A Phase 2 interventional study of pegylated liposomal doxorubicin (PLD) and VTX-2337 in Epithelial Ovarian Cancer, Fallopian Tube Cancer and Primary Peritoneal Cancer, sponsored by Celgene. Completed at 136 sites in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-09-26.
Sponsored by Celgene · Phase 2, Interventional, and Treatment
The purpose of this study is to compare the overall survival of patients treated with VTX-2337 + pegylated liposomal doxorubicin (PLD) versus those treated with PLD alone in women with recurrent or persistent, epithelial ovarian, fallopian tube or primary peritoneal cancer.
VTX-2337, a small molecule agonist of Toll-like Receptor 8 (TLR8), activates multiple components of the innate immune system and is being developed as a novel therapeutic agent for use in oncology. Experimental data obtained in an animal model of ovarian cancer supports the combination of VTX-2337 with PLD. In this model, the combination of VTX-2337 and PLD resulted in a significant reduction in tumor growth compared to either agent alone and an increase in the number of T lymphocytes infiltrating the tumor. The combination of PLD and VTX-2337 has been tested in a small number of women with ovarian cancer in a Phase 1b study and appears to be generally well-tolerated.
OBJECTIVES
Primary Objectives:
Secondary Objectives:
Exploratory Objectives:
OUTLINE:
This is Phase 2 multicenter clinical study to evaluate the efficacy and safety of the combination of VTX-2337 + PLD compared to PLD + Placebo.
The dosing schedule will be the same for both treatment arms, and will be based on a 28-day cycle. The starting dose schedule is PLD on Day 1 plus VTX-2337 or placebo on Day 3, Day 10, and Day 17 for the first 4 cycles. Starting with cycle 5, the dose regimen will be PLD on Day 1 plus VTX-2337 or placebo on Day 3.
Blood samples are collected periodically during cycle 1 for pharmacodynamics, pharmacogenomics, and other research studies.
Patients will receive therapy until disease progression based on Immune-Related RECIST or until adverse effects prohibit further therapy. Following treatment completion, all patients will be followed with physical exams and histories every three months for the first two years, and then every six months for the next three years, and then
2,695 studies on the registry are indexed under Ovarian Neoplasms; 727 are open to participants now.
This study's enrollment of 297 is above the median of 60 across 2,030 interventional studies indexed under Ovarian Neoplasms.
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Patients must have received treatment with a platinum-based chemotherapeutic regimen for management of primary disease containing carboplatin, cisplatin or another organoplatinum compound. This initial treatment may have included intraperitoneal therapy, consolidation, non-cytotoxic agents or extended therapy administered after surgical or non-surgical assessment.
Patients are allowed to receive, but are not required to receive, one additional cytotoxic regimen for management of recurrent or persistent disease.
Patients are allowed to have received, but are not required to have received, biologic/targeted therapy (e.g., bevacizumab and/or PARP inhibitor) as part of their primary treatment regimen or for management of recurrent or persistent disease.
Patients must have adequate bone marrow, renal, hepatic, and neurologic functions as defined by the following:
Patients must have recovered from effects of recent surgery, radiotherapy or chemotherapy:
Exclusion Criteria:
The dosing schedule will be be based on a 28-day cycle. The starting dose schedule is PLD on Day 1 plus VTX-2337 on Day 3, Day 10, and Day 17 for the first 4 cycles. Starting with cycle 5, the dose regimen will be PLD on Day 1 plus VTX-2337 on Day 3 only, without additional doses of VTX-2337 on Days 10 and Day 17.
Drug: pegylated liposomal doxorubicin (PLD) · Drug: VTX-2337
The dosing schedule will be based on a 28-day cycle. The starting dose schedule is PLD on Day 1 plus placebo on Day 3, Day 10, and Day 17 for the first 4 cycles. Starting with cycle 5, the dose regimen will be PLD on Day 1 plus placebo on Day 3 only.
Drug: pegylated liposomal doxorubicin (PLD) · Drug: Placebo
Also known as: Doxil, Lipodox
TLR8 Agonist
Overall Survival
Comparison of duration of survival between the 2 treatment groups
Time frame: Survival is measured from date of enrollment and randomization on the study until death from any cause, or if alive at last contact, date of last contact.
Progression-free Survival (PFS)
Comparison of PFS between the 2 treatment groups
Time frame: Progression-free survival is measured from enrollment and randomization on the study until first indication of progression based on irRECIST criteria or death from any cause, or if progression-free at last contact, the date of last disease assessment.
Frequency and Severity of Adverse Events (AEs)
An AE is any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug-related. An AE can be unfavorable and unintended sign, symptom, or disease which is temporally associated with the use of investigational product (IP), whether or not considered related to the IP. A serious AE = an AE occurring at any dose that: • Results in death • Is life- threatening • Requires or prolongs existing inpatient hospitalization • Results in persistent or significant disability/incapacity • Is a congenital anomaly/birth defect; • Constitutes an important medical event. The Investigator assessed the relationship of each AE to IP and graded the severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.0: Grade (GR) 1 = Mild; asymptomatic or mild symptoms; GR 2 = Moderate (minimal, local or noninvasive intervention indicated); GR 3 = Severe or medically significant; GR 4 = Life-threatening; GR 5 = Death
Time frame: Assessed during each cycle of therapy and within 30 days after the last cycle of therapy
Enrollment was initiated on 2012-Aug-13 and terminated on 2014-Apr-11. During this time, 297 patients were enrolled.
