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Efficacy and Safety oF FErric CarboxymalTose in Patients With Advanced Gastric Cancer(EFFECT-AGC)

Primary Purpose

Advanced Gastric Carcinoma

Status
Recruiting
Phase
Phase 3
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Ferinject
Conservative management
Sponsored by
Asan Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Gastric Carcinoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Age ≥ 19 years at the time of study registration
  2. Eastern Cooperative Oncology Group performance status ≤ 2
  3. Histologically or cytologically confirmed gastric or gastroesophageal junction (GEJ) adenocarcinoma
  4. Locally advanced unresectable or metastatic disease
  5. Patients who have not been treated with palliative systemic antitumor agents for advanced or recurrent gastric or GEJ adenocarcinoma
  6. Patients scheduled to receive palliative first-line fluoropyrimidine and platinum-based systemic therapy including targeted therapy or immunotherapy
  7. Life expectancy ≥24 weeks
  8. IDA

    1. Hb 8 to <11 g/dL
    2. Absolute ID (serum ferritin < 100 ng/mL) OR functional ID (TSAT* < 50% and serum ferritin 100-500 ng/mL)

      • TSAT = (serum iron level x 100)/ total iron-binding capacity (TIBC)

Exclusion Criteria:

  1. Body weight < 35 kg
  2. Immediate need for transfusion or Hb < 8 g/dL
  3. Possible functional ID or No ID (serum ferritin > 500 ng/mL OR TSAT ≥ 50%)
  4. Anemia attributable to factors other than cancer or chemotherapy (e.g., vitamin B12 and/or serum folate deficiency; hemolysis; or myelodysplastic syndromes)
  5. Ongoing bleeding or overt gross active bleeding (e.g., hematemesis, melena, or hematochezia)
  6. Neoplastic bone marrow infiltration
  7. History of ESA, IV or oral iron therapy, and/or RBC transfusion 4 weeks prior to randomization
  8. Iron overload or disturbances in utilization of iron (e.g., personal or family history of hemochromatosis and hemosiderosis)
  9. Known hypersensitivity to any of the required study products or known serious hypersensitivity to other parenteral iron products
  10. Known severe allergies including drug allergies, history of severe asthma, eczema or other atopic allergies, and in subjects with immune or inflammatory conditions (e.g., systemic lupus erythematosus, rheumatoid arthritis)
  11. Decreased renal function including renal dialysis (previous, current or planned within the next 6 months,) or serum creatinine levels ≥ 2.0 mg/dL, or estimated glomerular filtration rate < 30 mL/min/1.73 m2
  12. Chronic liver disease (including active hepatitis) and/or aspartate transaminase (AST) or alanine transaminase (ALT) ≥ 3 times the upper limit of the normal range
  13. Active acute or chronic infections (assessed by clinical judgment)
  14. Other significant medical condition(s) in the opinion of the investigator with an anticipated need for major surgery during the study, or any other kind of disorder that may be associated with increased risk to the subject or may interfere with study assessments, outcomes (e.g., uncontrolled hypertension, active cardiac disease, thromboembolic disease, or uncontrolled diabetes mellitus, neurological or psychiatric disorders)
  15. Pregnancy (e.g., positive human chorionic gonadotropin test) or breast-feeding. If the subject is of childbearing potential and does, not use adequate contraceptive precautions. The subject must agree to use adequate contraception during the study and for 1 month after the last dose of study treatment. A highly effective method of birth control must be used.

Sites / Locations

  • Asan Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Active treatment arm : IV FCM

Control treatment arm: Conservative management

Arm Description

Intravenous ferric carboxymaltose

Conservative management Absolute IDA: oral ferrous sulfate Functional IDA: no treatment or oral ferrous sulfate according to the physician's choice Other IV iron or PRC transfusion or ESA therapy is not allowed

Outcomes

Primary Outcome Measures

Maximum change of Hb concentration
Maximum change of Hb concentration from baseline to 12 weeks (or first RBC transfusion and/or ESA, or study withdrawl, or death, whichever will be first) without RBC transfusion and/or ESA

Secondary Outcome Measures

Change of Hb concentration
Change of Hb concentration from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Change in serum iron
Change in serum iron from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Change in serum ferritin
Change in serum iron, ferritin(ng/dL) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Change in serum TIBC
Change in serum TIBC(µg/dL) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Change in serum TSAT
Change in serum TSAT(%) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Tumor response
according to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1)
PFS
time from the date of first administration of palliative first-line chemotherapy to the date of the first objectively documented tumor progression or death, whichever occurs first)
OS
time from the date of first administration of palliative first-line chemotherapy to the date of death due to any cause

