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A Phase III Trial of Anlotinib in Metastatic or Advanced Alveolar Soft Part Sarcoma, Leiomyosarcoma and Synovial Sarcoma

Descriptive Information
Brief Title † A Phase III Trial of Anlotinib in Metastatic or Advanced Alveolar Soft Part Sarcoma, Leiomyosarcoma and Synovial Sarcoma
Official Title † A Phase III Study of AL3818 (Anlotinib) Hydrochloride Monotherapy in Subjects With Metastatic or Advanced Alveolar Soft Part Sarcoma, Leiomyosarcoma and Synovial Sarcoma
Brief Summary This study evaluates the safety and efficacy of AL3818 (anlotinib) hydrochloride in the treatment of metastatic or advanced alveolar soft part sarcoma (ASPS), leiomyosarcoma (LMS), and synovial sarcoma (SS). All participants with ASPS will receive open-label AL3818. In participants with LMS or SS, AL3818 will be compared to IV dacarbazine. Two-thirds of the participants will receive AL3818, one-third of the participants will receive IV dacarbazine.
Detailed Description APROMISS is a phase 3 study evaluating the safety and efficacy of AL3818 (anlotinib) hydrochloride in the treatment of metastatic or advanced alveolar soft part sarcoma (ASPS), leiomyosarcoma (LMS), and synovial sarcoma (SS). Population pharmacokinetics and exploratory exposure-response analyses will also be conducted in subjects receiving AL3818. Indication A: 53 subjects with metastatic or advanced ASPS not amenable to surgical resection will receive open-label AL3818 at a dose of 12 mg once daily in 21-day cycles (14 days on treatment, 7 days off treatment) until disease progression (defined by RECIST version 1.1) ot unacceptable toxicity. The primary endpoint is objective response rate (ORR), secondary endpoint is duration of response (DOR). Indication B: 68 subjects with metastatic or advanced LMS who have failed at least one prior line of approved therapy will be enrolled and randomized in a 2:1 ratio to receive either AL3818 (12 mg once daily in 21-day cycles) or IV dacarbazine until disease progression (defined by RECIST version 1.1) or unacceptable toxicity. Subjects randomized to dacarbazine will have the option to crossover and receive AL3818 at the time of documented disease progression. The primary endpoint is progression free survival (PFS), the secondary endpoints are objective response rate (ORR) and overall survival (OS). Indication C: 95 subjects with with metastatic or advanced SS who have failed at least one prior line of approved therapy, including first-line anthracycline-containing chemotherapy, will be enrolled and randomized in a 2:1 ratio to receive either AL3818 (12 mg once daily in 21-day cycles) or IV dacarbazine until disease progression (defined by RECIST version 1.1) or unacceptable toxicity. Subjects randomized to dacarbazine will have the option to crossover and receive AL3818 at the time of documented disease progression. The primary endpoint is progression free survival (PFS), the secondary endpoints are objective response rate (ORR) and overall survival (OS).
