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Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Lymphoma.

Primary Purpose

Chemotherapy-induced Thrombocytopenia

Status
Withdrawn
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Romiplostim
Placebo
Sponsored by
Amgen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chemotherapy-induced Thrombocytopenia

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 101 Subject has provided informed consent/assent prior to initiation of any study-specific activities/procedures or subject's legally acceptable representative has provided informed consent prior to any study-specific activities/procedures being initiated when the subject has any kind of condition that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent.
  • 102 Males or females ≥ 18 years of age at signing of the informed consent.
  • 103 Documented active lymphoma.
  • 104 Receiving cancer treatment with 14-, 21-, or 28-day cycles, using medication such as alkylating agents, anthracyclines, carboplatin, cisplatin, nucleoside analogs, or any other chemotherapy agents with thrombocytopenia as a warning or adverse reaction.
  • 105 Subjects must have 2 platelet counts < 30 x 109/L at least 7 days apart as a result of the chemotherapy administered in the cycle immediately preceding study entry, and no platelet count ≥ 50 x 109/L during 3-week period prior to enrollment despite dose delay or dose modification of chemotherapy regimen. The first platelet count < 30 x 109/L may be collected from local lab platelet count and must be confirmed within the 28-day screening period.
  • 106 Subjects must not have received chemotherapy within 14 days prior to first dose of investigational product.
  • 107 Subjects must have at least 4 additional planned cycles of chemotherapy at study enrollment.
  • 108 Subjects must be able to receive the same chemotherapy regimen (when possible, same schedule and same agents) for at least 2 additional cycles per investigator judgement.
  • 109 Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

Exclusion Criteria:

  • 201 Acute lymphoblastic leukemia.
  • 202 Acute myeloid leukemia.
  • 203 Any myeloid malignancy.
  • 204 Myelodysplastic syndrome.
  • 205 Myeloproliferative disease.
  • 206 Multiple myeloma.
  • 207 Within 4 months prior to enrollment, any history of active congestive heart failure (New York Heart Association [NYHA] class III to IV), symptomatic ischemia, uncontrolled arrhythmias, clinically significant electrocardiogram (ECG) abnormalities, screening ECG with corrected QT (QTc) interval of > 470 msec, pericardial disease, or myocardial infarction.
  • 208 New or uncontrolled venous thromboembolism or thrombotic events within 3 months prior to screening.
  • 209 Known human immunodeficiency virus infection, hepatitis C infection, or hepatitis B infection (subjects with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B are allowed).
  • 210 Secondary malignancy within the past 5 years except: Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease. Adequately treated cervical carcinoma in situ without evidence of disease. Adequately treated breast ductal carcinoma in situ without evidence of disease. Prostatic intraepithelial neoplasia without evidence of prostate cáncer. Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ.

Malignancy treated with curative intent and with no known active disease present for ≥ 3 years before enrollment and felt to be at low risk for recurrence by the treating physician (excluding malignancies listed in exclusion criteria 201 to 206).

  • 211 Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and development factor, eltrombopag, recombinant human TPO, any other TPO receptor agonist, or any investigational platelet producing agent.
  • 212 Currently receiving treatment in another investigational device or drug study, or less than 28 days since ending treatment on another investigational device or drug study(ies). Other investigational procedures while participating in this study are excluded.
  • 213 Anemia (hemoglobin < 8 g/dL) on the day of initiation of investigational product. Use of red cell transfusions and erythropoietic stimulating agents is permitted as per institutional guidelines.
  • 214 Neutropenia (absolute neutrophil count < 1 x 109/L) on the day of initiation of investigational product. Use granulocyte-colony stimulating factor is permitted as per institutional guidelines.
  • 215 Abnormal renal function with serum creatinine ≥ 1.5 times [X] the upper limit of normal [ULN] OR creatinine clearance ≤ 60 mL/min using Cockcroft-Gault estimated creatinine clearance as assessed by central laboratory during screening.
  • 216 Abnormal liver function (TBL > 3x ULN; alanine aminotransferase [ALT] or aspartate aminotransferase [AST] > 3x ULN for subjects without liver metastases or ≥ 5x ULN for subjects with liver metastases) as assessed by central laboratory during screening.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Romiplostim

    Placebo

    Arm Description

    the study in a 2:1 randomization ratio(108 subjects to romiplostim)

    the study in a 2:1 randomization ratio (54 subjects to placebo)

    Outcomes

    Primary Outcome Measures

    Chemotherapy dose delay or reduction
    Either a chemotherapy dose delay by ≥ 4 days or chemotherapy dose reduction by ≥ 15% due to thrombocytopenia as measured in any 2 planned cycles of chemotherapy during the treatment period.

