequate bone marrow function Adequate liver function defined within specific parameters Adequate renal function defined within specific parameters Adequate coagulation parameters defined within specific parameters Negative pregnancy test for females of a childbearing potential. Use of an effective form of contraception during the study (for subjects of childbearing potential and their partners). Life expectation ≥ 3 months Exclusion Criteria: Prior treatment for advanced or metastatic colorectal cancer. Prior treatment with an anti-angiogenesis agent, in either the neoadjuvant or adjuvant setting. Concurrent use of investigational anti-neoplastic agents (including up to 4 weeks prior to enrolment). History of any other malignancy unless the malignancy is in complete remission and the patient has been off all therapy for that malignancy for at least 5 years. Chronic treatment with systemic steroids or other immunosuppressive agents; topical or inhaled corticosteroids are allowed. Scheduled immunization with attenuated live vaccines during study period or within 1 week prior to study entry. Uncontrolled brain or lepto-meningeal metastases, including patients who continue to require glucocorticoids for brain or lepto-meningeal metastases. Patients with active bleeding or history of bleeding diathesis on oral anti-vitamin K medication (except low dose coumadin) within the past 6 month prior to randomization or coagulopathy. Patients with history of cerebral vascular accident, transient ischemic attack, or subarachnoid haemorrhage within the past 6 month prior to randomization. Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study Patients with serious non-healing wound, ulcer, bone fracture, or with a major surgical procedure, or significant traumatic injury within 4 weeks prior to randomization Patients with clinical symptoms or signs of gastrointestinal obstruction that require parenteral hydration and/or nutrition. Patients with history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months prior to randomization. Patients with history of hypersensitivity to any of the study drugs or ingredients.
Facility Information:
Facility Name
Hospital de Gastroenterologia "Dr. Carlos Bonorino Udaondo"
City
Buenos Aires
Country
Argentina
Facility Name
Instituto Oncológico de Rosario
City
Rosario
Country
Argentina
Facility Name
Fundaçáo Pio XII - Hospital do Cancer de Barretos
City
Barretos
Country
Brazil
Facility Name
Hospital Caridade
City
Ijui
Country
Brazil
Facility Name
Hospital Sao Lucas da Pucrs
City
Porto Alegre
Country
Brazil
Facility Name
Centro de Pesquisa do Instituto Brasileiro de Controle do Câncer - IBCC
City
São Paulo
Country
Brazil
Facility Name
Hosp. A.C Camargo
City
São Paulo
Country
Brazil
Facility Name
Instituto do Cancer del estado de S. Paulo (ICEPS )
City
São Paulo
Country
Brazil
Facility Name
M S Patel Cancer Centre- Shree Krishna Hospital
City
Karamsad
State/Province
Gujarat
ZIP/Postal Code
388 325
Country
India
Facility Name
Sri Ramachandra Hospital
City
Chennai
Country
India
Facility Name
Tata Hospital
City
Mumbai
Country
India
Facility Name
Central India Canter Research Institute
City
Nagpur
Country
India
Facility Name
Curie Manavta Cancer Center
City
Nashik
Country
India
Facility Name
Regional Cancer Center & Medical College
City
Thiruvananthapuram
Country
India
Facility Name
Centro Oncológico Clara Campal
City
Madrid
Country
Spain
Facility Name
Dnipropetrovsk City Multiple-discipline Clinical Hospital №4
City
Dnipropetrovsk
Country
Ukraine
Facility Name
Kharkiv Regional Clinical Oncology Center
City
Kharkiv
Country
Ukraine
Facility Name
Danylo Halytskiy Lviv National Medical University
City
Lviv
Country
Ukraine

12. IPD Sharing Statement

Citations:
PubMed Identifier
30262136
Citation
Romera A, Peredpaya S, Shparyk Y, Bondarenko I, Mendonca Bariani G, Abdalla KC, Roca E, Franke F, Melo Cruz F, Ramesh A, Ostwal V, Shah P, Rahuman SA, Paravisini A, Huerga C, Del Campo Garcia A, Millan S. Bevacizumab biosimilar BEVZ92 versus reference bevacizumab in combination with FOLFOX or FOLFIRI as first-line treatment for metastatic colorectal cancer: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2018 Dec;3(12):845-855. doi: 10.1016/S2468-1253(18)30269-3. Epub 2018 Sep 24. Erratum In: Lancet Gastroenterol Hepatol. 2018 Sep 28;:
Results Reference
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Bioequivalence Study Bevacizumab Biosimilar (BEVZ92) Versus Bevacizumab (AVASTIN®) in First-line Treatment mCRC Patients

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