Study Phase Phase 3
Study Type † Interventional
Study Design †
Primary Outcome Measure † Objective Response Rate (ORR) (ASPS)
Secondary Outcome Measure † Duration of Response (DOR) (ASPS)
Condition † Alveolar Soft Part Sarcoma Leiomyosarcoma Synovial Sarcoma Soft-Tissue Sarcoma
Intervention † DrugAL 3818
Study Arms / Comparison Groups Indication A: ASPS AL3818 Arm All subjects with ASPS will be assigned to the open-label AL3818 arm to receive 12 mg AL3818 capsules orally once daily in 21-day cycles (14 days on treatment from Day 1-14, 7 days off treatment from Day 15-21). Indication B: LMS AL3818 Arm Subjects with LMS will be randomized in a 2:1 ratio to receive either AL3818 or IV dacarbazine. Subjects randomized to AL3818 will receive 12 mg AL3818 capsules orally once daily in 21-day cycles (14 days on treatment from Day 1-14, 7 days off treatment from Day 15-21). Indication B: LMS Dacarbazine Arm Subjects with LMS will be randomized in a 2:1 ratio to receive either AL3818 or IV dacarbazine. Subjects randomized to IV dacarbazine will receive dacarbazine at a dose of 850, 1000, or 1200 mg/m2 (as selected prior to randomization by the treating investigator based on the subject's clinical status) as a 20-120 minute IV infusion on Day 1 of each 21-day treatment cycle. Indication C: SS AL3818 Arm Subjects with SS will be randomized in a 2:1 ratio to receive either AL3818 or IV dacarbazine. Subjects randomized to AL3818 will receive 12 mg AL3818 capsules orally once daily in 21-day cycles (14 days on treatment from Day 1-14, 7 days off treatment from Day 15-21). Indication C: SS Dacarbazine Arm Subjects with SS will be randomized in a 2:1 ratio to receive either AL3818 or IV dacarbazine. Subjects randomized to IV dacarbazine will receive dacarbazine at a dose of 850, 1000, or 1200 mg/m2 (as selected prior to randomization by the treating investigator based on the subject's clinical status) as a 20-120 minute IV infusion on Day 1 of each 21-day treatment cycle.
Publications *

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information
Recruitment Status † Drug
Estimated Enrollment † 216
Start Date † June 15, 2017
Completion Date August 2021
Primary Completion Date April 2021
Eligibility Criteria † Inclusion Criteria: 1. Written informed consent provided before any study-specific procedures are initiated. Subject must be able to understand and be willing to sign a written informed consent form. 2. Male or female at least 18 years of age. 3. Indication A - ASPS: Histologically proven, unresectable, locally advanced or metastatic alveolar soft part sarcoma. - Indication B - LMS: Histologically proven, unresectable, recurrent, locally advanced or metastatic leiomyosarcoma (of soft tissue, cutaneous origin, vascular origin and of the bone). - Indication C - SS: Histologically proven, unresectable, recurrent, locally advanced or metastatic synovial sarcoma. 4. Indication A - ASPS: Subjects with no prior therapy or subjects with prior treatment with chemotherapy or an angiogenesis inhibitor (e.g., sunitinib). - Indications B - LMS: Subjects previously treated with at least one prior line of approved therapy. - Indication C - SS: Subjects previously treated with at least one prior line of approved therapy, including first-line anthracycline containing regimen. 5. Show objective disease progression after the last administration of the last standard therapy or have stopped standard therapy due to intolerability (excluding ASPS subjects who have not received prior therapy) within 6 months of enrollment. 6. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. 7. Has measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 confirmed by CT or MRI scan within 28 days prior to enrollment. 8. Life expectancy of at least 3 months. 9. Females of childbearing potential must have a negative pregnancy test (by serum beta-HCG) within 7 days prior to the start of treatment. 10. Female of childbearing potential must be surgically sterile (have had a hysterectomy or bilateral oophorectomy, tubal ligation), abstinent (at the discretion of the investigator), or agree to use adequate contraception since signing of the informed consent form until at least 3 months after the last study drug administration. Females of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 2 years. - Males must agree to use adequate contraception since signing of the informed consent form until at least 3 months after the last study drug administration. Adequate contraception is defined in the study as any medically recommended method (or combination of methods) at the discretion of the investigator. 