    Secondary Outcome Measures

    Platelet recovery
    The time to first platelet recovery, defined by platelet count ≥ 50 x 10^9/L in the absence of platelet transfusions during the preceding 7 days
    Platelet count
    Achieving a platelet count ≥ 50 x 10^9/L, assessed 7 days after the third dose of investigational product and in the absence of platelet transfusions during the preceding 7 days
    Depth of the platelet count
    The depth of the platelet count nadir for chemotherapy cycles administered after the third dose of investigational product through the end of the treatment period
    Subject Incidence of Platelet Transfusion
    Incidence of platelet transfusions during the treatment period
    Bleeding events
    the duration-adjusted event rate of ≥ grade 2 bleeding events, as assessed by the Common Terminology Criteria for Adverse Events (CTCAE), during the treatment period
    Adverse Events, Serious Adverse Events, clinically significant lab value changes
    adverse events, including treatment-emergent adverse events, serious adverse events and clinically significant changes in laboratory values
    Antibody Formation
    anti-romiplostim antibodies and antibodies to TPO
    Vital Status
    vital status
    Changes in health
    myelodysplastic syndromes and secondary malignancies

    Full Information

    First Posted
    October 12, 2017
    Last Updated
    January 17, 2018
    Sponsor
    Amgen
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03343847
    Brief Title
    Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Lymphoma.
    Official Title
    A Phase 3 Randomized Placebo-controlled Double-blind Study of Romiplostim for the Treatment of Chemotherapy-induced Thrombocytopenia in Patients Receiving Chemotherapy for Treatment of Lymphomas
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2018
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Study was not feasible
    Study Start Date
    January 27, 2018 (Anticipated)
    Primary Completion Date
    July 17, 2021 (Anticipated)
    Study Completion Date
    July 17, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Amgen

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    To evaluate the efficacy of romiplostim for the treatment of CIT in patients receiving chemotherapy for the treatment of lymphomas measured by the ability to administer on-time, full-dose chemotherapy.
    Detailed Description
    This is a phase 3, randomized, placebo-controlled, multicenter, international study for the treatment of CIT in adult subjects receiving chemotherapy for the treatment of lymphomas, defined by 2 platelet counts < 30 x 10^9/L at least 7 days apart. The study will consist of a screening period of up to 4 weeks, a 16-week treatment period, an end-of-treatment (EOT) visit, and long-term follow-up.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Chemotherapy-induced Thrombocytopenia

