CLINICAL TRIAL / NCT03937154
Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Non-small Cell Lung Cancer (NSCLC), Ovarian Cancer, or Breast Cancer
- Interventional
- Active
- NCT03937154
Contact Information
PROCLAIM: A Phase 3 Randomized Placebo-controlled Double-blind Study of Romiplostim for the Treatment of Chemotherapy-induced Thrombocytopenia in Patients Receiving Chemotherapy for Treatment of Non-small Cell Lung Cancer (NSCLC), Ovarian Cancer, or Breast Cancer
To evaluate the efficacy of romiplostim for the treatment of CIT in patients receiving chemotherapy for the treatment of NSCLC, ovarian cancer, or breast cancer measured by the ability to administer on-time, full-dose chemotherapy
This is a phase 3, randomized, placebo-controlled, multicenter, international study for
the treatment of CIT in adult subjects receiving chemotherapy for the treatment of NSCLC,
ovarian cancer, or breast cancer. Subjects must have a platelet count ≤ 85 x 10^9/L on
day 1 of the study. The study will consist of a screening period of up to 4 weeks, a
treatment period long enough to allow for assessment of 3 planned cycles of chemotherapy,
a follow-up visit, and long-term follow-up (LTFU). Given that subjects are required to
have 3 remaining planned cycles of chemotherapy, the chemotherapy cycles may be 3 or 4
weeks in duration, and the investigational product dose adjustment guidelines allow for
up to 12 weeks of dosing before a subject is declared a non-responder, the majority of
study subjects will receive investigational product for a range of 10-24 weeks.
Gender
All
Age Group
18 Years to 100 Years
Accepting Healthy Volunteers
No
Inclusion Criteria:
- Subject has provided informed consent prior to initiation of any study-specific
activities/procedures or subject's legally acceptable representative has provided
informed consent prior to any study-specific activities/procedures being initiated
when the subject has any kind of condition that, in the opinion of the investigator,
may compromise the ability of the subject to give written informed consent.
- Males or females greater than or equal to 18 years of age at signing of the informed
consent.
- Documented active stage I, II, III or IV locally advanced or metastatic of the
following tumor types: NSCLC, breast cancer, or ovarian cancer (includes fallopian
tube epithelial carcinomas and peritoneal epithelial carcinoma of unknown primary),
or any stage recurrent disease. Patients with documented locally advanced (stage
III) NSCLC should not be amenable to definitive treatment with chemoradiation and/or
surgery.
- Subjects must be receiving cancer treatment with 21- or 28-day cycles, using one of
the following carboplatinum-based combination chemotherapy regimens:
carboplatin/gemcitabine based, carboplatin/pemetrexed based, carboplatin/liposomal
doxorubicin based or carboplatin/taxane based (which includes either paclitaxel,
nab-paclitaxel, or docetaxel) or single agent chemotherapy regimen with any of the
above mentioned drugs. Use of combination regimens with one of the above
carboplatinum-based regimens is permitted with (1) anti-angiogenic agents (such as
bevacizumab); (2) targeted therapy (such as anti-epidermal growth factor agents or
anti- human epidermal growth factor receptor 2) or (3) immune checkpoint inhibitors.
Cycle duration is based on intervals between day 1 of chemotherapy cycles
(overlapping with carboplatin intervals) every 21 or 28 day cycles for single agent
regimens. OR, Subjects must have CIT from a non-protocol chemotherapy regimen,
planning to start treatment with one of the above protocol chemotherapy regimens
which has been delayed ≥ 1 week due to CIT.
- Subjects must have a local platelet count ≤ 85 x 109/L on day 1 of the study.
- Subjects must be at least 21 or 28 days removed from the start of the chemotherapy
cycle immediately prior to study day 1 if receiving a 21-day or 28-day cycle
chemotherapy regimen, respectively.
- Subjects must have at least 3 remaining planned cycles of chemotherapy at study
enrollment.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
Exclusion Criteria:
- Acute lymphoblastic leukemia.
- Acute myeloid leukemia.
- Any myeloid malignancy.
- Myelodysplastic syndrome. Baseline bone marrow biopsy is not required to rule out
MDS. However, if a bone marrow biopsy and cytogenetics were performed as part of
diagnostic or staging work-up, these results will be collected to confirm.
- Myeloproliferative disease.
- Multiple myeloma.
- Within 4 months prior to enrollment, any history of active congestive heart failure
(New York Heart Association [NYHA] Class III to IV), symptomatic ischemia,
uncontrolled arrhythmias, clinically significant electrocardiogram (ECG)
abnormalities, screening ECG with corrected QT (QTc) interval of greater than 470
msec, pericardial disease, or myocardial infarction.
- Major surgery less than or equal to 28 days or minor surgery less than or equal to 3
days prior to enrollment.
- New or uncontrolled venous thromboembolism or thrombotic events within 3 months
prior to screening. To be eligible, subjects must have received at least 14 days of
anticoagulation for a new thrombotic event and considered to be stable and suitable
for continued therapeutic anticoagulation during trial participation.
- History of arterial thrombotic events (eg, myocardial ischemia, transient ischemic
attack, or stroke) within 6 months prior to screening.
