Low Dose Cyclophosphamide +/-- Nintedanib in Advanced Ovarian Cancer (METRO-BIBF)

• ClinicalTrials.gov Identifier: NCT01610869
• Recruitment Status: Completed
• First Posted: June 4, 2012
• Last Update Posted: May 29, 2019
• Sponsor: University College, London
• Collaborator: Boehringer Ingelheim
• Information provided by (Responsible Party): University College, London

Study Description

Brief Summary:

The primary objective is to explore the efficacy and safety of an all oral combination of BIBF 1120 (an inhibitor of angiogenic signalling) and metronomic cyclophosphamide in patients with multiply-relapsed advanced ovarian cancer, who have completed a minimum of two lines of previous chemotherapy and who for any reason are not suitable for further 'standard' intravenous chemotherapy treatments.

Condition or disease	Intervention/treatment	Phase
Ovarian Cancer; Fallopian Tube Cancer	Drug: BIBF 1120	Phase 2

Detailed Description:

A randomised placebo controlled double blind multi-centre phase II trial: BIBF 1120 200mg bd plus 100mg daily of oral cyclophosphamide (experimental arm) or oral cyclophosphamide 100mg daily plus placebo (control arm). Patients will receive oral BIBF 1120 and cyclophosphamide or cyclophosphamide and placebo continuously until disease progression or unacceptable toxicity.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 117 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Triple (Participant, Care Provider, Investigator)
• Primary Purpose: Treatment
• Official Title: Phase II, Randomised, Placebo Controlled, Multicentre, Feasibility Study of Low Dose (Metronomic) Cyclophosphamide With and Without Nintedanib (BIBF 1120) in Advanced Ovarian Cancer
• Actual Study Start Date: August 2014
• Actual Primary Completion Date: January 11, 2018
• Actual Study Completion Date: January 11, 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: Cyclophosphamide and BIBF-1120; Patients will receive oral BIBF 1120 (200mg bd) and cyclophosphamide (100mg) on a daily basis until disease progression or unacceptable toxicity.	Drug: BIBF 1120; Patients will receive either cyclophosphamide (100mg)and oral BIBF 1120 (200mg bd) or cyclophosphamide (100mg) and placebo.; Other Name: BIBF 1120 brand name: Nintedanib.
Placebo Comparator: Cyclophosphamide and placebo; Patients will receive oral BIBF 1120 (200mg bd) and placebo capsules on a daily basis until disease progression or unacceptable toxicity.	Drug: BIBF 1120; Patients will receive either cyclophosphamide (100mg)and oral BIBF 1120 (200mg bd) or cyclophosphamide (100mg) and placebo.; Other Name: BIBF 1120 brand name: Nintedanib.

Outcome Measures

Primary Outcome Measures :

1. Overall survival [ Time Frame: After follow-up is complete (year 3-4 of the trial) ]
   To be measured in days, from the date of randomisation to the date of death.

Secondary Outcome Measures :

1. Quality of life and qualitative health data [ Time Frame: After follow-up is complete (year 3-4 of the trial) ]
   Health questionnaires which record qualitative health data on the patient perspective of their illness and treatment. This will be measured on a 6 weekly basis, from baseline to the end of treatment.
2. Adverse events for all patients [ Time Frame: After follow-up is complete (year 3-4 of the trial) ]
   Adverse events will be collected for patients in both groups during treatment and the groups compared during analysis. This will be measured on a 6 weekly basis, from baseline to the end of treatment. The first 12 patients will be assessed on a 3 weekly basis, from baseline to end of treatment.
3. Progression free survival [ Time Frame: After follow-up is complete (year 3-4 of the trial) ]
   Progression free survival will be determined by measurement of tumour size using RECIST 1.1 at progression or by a rise in CA-125 tumour marker. Measured from the date of randomisation until date of confirmed disease progression. Tumour assessment carried out on 3 monthly basis, CA-125 carried out on 6 weekly basis.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Female subjects, ≥18 years, histologically proven recurrent advanced epithelial ovarian, fallopian tube or primary peritoneal carcinomas
• Have either undergone a hysterectomy or bilateral oophorectomy/salpingectomy and/or have been postmenopausal for 24 consecutive months (i.e. who have not had menses at any time in the preceding 24 consecutive months without an alternative medical cause)
• Performance status 0-2
• Adequate organ function
• Life expectancy >6 weeks
• Has received 2 or more lines of chemotherapy for ovarian cancer and patient is platinum resistant or platinum intolerant or not suitable for any further standard intravenous chemotherapy
• No previous oral cyclophosphamide, nintedanib, or other tyrosine kinase inhibitors such as cediranib but patients can have received anti-VEGF therapies such as bevacizumab as they will be stratified for this
• Measurable lesions according to RECIST 1.1 criteria or serum CA125 levels for evaluation by GCIG CA125 criteria are welcomed but not a prerequisite for inclusion as response will only be assessed for those with evaluable disease
• Able to give written informed consent and to complete QoL