| Milestone | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| Started | 149 | 148 |
| Completed | 147 | 147 |
| Not completed | 2 | 1 |
| Withdrew: Did not initiate treatment | 2 | 1 |
Comparison of duration of survival between the 2 treatment groups
| days | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| Overall Survival | 574 (242 to 1141) | 552 (240 to 869) |
Comparison of PFS between the 2 treatment groups
| days | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| Progression-free Survival (PFS) | 159 (87 to 351) | 147 (85 to 267) |
An AE is any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug-related. An AE can be unfavorable and unintended sign, symptom, or disease which is temporally associated with the use of investigational product (IP), whether or not considered related to the IP. A serious AE = an AE occurring at any dose that: • Results in death • Is life- threatening • Requires or prolongs existing inpatient hospitalization • Results in persistent or significant disability/incapacity • Is a congenital anomaly/birth defect; • Constitutes an important medical event. The Investigator assessed the relationship of each AE to IP and graded the severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.0: Grade (GR) 1 = Mild; asymptomatic or mild symptoms; GR 2 = Moderate (minimal, local or noninvasive intervention indicated); GR 3 = Severe or medically significant; GR 4 = Life-threatening; GR 5 = Death
| participants | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| Grade 1 | 8 | 3 |
| Grade 2 | 40 | 44 |
| Grade 3 | 83 | 90 |
| Grade 4 | 10 | 3 |
| Grade 5 | 6 | 7 |
Collected over Adverse Event assessments began with initiation of any study treatment up until 30 days following the last cycle of treatment.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Pegylated Liposomal Doxorubicin (PLD) + Placebo | — | 30/147 (20.4%) | 147/147 (100%) |
| Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | — | 36/147 (24.5%) | 147/147 (100%) |
| Event | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| NauseaGastrointestinal disorders | 8/147 | 9/147 |
| VomitingGastrointestinal disorders | 5/147 | 7/147 |
| Abdominal PainGastrointestinal disorders | 3/147 | 6/147 |
| SepsisInfections and infestations | 5/147 | 1/147 |
| DiarrheaGastrointestinal disorders | 1/147 | 4/147 |
| FatigueGeneral disorders | 2/147 | 4/147 |
| Creatinine IncreasedInvestigations | 4/147 | 0/147 |
| AnemiaBlood and lymphatic system disorders | 3/147 | 2/147 |
| Small Intestinal ObstructionGastrointestinal disorders | 3/147 | 0/147 |
| FeverGeneral disorders | 1/147 | 3/147 |
| Event | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) |
|---|---|---|
| FatigueGeneral disorders | 109/147 | 127/147 |
| Injection Site ReactionGeneral disorders | 13/147 | 107/147 |
| AnemiaBlood and lymphatic system disorders | 103/147 | 105/147 |
| NauseaGastrointestinal disorders | 93/147 | 97/147 |
| ChillsGeneral disorders | 25/147 | 92/147 |
| White Blood Cell DecreasedInvestigations | 83/147 | 74/147 |
| ConstipationGastrointestinal disorders | 75/147 | 79/147 |
| VomitingGastrointestinal disorders | 48/147 | 70/147 |
| FeverGeneral disorders | 19/147 | 70/147 |
| Abdominal PainGastrointestinal disorders | 54/147 | 61/147 |
All enrolled patients
| Age, Continuous(years) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| Median | 61.6 (29.7 to 91.1) | 63.5 (39.6 to 84.8) | 62.7 (29.7 to 91.1) |
| Age, Customized(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| <40 years | 4 | 1 | 5 |
| 40-49 years | 22 | 11 | 33 |
| 50-59 years | 39 | 42 | 81 |
| 60-69 years | 50 | 51 | 101 |
| 70-79 years | 31 | 38 | 69 |
| > 79 years | 3 | 5 | 8 |
| Sex: Female, Male(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| Female | 149 | 148 | 297 |
| Male | 0 | 0 | 0 |
| Ethnicity (NIH/OMB)(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| Hispanic or Latino | 4 | 3 | 7 |
| Not Hispanic or Latino | 143 | 145 | 288 |
| Unknown or Not Reported | 2 | 0 | 2 |
| Race (NIH/OMB)(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 1 | 1 | 2 |
| Asian | 3 | 3 | 6 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 4 | 6 | 10 |
| White | 141 | 137 | 278 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 1 | 1 |
| Eastern Cooperative Oncology Group (ECOG) Performance Status(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| 0 = Fully active, no restrictions | 104 | 105 | 209 |
| 1=Restricted activity;ambulatory;can do light work | 45 | 43 | 88 |
| Prior Platinum-Free Interval as per Case Report Forms(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| <= 6 months | 79 | 72 | 151 |
| > 6 months | 70 | 76 | 146 |
| Prior Chemotherapy Regimens(Participants) | Pegylated Liposomal Doxorubicin (PLD) + Placebo | Pegylated Liposomal Doxorubicin (PLD)+VTX-2337 (VTX) | Total |
|---|---|---|---|
| 1 | 81 | 69 | 150 |
| 2 | 64 | 74 | 138 |
| 3 | 4 | 5 | 9 |
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