Full Information

First Posted
December 27, 2021
Last Updated
May 9, 2022
Sponsor
Asan Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT05226169
Brief Title
Efficacy and Safety oF FErric CarboxymalTose in Patients With Advanced Gastric Cancer(EFFECT-AGC)
Official Title
Randomized Controlled Trial of Intravenous Ferric Carboxymaltose for Iron-Deficiency Anemia in Patients With Advanced Gastric Cancer Receiving Palliative Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 29, 2022 (Actual)
Primary Completion Date
November 30, 2024 (Anticipated)
Study Completion Date
November 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Asan Medical Center

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 main objective of this study is to evaluate the efficacy and safety of IV FCM(ferric carboxymaltose) in patients with AGC receiving palliative chemotherapy. This study will also evaluate the effect of IV FCM on the treatment outcomes of palliative chemotherapy in patients with gastric cancer receiving fluoropyrimidine and platinum-based regimen in the same 1st-line palliative setting.
Detailed Description
Gastric cancer is associated with chronic blood loss, poor nutrition, and surgical interventions interfering with iron absorption, all of which synergistically increase the risk of iron-deficiency anemia (IDA). A retrospective review of gastric cancer reported that at the time of gastric cancer diagnosis, the prevalence of anemia was 58.7% and the overall prevalence of IDA was 40%. Moreover, patients with unresectable locally advanced or metastatic gastric cancer are treated with myelosuppressive chemotherapies, which further increases the risk for anemia. The absorption of oral iron in gastric cancer patients is limited due to malabsorption, ongoing gastrointestinal bleeding, and lack of adherence to treatment due to dyspepsia, vomiting, abdominal pain, diarrhea, and constipation. Therefore, IV iron may be preferable due to easy administration, effective iron absorption, and infrequent complications in gastric cancer patients. • There are a number of IV iron formulations in the market; the recommended IV iron preparations are low-molecular-weight iron dextran, ferric gluconate, iron sucrose, ferric carboxymaltose (FCM), and ferumoxytol. FCM (FerinjectTM; Vifor Pharma, Glattbrugg, Switzerland) is a stable colloidal solution of nanoparticles which consist of a polynuclear iron (III)-(oxyhydr)oxide core stabilized by carboxymaltose, which allows slow and prolonged iron release, and is given as a single high-dose (1,000 mg of iron) in a 15-minute infusion. Based on extensive experience in clinical trial and real-world settings, IV FCM is an effective and generally well tolerated treatment for rapidly replenishing iron stores and correcting anemia in patients with ID or IDA of various etiologies. FCM was effective in patients with active malignancy and IDA (n=420), and hematological malignancies or solid tumors and anemia (n=367) in two real-world, noninterventional studies conducted in Germany and France. Recently, two prospective studies conducted in South Korea have reported a significant increase in Hb levels by treatment with IV FCM in patients with solid cancers (including gastric cancer) receiving chemotherapy and in patients with acute isovolemic anemia following gastrectomy. Therefore, the main objective of this study is to evaluate the efficacy and safety of IV FCM in patients with AGC receiving palliative chemotherapy. This study will also evaluate the effect of IV FCM on the treatment outcomes of palliative chemotherapy in patients with gastric cancer receiving fluoropyrimidine and platinum-based regimen in the same 1st-line palliative setting.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Gastric Carcinoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Active treatment arm : IV FCM
Arm Type
Experimental
Arm Description
Intravenous ferric carboxymaltose
Arm Title
Control treatment arm: Conservative management
Arm Type
Active Comparator
Arm Description
Conservative management Absolute IDA: oral ferrous sulfate Functional IDA: no treatment or oral ferrous sulfate according to the physician's choice Other IV iron or PRC transfusion or ESA therapy is not allowed
Intervention Type
Drug
Intervention Name(s)
Ferinject
Other Intervention Name(s)
IV FCM
Intervention Description
Patients will receive an IV FCM (1,000 mg iron) infusion on the first day (visit 1) of chemotherapy. FCM (FerinjectTM; Vifor Pharma, Glattbrugg, Switzerland) will be diluted in 250 ml of sterile 0.9% normal saline by an aseptic technique and infused over 15 min under the supervision of a clinician. Patients with a Hb level ≤ 10 g/dL and ID (serum ferritin < 100 ng/mL or TSAT < 50% and serum ferritin 100-500 ng/mL) will receive an additional dose of 500 mg of IV FCM at 6, 12, 24, 36, and 48 weeks. FCM will be diluted in 100 ml of sterile 0.9% normal saline by an aseptic technique and infused over 6 min under the supervision of a clinician.
Intervention Type
Other
Intervention Name(s)
Conservative management
Intervention Description
Patients with absolute (must be administered) or functional (according to the physician's choice) IDA in the control arm will be received oral iron, administered as Feroba-You 256mg once or twice a day. Advice will be given regarding ingestion without food and with liquid high in ascorbic acid to maximize enteric absorption. If patients in the control arm still meet the absolute or functional IDA at the end of study (at 48 weeks), they can receive IV FCM (1,000 mg) according to the physician's decision.
