Study of Ramucirumab, Trastuzumab and Paclitaxel in Patients With HER2-positive Recurrent/Metastatic Gastric Cancer (HER-RAM Study)
Primary Purpose
Recurrent/Metastatic Gastric Cancer
Status
Unknown status
Phase
Phase 1
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Trastuzumab + Ramucirumab + Paclitaxel
Sponsored by
About this trial
This is an interventional treatment trial for Recurrent/Metastatic Gastric Cancer
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically proven metastatic or locally advanced HER2-positive gastric cancer
- Documented disease progression after receiving prior line of trastuzumab-containing chemotherapy for gastric cancer
- Able and willing to give written informed consent and has signed the informed consent form (ICF), prior to performance of any trial activities.
- Eligible male and female subjects aged ≥19 years.
- Has measurable disease as determined by RECIST 1.1.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
- Has baseline left ventricular ejection fraction (LVEF) ≥ 55%.
- Adequate organ function as demonstrated by laboratory test results within 14 days prior to first dose of study treatment.
- Have urinary protein that is <2 on dipstick or routine urinalysis.
- Female subject of childbearing potential should have a negative urine or serum pregnancy within 72 hours prior to first dose of study treatment.
- Female subjects of childbearing potential and male subjects should be willing to use methods of birth control for the course of the study and up to 120 days after the last dose of study treatment.
Exclusion Criteria:
- Received prior anticancer treatment with targeted agents, chemotherapy, or radiotherapy within 14 days, with monoclonal antibodies within 28 days, has previously received treatment with ramucirumab, or has participated in another clinical trial within 14 days prior to start of study treatment.
- Has experienced any Grade 3-4 gastrointestinal bleeding within 3 months prior to treatment.
- Has experienced any arterial thromboembolic events, including but not limited to myocardial infarction, transient ischemic attack, cerebrovascular accident, or unstable angina, within 3 months prior to treatment.
- Has history of severe thromboembolism, including deep vein thrombosis and pulmonary embolism within 6 months prior to treatment.
- Has an active or ongoing infection, symptomatic congestive heart failure, uncontrolled angina pectoris, symptomatic or poorly controlled arrhythmia, uncontrolled thrombotic or hemorrhagic disorder, or any other serious uncontrolled medical disorders in the opinion of the investigator.
- Has ongoing or active psychiatric illness or social situation that would limit compliance with study requirements.
- Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
- Has evidence of active, non-infectious pneumonitis.
- Has a known history of Human Immunodeficiency Virus (HIV).
- Has known active hepatitis B or hepatitis C.
- Have an elective or a planned major surgery during the course of the trial or has undergone major surgery within 4 weeks prior to enrollment.
- Has history of GI perforation and/or fistula within 6 months prior to treatment.
- Is pregnant or breastfeeding, or possibly pregnant.
- Has history of Child-Pugh Class B or more of liver cirrhosis or hepatic encephalopathy, or cirrhosis with clinically meaningful ascites.
- Is undergoing long-term antiplatelet therapy within 7 days prior to treatment.
- Has known history of hypersensitivity to one or more of the study treatments or their substances, or known severe hypersensitivity to monoclonal antibodies.
- Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
Sites / Locations
- Yonsei University Health System, Severance Hospital
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Study treatment
Arm Description
(Phase Ib part) Trastuzumab 4 mg/kg (loading dose) followed by 2 mg/kg IV, ramucirumab 8 mg/kg IV, and paclitaxel 80 or 70 mg/m2 IV (according to dose level) (Phase II part) Trastuzumab 4 mg/kg (loading dose) followed by 2 mg/kg IV, ramucirumab 8 mg/kg IV, and paclitaxel at RP2D (80 or 70 mg/m2 IV)
Outcomes
Primary Outcome Measures
Phase 1b: Maximum tolerated dose of trastuzumab, ramucirumab, and paclitaxel combination treatment in patients with HER2-positive gastric cancer
Phase 2: Progression-free survival in patients with HER2-positive gastric cancer receiving trastuzumab, ramucirumab, and paclitaxel combination treatment
Secondary Outcome Measures
Overall survival
Objective response rate according to RECIST 1.1
Disease control rate according to RECIST 1.1
Safety and tolerability based on incidence of treatment-emergent adverse events as assessed by CTCAE v4.02
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04888663
Brief Title
Study of Ramucirumab, Trastuzumab and Paclitaxel in Patients With HER2-positive Recurrent/Metastatic Gastric Cancer (HER-RAM Study)
Official Title
An Open-label, Multicenter Phase Ib/II Study of Ramucirumab in Combination With Trastuzumab and Weekly Paclitaxel in Patients With HER2-positive Recurrent/Metastatic Gastric Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
May 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 13, 2018 (Actual)
Primary Completion Date
September 2, 2021 (Anticipated)
Study Completion Date
September 2, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yonsei University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Human epidermal growth factor receptor 2 (HER2) is overexpressed or amplified in 10-20% of gastric or gastroesophageal junction cancer. Trastuzumab combined with fluorouracil and platinum has been established as first-line treatment for patients with HER2-positive gastric cancer. The role of trastuzumab in second-line treatment for HER2-positive gastric cancer has not yet been addressed. Here, we evaluated the safety and efficacy of adding trastuzumab to ramucirumab and paclitaxel combination as a second-line treatment in HER2-positive gastric cancer progressed after trastuzumab-containing chemotherapy.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent/Metastatic Gastric Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Study treatment