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Romiplostim
    Arm Type
    Experimental
    Arm Description
    the study in a 2:1 randomization ratio(108 subjects to romiplostim)
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    the study in a 2:1 randomization ratio (54 subjects to placebo)
    Intervention Type
    Biological
    Intervention Name(s)
    Romiplostim
    Intervention Description
    This trial is designed to study romiplostim for the treatment of chemotherapy-induced thrombocytopenia (CIT) in patients receiving chemotherapy for the treatment of lymphoma.
    Intervention Type
    Other
    Intervention Name(s)
    Placebo
    Intervention Description
    Placebo Comparator
    Primary Outcome Measure Information:
    Title
    Chemotherapy dose delay or reduction
    Description
    Either a chemotherapy dose delay by ≥ 4 days or chemotherapy dose reduction by ≥ 15% due to thrombocytopenia as measured in any 2 planned cycles of chemotherapy during the treatment period.
    Time Frame
    17 weeks
    Secondary Outcome Measure Information:
    Title
    Platelet recovery
    Description
    The time to first platelet recovery, defined by platelet count ≥ 50 x 10^9/L in the absence of platelet transfusions during the preceding 7 days
    Time Frame
    7 days post transfusion through platelet recovery
    Title
    Platelet count
    Description
    Achieving a platelet count ≥ 50 x 10^9/L, assessed 7 days after the third dose of investigational product and in the absence of platelet transfusions during the preceding 7 days
    Time Frame
    7 days after 3rd dose of IP with no transfusions in preceding 7 days
    Title
    Depth of the platelet count
    Description
    The depth of the platelet count nadir for chemotherapy cycles administered after the third dose of investigational product through the end of the treatment period
    Time Frame
    3rd dose of IP through End of treatment, up to 43 months
    Title
    Subject Incidence of Platelet Transfusion
    Description
    Incidence of platelet transfusions during the treatment period
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Bleeding events
    Description
    the duration-adjusted event rate of ≥ grade 2 bleeding events, as assessed by the Common Terminology Criteria for Adverse Events (CTCAE), during the treatment period
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Adverse Events, Serious Adverse Events, clinically significant lab value changes
    Description
    adverse events, including treatment-emergent adverse events, serious adverse events and clinically significant changes in laboratory values
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Antibody Formation
    Description
    anti-romiplostim antibodies and antibodies to TPO
    Time Frame
    throughout treatment period, up to 17 weeks
    Title
    Vital Status
    Description
    vital status
    Time Frame
    treatment period through end of study, up to 43 months
    Title
    Changes in health
    Description
    myelodysplastic syndromes and secondary malignancies
    Time Frame
    treatment period through end of study, up to 43 months
    Other Pre-specified Outcome Measures:
    Title
    Platelet count
    Description
    Exploratory - Percentage of time with a platelet count ≥ 50 x 10^9/L, starting after the third dose of investigational product through the end-of-treatment period, in the absence of platelet transfusions during the preceding 7 days.
    Time Frame
    treatment period through end of study, up to 43 months
    Title
    Change in Clinical Outcome Assessment (COA) scores
    Description
    Change in Patient Global Assessment-CIT (PGA-CIT) scores from week 1 (baseline) to weeks 2 and 3. 4-item instrument designed to assess global change in quality of life and symptoms over time (since the previous clinic visit). The amount of change is rated using a 7-point Likert-style scale ranging from 1 (very much worse) to 7 (very much better). Items are scored as single items with higher scores indicating a greater degree of improvement.
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Change in Health-Related Quality of Life (HRQoL) score
    Description
    Change in Patient Global Assessment-CIT (PGA-CIT) scores from week 1 (baseline) to weeks 2 and 3. 4-item instrument designed to assess global change in quality of life and symptoms over time (since the previous clinic visit). The amount of change is rated using a 7-point Likert-style scale ranging from 1 (very much worse) to 7 (very much better). Items are scored as single items with higher scores indicating a greater degree of improvement.
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Romiplostim concentration
    Description
    Exploratory - Trough serum concentration of romiplostim
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Change in Clinical Outcomes Assessment (COA) scores
    Description
    European Quality of Life-5 Dimensions (EQ-5D) scores from week 1 (baseline) to weeks 2 and 3. The EQ-5D provides a simple descriptive health profile and a single index value for health status. The EQ-5D descriptive health profile comprises 5 dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each dimension comprises 3 levels (no problems, some/moderate problems, extreme problems). A unique EQ-5D-3L health state is defined by combining one level from each of the 5 dimensions. EQ-5D Index values range from -0.59 to 1.00. In addition, the EQ-5D includes a single item visual analogue scale item that records the subject's self-rated health status on a vertical graduated (0 to 100) line. Higher EQ-5D index and visual analogue scale scores represent better health status.
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Change in Clinical Outcomes Assessment (COA) scores
    Description
    Change in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores from week 1 (baseline) to weeks 2 and 3. Version 4 (for patients with thrombocytopenia) and 2) a patient global assessment - CIT (PGA-CIT) instrument The FACT-Th18 is a 45-item instrument that includes 28 FACT general items covering 4 domains (physical well-being, social/family well-being, emotional well-being, and functional well-being) with an additional 17 items covering Additional Concerns, 15 of which specific to thrombocytopenia. Scale scores range from 0 (Not at all) to 4 (Very Much) and can be derived for each of the 4 FACT--G domains, a FACT-G total score, a thrombocytopenia subscale score, and a FACT-Th total score. The FACT-Th has been evaluated as a reliable and valid measure for assessing the impact of thrombocytopenia on patients' lives that can distinguish cancer patients with and without thrombocytopenia and is responsive to increase in platelet count over time.
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Change in Health-Related Quality of Life (HRQoL) score