Exclusion Criteria

• Carcinosarcoma or malignant tumour of non-epithelial origin (e.g. germ cell tumour, sex cord-stromal tumour) of the ovary, fallopian tube or peritoneum
• Clinically relevant non-healing wound, ulcer (intestinal tract, skin) or bone fracture
• Symptoms or signs of gastrointestinal obstruction requiring parenteral nutrition or hydration or any other GI disorders or abnormalities that would interfere with drug absorption or inability to take oral medication
• Active brain metastases (i.e. symptoms deteriorating, changing condition in < 4 weeks) or leptomeningeal disease. Trial entry is allowed if the brain metastases are stable (asymptomatic or condition stable for > 4 weeks).
• Dexamethasone for brain metastases is allowed if administered as stable dose for > 4 weeks before randomisation (if < 4 weeks then the patient is not eligible)
• Clinically relevant therapy-related toxicity from previous chemotherapy and radiotherapy
• History of major thromboembolic event within the last 6 months, such as pulmonary embolism or proximal deep vein thrombosis, unless on stable therapeutic anticoagulation (>3 months if on warfarin, PT / INR needs to be monitored regularly as per table 8.1 in protocol)
• Known inherited or acquired bleeding disorder
• Significant cardiovascular diseases, including uncontrolled hypertension, clinically relevant cardiac arrhythmia, unstable angina or myocardial infarction within the past 6 months, congestive heart failure > NYHA II, severe peripheral vascular disease, significantly relevant pericardial effusion
• History of a cerebral vascular accident, transient ischemic attack or subarachnoid hemorrhage within the past 6 months
• Radiographic evidence of cavitating or necrotic tumours with invasion of adjacent major blood vessels

• Laboratory values indicating an increased risk for adverse events:

  1. calculated GFR < 45 ml/min. Sites can use any calculation method according to local practice.
  2. absolute neutrophil count (ANC) < 1.5x109/L
  3. platelets < 100 x109/L
  4. haemoglobin < 90 g/L
  5. proteinuria CTCAE 2 or greater
  6. total bilirubin > x 2 ULN
  7. ALT and/or AST > 1.5 x ULN
  8. unless liver metastases present when ALT or AST > 2.5 ULN
  9. International normalized ratio (INR) > 2 or activated partial thromboplastin time (APTT) >1.5 x ULN in the absence of therapeutic anticoagulation. INR > 4 or APTT > 2.5 x ULN in presence of therapeutic anticoagulation
• Serious infections in particular if requiring systemic antibiotic (antimicrobial, antifungal or antiviral therapy), including hepatitis B and/or C infection, HIV- infection
• Poorly controlled diabetes mellitus or patient on sulphonylurea-type hypoglycaemics (e.g. gliclazide) as main diabetic control (as contraindicated with cyclophosphamide)
• Previous breast cancer patients are permitted only if diagnosis and any chemotherapy treatment for this was > 5 years previously and there is no evidence of metastatic breast cancer at trial entry (Please contact UCL CTC / CI if patient still on hormone treatment for breast cancer).