Primary Outcome Measure Information:
Title
Maximum change of Hb concentration
Description
Maximum change of Hb concentration from baseline to 12 weeks (or first RBC transfusion and/or ESA, or study withdrawl, or death, whichever will be first) without RBC transfusion and/or ESA
Time Frame
baseline to 12 weeks
Secondary Outcome Measure Information:
Title
Change of Hb concentration
Description
Change of Hb concentration from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Time Frame
baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Title
Change in serum iron
Description
Change in serum iron from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Time Frame
baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Title
Change in serum ferritin
Description
Change in serum iron, ferritin(ng/dL) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Time Frame
baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Title
Change in serum TIBC
Description
Change in serum TIBC(µg/dL) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Time Frame
baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Title
Change in serum TSAT
Description
Change in serum TSAT(%) from baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Time Frame
baseline to 3, 6, 9, 12, 24, 36, and 48 weeks
Title
Tumor response
Description
according to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1)
Time Frame
every 6-8weeks, assessed up to 24 months
Title
PFS
Description
time from the date of first administration of palliative first-line chemotherapy to the date of the first objectively documented tumor progression or death, whichever occurs first)
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 24 months
Title
OS
Description
time from the date of first administration of palliative first-line chemotherapy to the date of death due to any cause
Time Frame
through study completion, an average of 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 19 years at the time of study registration Eastern Cooperative Oncology Group performance status ≤ 2 Histologically or cytologically confirmed gastric or gastroesophageal junction (GEJ) adenocarcinoma Locally advanced unresectable or metastatic disease Patients who have not been treated with palliative systemic antitumor agents for advanced or recurrent gastric or GEJ adenocarcinoma Patients scheduled to receive palliative first-line fluoropyrimidine and platinum-based systemic therapy including targeted therapy or immunotherapy Life expectancy ≥24 weeks IDA Hb 8 to <11 g/dL Absolute ID (serum ferritin < 100 ng/mL) OR functional ID (TSAT* < 50% and serum ferritin 100-500 ng/mL) TSAT = (serum iron level x 100)/ total iron-binding capacity (TIBC) Exclusion Criteria: Body weight < 35 kg Immediate need for transfusion or Hb < 8 g/dL Possible functional ID or No ID (serum ferritin > 500 ng/mL OR TSAT ≥ 50%) Anemia attributable to factors other than cancer or chemotherapy (e.g., vitamin B12 and/or serum folate deficiency; hemolysis; or myelodysplastic syndromes) Ongoing bleeding or overt gross active bleeding (e.g., hematemesis, melena, or hematochezia) Neoplastic bone marrow infiltration History of ESA, IV or oral iron therapy, and/or RBC transfusion 4 weeks prior to randomization Iron overload or disturbances in utilization of iron (e.g., personal or family history of hemochromatosis and hemosiderosis) Known hypersensitivity to any of the required study products or known serious hypersensitivity to other parenteral iron products Known severe allergies including drug allergies, history of severe asthma, eczema or other atopic allergies, and in subjects with immune or inflammatory conditions (e.g., systemic lupus erythematosus, rheumatoid arthritis) Decreased renal function including renal dialysis (previous, current or planned within the next 6 months,) or serum creatinine levels ≥ 2.0 mg/dL, or estimated glomerular filtration rate < 30 mL/min/1.73 m2 Chronic liver disease (including active hepatitis) and/or aspartate transaminase (AST) or alanine transaminase (ALT) ≥ 3 times the upper limit of the normal range Active acute or chronic infections (assessed by clinical judgment) Other significant medical condition(s) in the opinion of the investigator with an anticipated need for major surgery during the study, or any other kind of disorder that may be associated with increased risk to the subject or may interfere with study assessments, outcomes (e.g., uncontrolled hypertension, active cardiac disease, thromboembolic disease, or uncontrolled diabetes mellitus, neurological or psychiatric disorders) Pregnancy (e.g., positive human chorionic gonadotropin test) or breast-feeding. If the subject is of childbearing potential and does, not use adequate contraceptive precautions. The subject must agree to use adequate contraception during the study and for 1 month after the last dose of study treatment. A highly effective method of birth control must be used.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Min-Hee Ryu, PhD
Phone
82-2-3010-5935
Email
miniryu@amc.seoul.kr
Facility Information:
Facility Name
Asan Medical Center
City
Seoul
ZIP/Postal Code
138-736
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Min-Hee Ryu, MD., Ph.D.
Phone
+82-10-5285-9492
Email
miniryu@amc.seoul.kr
First Name & Middle Initial & Last Name & Degree
Min-Hee Ryu, M.D., Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Efficacy and Safety oF FErric CarboxymalTose in Patients With Advanced Gastric Cancer(EFFECT-AGC)

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