    Description
    European Quality of Life-5 Dimensions (EQ-5D) scores from week 1 (baseline) to weeks 2 and 3. The EQ-5D provides a simple descriptive health profile and a single index value for health status. The EQ-5D descriptive health profile comprises 5 dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each dimension comprises 3 levels (no problems, some/moderate problems, extreme problems). A unique EQ-5D-3L health state is defined by combining one level from each of the 5 dimensions. EQ-5D Index values range from -0.59 to 1.00. In addition, the EQ-5D includes a single item visual analogue scale item that records the subject's self-rated health status on a vertical graduated (0 to 100) line. Higher EQ-5D index and visual analogue scale scores represent better health status.
    Time Frame
    Through treatment period, up to 17 weeks
    Title
    Change in Health-Related Quality of Life (HRQoL) score
    Description
    Change in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores from week 1 (baseline) to weeks 2 and 3. Version 4 (for patients with thrombocytopenia) and 2) a patient global assessment - CIT (PGA-CIT) instrument The FACT-Th18 is a 45-item instrument that includes 28 FACT general items covering 4 domains (physical well-being, social/family well-being, emotional well-being, and functional well-being) with an additional 17 items covering Additional Concerns, 15 of which specific to thrombocytopenia. Scale scores range from 0 (Not at all) to 4 (Very Much) and can be derived for each of the 4 FACT--G domains, a FACT-G total score, a thrombocytopenia subscale score, and a FACT-Th total score. The FACT-Th has been evaluated as a reliable and valid measure for assessing the impact of thrombocytopenia on patients' lives that can distinguish cancer patients with and without thrombocytopenia and is responsive to increase in platelet count over time.
    Time Frame
    Through treatment period, up to 17 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    100 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 101 Subject has provided informed consent/assent prior to initiation of any study-specific activities/procedures or subject's legally acceptable representative has provided informed consent prior to any study-specific activities/procedures being initiated when the subject has any kind of condition that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent. 102 Males or females ≥ 18 years of age at signing of the informed consent. 103 Documented active lymphoma. 104 Receiving cancer treatment with 14-, 21-, or 28-day cycles, using medication such as alkylating agents, anthracyclines, carboplatin, cisplatin, nucleoside analogs, or any other chemotherapy agents with thrombocytopenia as a warning or adverse reaction. 105 Subjects must have 2 platelet counts < 30 x 109/L at least 7 days apart as a result of the chemotherapy administered in the cycle immediately preceding study entry, and no platelet count ≥ 50 x 109/L during 3-week period prior to enrollment despite dose delay or dose modification of chemotherapy regimen. The first platelet count < 30 x 109/L may be collected from local lab platelet count and must be confirmed within the 28-day screening period. 106 Subjects must not have received chemotherapy within 14 days prior to first dose of investigational product. 107 Subjects must have at least 4 additional planned cycles of chemotherapy at study enrollment. 108 Subjects must be able to receive the same chemotherapy regimen (when possible, same schedule and same agents) for at least 2 additional cycles per investigator judgement. 109 Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Exclusion Criteria: 201 Acute lymphoblastic leukemia. 202 Acute myeloid leukemia. 203 Any myeloid malignancy. 204 Myelodysplastic syndrome. 205 Myeloproliferative disease. 206 Multiple myeloma. 207 Within 4 months prior to enrollment, any history of active congestive heart failure (New York Heart Association [NYHA] class III to IV), symptomatic ischemia, uncontrolled arrhythmias, clinically significant electrocardiogram (ECG) abnormalities, screening ECG with corrected QT (QTc) interval of > 470 msec, pericardial disease, or myocardial infarction. 208 New or uncontrolled venous thromboembolism or thrombotic events within 3 months prior to screening. 209 Known human immunodeficiency virus infection, hepatitis C infection, or hepatitis B infection (subjects with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B are allowed). 210 Secondary malignancy within the past 5 years except: Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease. Adequately treated cervical carcinoma in situ without evidence of disease. Adequately treated breast ductal carcinoma in situ without evidence of disease. Prostatic intraepithelial neoplasia without evidence of prostate cáncer. Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ. Malignancy treated with curative intent and with no known active disease present for ≥ 3 years before enrollment and felt to be at low risk for recurrence by the treating physician (excluding malignancies listed in exclusion criteria 201 to 206). 211 Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and development factor, eltrombopag, recombinant human TPO, any other TPO receptor agonist, or any investigational platelet producing agent. 212 Currently receiving treatment in another investigational device or drug study, or less than 28 days since ending treatment on another investigational device or drug study(ies). Other investigational procedures while participating in this study are excluded. 213 Anemia (hemoglobin < 8 g/dL) on the day of initiation of investigational product. Use of red cell transfusions and erythropoietic stimulating agents is permitted as per institutional guidelines. 214 Neutropenia (absolute neutrophil count < 1 x 109/L) on the day of initiation of investigational product. Use granulocyte-colony stimulating factor is permitted as per institutional guidelines. 215 Abnormal renal function with serum creatinine ≥ 1.5 times [X] the upper limit of normal [ULN] OR creatinine clearance ≤ 60 mL/min using Cockcroft-Gault estimated creatinine clearance as assessed by central laboratory during screening. 216 Abnormal liver function (TBL > 3x ULN; alanine aminotransferase [ALT] or aspartate aminotransferase [AST] > 3x ULN for subjects without liver metastases or ≥ 5x ULN for subjects with liver metastases) as assessed by central laboratory during screening.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    MD
    Organizational Affiliation
    Amgen
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Links:
    URL
    http://www.amgentrials.com
    Description
    AmgenTrials clinical trials website

    Learn more about this trial

    Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Lymphoma.

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