• Other malignancy diagnosed within the past 5 years. In exception to this rule, the following malignancies may be included:

  1. non-melanoma skin cancer (if adequately treated)
  2. cervical carcinoma in situ (if adequately treated)
  3. prior or synchronous endometrial cancer (if adequately treated), provided all of the following criteria are met: G1 or G2, no LVSI and FIGO (2010) stage IA only
• Serious illness or concomitant non-oncological disease such as neurologic, psychiatric or infectious disease or a laboratory abnormality that may increase the risk associated with study participation or study drug administration and in the judgment of the investigator would make the patient inappropriate for entry into the study
• Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up schedule e.g. active alcohol or drug abuse
• Any contraindications for therapy with cyclophosphamide, e.g. a history of severe hypersensitivity reactions to listed excipients for cyclophosphamide treatment with other investigational drugs
• Patients should not commence trial treatment within 6 weeks of any major surgical procedure
• Participation in another clinical trial testing a drug within the past four weeks before start of therapy or concomitantly with this trial
• Chemotherapy, including immunotherapy or monoclonal antibody treatment (VEGF) within 4 weeks of starting study treatment
• Hormone treatment for ovarian cancer within 2 weeks of starting study treatment (ongoing HRT is allowable)
• Any previous tyrosine kinase inhibitor treatment that has predominantly anti-angiogenic action
• Radiotherapy within 3 months not allowed except when given for symptom control >28d previously. All patients receiving any radiotherapy will require evidence of recurrent ovarian cancer outside the irradiated field either on imaging or via rising CA125
• Hypersensitivity to nintedanib, peanut or soya, or to any of the excipients of nintedanib

Contacts and Locations

Locations

United Kingdom

Kent Oncology Centre

Maidstone, Kent, United Kingdom

Beatson West of Scotland Cancer Centre

Glasgow, Scotland, United Kingdom

Velindre Hospital

Cardiff, Wales, United Kingdom

Royal United Hospital

Bath, United Kingdom

Addenbrookes Hospital

Cambridge, United Kingdom

Royal Derby Hospital

Derby, United Kingdom

Royal Surrey County Hospital

Guildford, United Kingdom

St James's University Hospital

Leeds, United Kingdom

Clatterbridge Centre for Oncology

Liverpool, United Kingdom

Mount Vernon Hospital

London, United Kingdom

Royal Marsden Hospital

London, United Kingdom

St Bartholomew's Hospital

London, United Kingdom

University College London Hospital (UCLH)

London, United Kingdom

Christie Hospital

Manchester, United Kingdom

Churchill Hospital

Oxford, United Kingdom

Wexham Park Hospital

Slough, United Kingdom

Sponsors and Collaborators

University College, London

Boehringer Ingelheim

Investigators

• Principal Investigator: Dr Marcia Hall; Mount Vernon Cancer Centre

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Hall MR, Dehbi HM, Banerjee S, Lord R, Clamp A, Ledermann JA, Nicum S, Lilleywhite R, Bowen R, Michael A, Feeney A, Glasspool R, Hackshaw A, Rustin G. A phase II randomised, placebo-controlled trial of low dose (metronomic) cyclophosphamide and nintedanib (BIBF1120) in advanced ovarian, fallopian tube or primary peritoneal cancer. Gynecol Oncol. 2020 Dec;159(3):692-698. doi: 10.1016/j.ygyno.2020.09.048. Epub 2020 Oct 16.

• Responsible Party: University College, London
• ClinicalTrials.gov Identifier: NCT01610869
• Other Study ID Numbers: UCL/10/0470; 2011-005814-12 ( Other Grant/Funding Number: Boehringer Ingelheim Ltd )
• First Posted: June 4, 2012
• Last Update Posted: May 29, 2019
• Last Verified: October 2018

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Keywords provided by University College, London:

Recurrence; Ovarian Neoplasms; Ovarian Diseases; Fallopian Tube Neoplasms; Neoplasms; Carcinoma; Neoplasms by site

Additional relevant MeSH terms:

Ovarian Neoplasms; Carcinoma, Ovarian Epithelial; Fallopian Tube Neoplasms; Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Genital Diseases; Endocrine System Diseases; Gonadal Disorders; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Fallopian Tube Diseases; Nintedanib; Antineoplastic Agents; Protein Kinase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action