Arm Type
Experimental
Arm Description
(Phase Ib part) Trastuzumab 4 mg/kg (loading dose) followed by 2 mg/kg IV, ramucirumab 8 mg/kg IV, and paclitaxel 80 or 70 mg/m2 IV (according to dose level) (Phase II part) Trastuzumab 4 mg/kg (loading dose) followed by 2 mg/kg IV, ramucirumab 8 mg/kg IV, and paclitaxel at RP2D (80 or 70 mg/m2 IV)
Intervention Type
Drug
Intervention Name(s)
Trastuzumab + Ramucirumab + Paclitaxel
Intervention Description
For both Phase Ib and II: Trastuzumab 4 mg/kg (loading dose) followed by 2 mg/kg on Days 1, 8, 15 and 22, and ramucirumab 8 mg/kg on Days 1 and 15, as well as paclitaxel will be administered intravenously in a 4-week cycle (every 28 days) For Phase Ib, Paclitaxel 80 or 70 mg/m2 (according to dose level) will be administered on Days 1, 8, 15 For Phase II, paclitaxel at RP2D (80 or 70 mg/m2) will be administered on Days 1, 8, 15 of each cycle
Primary Outcome Measure Information:
Title
Phase 1b: Maximum tolerated dose of trastuzumab, ramucirumab, and paclitaxel combination treatment in patients with HER2-positive gastric cancer
Time Frame
Phase 1b: During the first 4 weeks of treatment
Title
Phase 2: Progression-free survival in patients with HER2-positive gastric cancer receiving trastuzumab, ramucirumab, and paclitaxel combination treatment
Time Frame
Phase 2: At 24 weeks after start of treatment
Secondary Outcome Measure Information:
Title
Overall survival
Time Frame
through study completion, an average of 2 years
Title
Objective response rate according to RECIST 1.1
Time Frame
through study completion, an average of 2 years
Title
Disease control rate according to RECIST 1.1
Time Frame
through study completion, an average of 2 years
Title
Safety and tolerability based on incidence of treatment-emergent adverse events as assessed by CTCAE v4.02
Time Frame
Throughout the overall study period as well as up to 3 months after the last dose study treatment for each subject
10. Eligibility
Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologically or cytologically proven metastatic or locally advanced HER2-positive gastric cancer
Documented disease progression after receiving prior line of trastuzumab-containing chemotherapy for gastric cancer
Able and willing to give written informed consent and has signed the informed consent form (ICF), prior to performance of any trial activities.
Eligible male and female subjects aged ≥19 years.
Has measurable disease as determined by RECIST 1.1.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
Has baseline left ventricular ejection fraction (LVEF) ≥ 55%.
Adequate organ function as demonstrated by laboratory test results within 14 days prior to first dose of study treatment.
Have urinary protein that is <2 on dipstick or routine urinalysis.
Female subject of childbearing potential should have a negative urine or serum pregnancy within 72 hours prior to first dose of study treatment.
Female subjects of childbearing potential and male subjects should be willing to use methods of birth control for the course of the study and up to 120 days after the last dose of study treatment.
Exclusion Criteria:
Received prior anticancer treatment with targeted agents, chemotherapy, or radiotherapy within 14 days, with monoclonal antibodies within 28 days, has previously received treatment with ramucirumab, or has participated in another clinical trial within 14 days prior to start of study treatment.
Has experienced any Grade 3-4 gastrointestinal bleeding within 3 months prior to treatment.
Has experienced any arterial thromboembolic events, including but not limited to myocardial infarction, transient ischemic attack, cerebrovascular accident, or unstable angina, within 3 months prior to treatment.
Has history of severe thromboembolism, including deep vein thrombosis and pulmonary embolism within 6 months prior to treatment.
Has an active or ongoing infection, symptomatic congestive heart failure, uncontrolled angina pectoris, symptomatic or poorly controlled arrhythmia, uncontrolled thrombotic or hemorrhagic disorder, or any other serious uncontrolled medical disorders in the opinion of the investigator.
Has ongoing or active psychiatric illness or social situation that would limit compliance with study requirements.
Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
Has evidence of active, non-infectious pneumonitis.
Has a known history of Human Immunodeficiency Virus (HIV).
Has known active hepatitis B or hepatitis C.
Have an elective or a planned major surgery during the course of the trial or has undergone major surgery within 4 weeks prior to enrollment.
Has history of GI perforation and/or fistula within 6 months prior to treatment.
Is pregnant or breastfeeding, or possibly pregnant.
Has history of Child-Pugh Class B or more of liver cirrhosis or hepatic encephalopathy, or cirrhosis with clinically meaningful ascites.
Is undergoing long-term antiplatelet therapy within 7 days prior to treatment.
Has known history of hypersensitivity to one or more of the study treatments or their substances, or known severe hypersensitivity to monoclonal antibodies.
Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sun Young RHA, MD, PhD
Organizational Affiliation
Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Yonsei University Health System, Severance Hospital
City
Seoul
State/Province
Seodaemun-gu
ZIP/Postal Code
03722
Country
Korea, Republic of
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Study of Ramucirumab, Trastuzumab and Paclitaxel in Patients With HER2-positive Recurrent/Metastatic Gastric Cancer (HER-RAM Study)
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