A Study of Ramucirumab in Participants With Gastric, Esophageal, and Gastroesophageal Cancer

Phase 2

Completed

Conditions: Esophageal Cancer
Stomach Cancer

Interventions: Biological: Ramucirumab
Drug: Placebo
Drug: Oxaliplatin
Drug: Leucovorin
Drug: 5-Fluorouracil

Registration Number: NCT01246960

Lead Sponsor: Eli Lilly and Company

Brief Summary: The purpose of this study is to determine whether ramucirumab when used in conjunction with chemotherapy treatment can help participants with stomach, esophagus, and gastroesophageal cancer.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 168

Inclusion Criteria

Histologic or cytologic confirmation of adenocarcinoma of the esophagus, gastroesophageal junction (GEJ), or stomach
Metastatic or locally advanced, unresectable disease at time of study entry
Provided signed informed consent and is amenable to compliance with protocol schedules and testing
Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0-1 at study entry
Adequate renal, hematological, and hepatic function
Measurable or non-measurable disease at the time of study entry
Resolution to Grade less than or equal to 1 by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 4.0, of all clinically significant toxic effects of prior locoregional therapy, surgery, or other anticancer therapy, except where otherwise mentioned in the eligibility criteria
Eligible participants of reproductive potential (both sexes) must agree to use adequate contraceptive methods (hormonal or barrier methods) during the study period and at least 12 weeks after the last dose of study therapy
Life expectancy of greater than or equal to 3 months
Willingness to provide blood and tissue samples for research purposes. Submission of tumor specimen is mandatory for participation in this study, if a histologic, paraffin-embedded specimen exists (either from a surgical resection or biopsy); submission of paraffin block or a minimum of 8 unstained slides is required if sufficient sample. NOTE: If insufficient additional tissue exists (that is, all tissue has been utilized for prior diagnostic purposes), participation in the study is allowable without the requirement for an additional biopsy; this situation must be discussed with the study principal investigator and/or the ImClone medical monitor or designee.

Exclusion Criteria

The participant has received prior first-line systemic therapy for advanced/unresectable and/or metastatic disease (prior adjuvant or neo-adjuvant therapy is permitted)
Previous or concurrent malignancy except for basal or squamous cell skin cancer and/or in situ carcinoma of the cervix, or other solid tumors treated curatively and without evidence of recurrence for at least 3 years prior to study entry
Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the participant ineligible for entry into this study
The participant is receiving chronic therapy with nonsteroidal anti-inflammatory agents (NSAIDs; for example, indomethacin, ibuprofen, naproxen, or similar agents) or other antiplatelet agents (for example, clopidogrel, ticlopidine, dipyridamole, anagrelide). Aspirin use at doses up to 325 milligrams per day (mg/day) is permitted.
The participant has significant third-space fluid retention (for example, ascites or pleural effusion), and is not amenable for required repeated drainage
The participant is pregnant or breastfeeding
Uncontrolled intercurrent illness including, but not limited to, active or uncontrolled clinically serious infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, uncontrolled thromboembolic, or hemorrhagic disorder, psychiatric illness/social situations, or other co-morbid systemic illnesses, or other severe concurrent disease
Immunocompromised participants including participants known to be human immunodeficiency virus (HIV) positive.
Progressive disease less than or equal to 12 months of completing platinum or 5-FU treatment, including capecitabine, if given previously in the perioperative (adjuvant or neoadjuvant) setting
Current or recent (within 28 days prior to randomization) treatment with an investigational drug that has not received regulatory approval for any indication at the time of study entry, or participation in another interventional clinical trial. Participants participating in surveys or observational studies are eligible to participate in this study.
Are currently enrolled in, or discontinued within the last 28 days from, a clinical trial involving ramucirumab drug product (DP), or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study
Received prior therapy with an antiangiogenic agent (including but not limited to bevacizumab, sunitinib, or sorafenib)
Major surgical procedure or significant traumatic injury less than 28 days prior to randomization, or anticipation of need for elective or planned major surgical procedure during the course of the study. Subcutaneous venous access device placement within 7 days prior to randomization
Clinically significant peripheral neuropathy at the time of registration
Known central nervous system metastases that are symptomatic or untreated
New York Heart Association (NYHA) classification III-IV congestive heart failure
Greater than normal risk of bleeding or coagulopathy in the absence of therapeutic anticoagulation; Grade 3/4 gastrointestinal bleeding within 3 months prior to registration; active bleeding (that is, within 14 days prior to first dose of study therapy); or pathological condition present that carries a high risk of bleeding (for example, tumor involving major vessels or known varices)
Participant has experienced any arterial thromboembolic events, including but not limited to myocardial infarction, stroke, transient ischemic attack (TIA), cerebrovascular accident, or unstable angina, less than or equal to 6 months prior to registration
Clinically significant vascular disease (for example, aortic aneurysm, aortic dissection) for which more than minimal intervention is being administered or planned
History of hypertensive crisis or hypertensive encephalopathy or current poorly-controlled hypertension despite standard medical management
History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess less than 6 months prior to registration
Known hypersensitivity to any of the treatment components of modified FOLFOX6 (mFOLFOX6) (oxaliplatin, 5-FU, and leucovorin) or ramucirumab DP