- Evidence of active infection within 2 weeks prior to the first dose of study
treatment.
- Known human immunodeficiency virus infection with any detectable viral load at
screening. Subjects without a documented diagnosis in their medical history will
require a local laboratory assessment at screening. If local laboratory results are
not available use central laboratory results.
- Known active of chronic hepatitis C or hepatitis B infection. Subjects without a
documented diagnosis in their medical history will require a local laboratory
assessment at screening. If local laboratory results are not available use central
laboratory results. Hepatitis B and C infection is based on the following results:
- Positive for hepatitis B surface antigen (HBsAg) (indicative of chronic hepatitis B
or recent acute hepatitis B).
- Negative HBsAg and positive for hepatitis B core antibody: hepatitis B virus DNA by
polymerase chain reaction (PCR) is necessary. Detectable hepatitis B virus DNA
suggests occult hepatitis B.
- Positive hepatitis C virus antibody: hepatitis C virus RNA by PCR is necessary.
Detectable hepatitis C virus RNA suggests chronic hepatitis C.
- In addition to the conditions listed in exclusion criteria 201 through 206,
secondary malignancy within the past 5 years except:
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of
disease.
- Adequately treated cervical carcinoma in situ without evidence of disease.
- Adequately treated breast ductal carcinoma in situ without evidence of disease.
- Prostatic intraepithelial neoplasia without evidence of prostate cancer.
- Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ.
- Malignancy treated with curative intent and with no known active disease present for
greater than or equal to 3 years before enrollment and felt to be at low risk for
recurrence by the treating physician (excluding malignancies listed in exclusion
criteria 201 - 206).
- Thrombocytopenia due to another etiology other than CIT (eg, chronic liver disease,
prior history of immune thrombocytopenia purpura).
- Any combined modality regimen containing radiation therapy or surgery occurring
concomitantly with neo-adjuvant chemotherapy or where radiation therapy is planned
during the cycle preceding 3 planned on-study cycles of chemotherapy.
Prior/Concomitant Therapy:
- Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and
development factor, eltrombopag, recombinant human TPO, any other TPO receptor
agonist, or any investigational platelet producing agent.
Prior/Concurrent Clinical Study Experience - Currently receiving (or plan to receive)
treatment in another investigational device or drug study, or less than 28 days since
ending treatment on another investigational device or drug study(ies). Other
investigational procedures while participating in this study are excluded.
Diagnostic Assessments
- Anemia (hemoglobin < 80 g/L [8 g/dL]) on the day of initiation of investigational
product as assessed by local labs. Use of red cell transfusions and erythropoietic
stimulating agents is permitted throughout the study as per institutional
guidelines.
- Neutropenia (absolute neutrophil count less than 1 x 10 9/L) on the day of
initiation of investigational product as assessed by local labs. Use of
granulocyte-colony stimulating factor is permitted throughout the study as per
institutional guidelines.
- Abnormal renal function with creatinine clearance less than 30 mL/min using the
Cockcroft-Gault estimated creatinine clearance as assessed by local laboratory. If
local laboratory results are not available use central laboratory results.
during screening.
- Abnormal liver function (total bilirubin greater than 3X ULN; alanine
aminotransferase [ALT] or aspartate aminotransferase [AST] greater than 3X ULN for
subjects without liver metastases or greater than or equal to 5X ULN for subjects
with liver metastases) as assessed by local laboratory during screening. If local
laboratory results are not available use central laboratory results.
Other Exclusions
- Females who are pregnant or breastfeeding or planning to become pregnant or
breastfeed during treatment and for an additional 7 months after treatment (and
chemotherapy) discontinuation (females of childbearing potential should only be
included after a confirmed menstrual period and a negative highly sensitive urine or
serum pregnancy test.)
- Females of childbearing potential unwilling to use a highly effective method of
contraception during treatment and for an additional 7 months after treatment (and
chemotherapy) discontinuation. Refer to Appendix 5 for additional contraceptive
information.
- Males unwilling to use contraception* (male condom or sexual abstinence) or their
female partner(s) of childbearing potential who are unwilling to use a highly
effective method of contraception during treatment (and chemotherapy) and for an
additional 7 months after treatment (and chemotherapy) discontinuation. *If the
male's sole partner is of non-childbearing potential, he is not required to use
additional forms of contraception during the study.
- Subject has known sensitivity to any of the products to be administered during
dosing.
- Subject likely to not be available to complete all protocol-required study visits or
procedures, and/or to comply with all required study procedures (eg, COAs) to the
best of the subject and investigator's knowledge.
- History or evidence of any other clinically significant disorder, condition or
disease (with the exception of those outlined above) that, in the opinion of the
investigator or Amgen physician, if consulted, would pose a risk to subject safety
or interfere with the study evaluation, procedures or completion.
- Male subjects with a pregnant partner who are unwilling to practice abstinence or
use a condom during treatment (and chemotherapy) and for an additional 7 months
after treatment (and chemotherapy) discontinuation.
- Male subjects unwilling to abstain from donating sperm during treatment (and
chemotherapy) and for an additional 7 months after treatment (and chemotherapy)
discontinuation.