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ramucirumab	Ramucirumab	* Oxaliplatin 85 milligrams per square meter (mg/m\^2) given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-Fluorouracil (5-FU) 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Ramucirumab 8 milligrams per kilogram (mg/kg) given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Placebo	Placebo	* Oxaliplatin 85 mg/m\^2 given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-FU 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Placebo given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Ramucirumab	Oxaliplatin	* Oxaliplatin 85 milligrams per square meter (mg/m\^2) given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-Fluorouracil (5-FU) 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Ramucirumab 8 milligrams per kilogram (mg/kg) given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Ramucirumab	Leucovorin	* Oxaliplatin 85 milligrams per square meter (mg/m\^2) given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-Fluorouracil (5-FU) 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Ramucirumab 8 milligrams per kilogram (mg/kg) given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Ramucirumab	5-Fluorouracil	* Oxaliplatin 85 milligrams per square meter (mg/m\^2) given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-Fluorouracil (5-FU) 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Ramucirumab 8 milligrams per kilogram (mg/kg) given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Placebo	Oxaliplatin	* Oxaliplatin 85 mg/m\^2 given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-FU 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Placebo given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Placebo	Leucovorin	* Oxaliplatin 85 mg/m\^2 given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-FU 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Placebo given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met
Placebo	5-Fluorouracil	* Oxaliplatin 85 mg/m\^2 given on Day 1 of a 2-week cycle * Leucovorin 400 mg/m\^2 given on Day 1 of a 2-week cycle * 5-FU 400 mg/m\^2 bolus given on Day 1 of a 2-week cycle * 5-FU 2400 mg/m\^2 continuously given over 46-48 hours on Day 1 of a 2-week cycle * Placebo given on Day 1 of a 2-week cycle Participants will receive study treatment every 2 weeks until disease progression, unacceptable toxicity, or another withdrawal criterion is met

Primary Outcome Measures

Name	Time	Method
Progression-Free Survival (PFS)	Randomization to measured PD or date of death from any cause (up to Month 25.0)	PFS was defined using Response Evaluation Criteria in Solid Tumors \[RECIST version (v.) 1.1\] as the time from randomization to the first observation of progressive disease (PD) or death due to any cause, whichever came first. PD was a ≥20% increase in the sum of the diameters of target lesions with the sum demonstrating an absolute increase of ≥5 millimeters (mm); the appearance of ≥1 new lesions or unequivocal progression of non-target lesions. If a participant did not have a baseline disease assessment, PFS time was censored at the randomization date, regardless of whether or not PD or death was observed. Participants not known to have died or have objective PD were censored at the last post-baseline radiological assessment date.

Secondary Outcome Measures

Name	Time	Method
Time to Disease Progression (TTP)	Randomization to measured PD (up to Month 25.0)	TTP was defined using RECIST v. 1.1 as the time from study randomization to the first date of PD. PD was a ≥20% increase in the sum of the diameters of target lesions with the sum demonstrating an absolute increase of ≥5 mm; the appearance of ≥1 new lesions or unequivocal progression of non-target lesions. TTP was censored at the date of last adequate tumor assessment if death was due to causes other than PD.
Duration of Response	Time of first response to measured PD (up to Month 23.0)	Duration of response was defined using RECIST v. 1.1 criteria as the time from the date criteria were met for the first objectively recorded CR or PR until the first date criteria for PD were met or death from any cause. CR was the disappearance of all lesions and pathological lymph node reduction in the short axis to \<10 mm. PR was a ≥30% decrease in the sum of the diameters of target lesions. PD was a ≥20% increase in the sum of the diameters of target lesions with the sum demonstrating an absolute increase of ≥5 mm; the appearance of ≥1 new lesions or unequivocal progression of non-target lesions. Participants who were not known to have died and who did not have PD were censored at the date of the last tumor assessment prior to the date of any subsequent systemic anticancer therapy.
Overall Survival (OS)	Randomization to date of death from any cause (up to Month 28.3)	OS was defined as the time from randomization to death due to any cause. OS was censored at the date of the last follow-up visit for participants who were alive or lost to follow-up.
Percentage of Participants Achieving an Objective Response (Objective Response Rate)	Randomization to measured PD (up to Month 23.0)	The percentage of participants who achieved a best overall response of partial response (PR) or complete response (CR) is reported. Response was defined using RECIST, v. 1.1 criteria. CR was the disappearance of all lesions and pathological lymph node reduction in the short axis to \<10 mm. PR was a ≥30% decrease in the sum of the diameters of target lesions. The percentage of participants with objective response=(number of participants whose best overall response achieved was CR or PR/number of participants treated)\*100.
Number of Participants With Treatment-Emergent Anti-Ramucirumab Antibodies	Months 1, 2, 4, 6, and 8	Participants with treatment-emergent anti-ramucirumab antibodies were participants with a 4-fold increase (2 dilution increase) in immunogenicity titer over baseline titer, or participants who tested negative at baseline and positive post-baseline (at titer of ≥1:20).

Trial Locations

Locations (1): For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.
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Marshfield, Wisconsin, United States