11. Adequate hematologic, hepatic and renal function as assessed by the following laboratory requirements conducted within 7 days of starting study treatment: - Total bilirubin 30ml/min/1.73 m2 according to the Modified Diet in Renal Disease abbreviated formula or creatinine clearance (CrCL) > 60 ml/min (Cockcroft and Gault) - International normalize ratio (INR) and the partial thromboplastin time (PTT) 100,000 cells/mm3, hemoglobin > 9 g/dL, absolute neutrophil count > 1,500 cells/mm3 - Alkaline phosphatase limit 50% by Doppler ultrasound assessment Exclusion Criteria: 1. Prior treatment with or have known hypersensitivity to AL3818. 2. a. Indication A - ASPS: Prior treatment with cediranib. - b. Indication B- LMS: Prior treatment with or have known hypersensitivity to dacarbazine. - c. Indication C - SS: Prior treatment with or have known hypersensitivity to dacarbazine. 3. Previous or concurrent cancer that is distinct in primary site or histology from ASPS, LS, or SS within 5 years before enrollment except for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors (Ta, Tis and T1). 4. Received last dose of systemic cytotoxic therapy, radiation therapy or therapy with any investigational product within 28 days of enrollment. 5. Prior treatment with extended-field radiotherapy within 28 days prior to enrollment or prior treatment with extended-field radiotherapy for evaluating tumor lesions within 14 days prior to enrollment. 6. Known active CNS metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate provided that they are stable with no evidence of progression by imaging, and all neurologic symptoms have returned to baseline, and should not be using corticosteroids for at least 7 days prior to study treatment. 7. Cavitary tumors or tumors invading or abutting large blood vessels. 8. History of gastrointestinal perforation, abdominal fistula or intra-abdominal abscess within 6 months of enrollment. 9. Known history of bleeding disorders (e.g., von Willebrand disease or hemophilia). 10. Clinically significant bleeding such as gross hematuria, gastrointestinal bleeding and hemoptysis within 6 months prior to enrollment. 11. CTCAE version 4.03 > grade 2 pulmonary hemorrhage or > grade 3 of other forms of bleeding within 28 days prior to enrollment. 12. Thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, arterial thrombosis) within 6 months prior to enrollment. 13. Use of aspirin (>325 mg/day) within 10 days prior to the first dose of study treatment. The use of prophylactic therapeutic anti-coagulants are allowed provided that INR or aPTT are within therapeutic limits (according to the medical standard of the enrollment institution) and patient has been on a stable dose of anticoagulants for at least two weeks prior to the first dose of study treatment. 14. Serious non-healing wound, active ulcer, or unhealed bone fracture. 15. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to enrollment. 16. CTCAE version 4.03 > grade 3 peripheral neuropathy 17. Any unrecovered toxicity reactions of CTCAE version 4.03 > grade 1 caused by any previous therapy (excluding alopecia and neurotoxicity 470 msec on electrocardiogram 19. Severe and uncontrolled disease, including: - a. Class I and above myocardial ischemia or myocardial infarction, cardiac arrhythmia and Class 2 or above congestive heart failure classified according to New York Heart Association (NYHA) - b. Uncontrolled hypertension (systolic blood pressure > 150 mm Hg or diastolic blood pressure > 90 mmHg despite optimal medical management) - c. Active or failed to control serious infections (CTCAE version 4.03 > grade 2 infections) - d. Liver disease such as cirrhosis of the liver, decompensated liver disease, chronic active hepatitis needing anti-viral therapy - e. Renal failure needing hemodialysis or peritoneal dialysis - f. Poorly controlled diabetes (fasting blood glucose > 180 mg/dL) - g. Untreated and uncontrolled epileptic seizures - h. History of psychotropic drug abuse and inability to quit - i. Untreated psychiatric disorders 20. Known HIV-positive 21. Had organ transplantation 22. Clinical conditions affecting the intake and use of oral medications (e.g., inability to swallow, chronic diarrhea, and intestinal obstruction) 23. Females who are pregnant or are breast-feeding. 24. Concomitant treatment with strong inhibitors or inducers of CYP1A2, CYP3A4 or CYP3A5 or sensitive substrates with narrow therapeutic index (TI) of CYP3A4, CYP2C9 and CYP2C19 within 14 days prior to enrollment and during the study unless there was an emergent or life-threatening medical condition that required it. 25. Any medical intervention, condition or any other circumstance which in the opinion of the investigator or the sponsor's medical monitor, could compromise adherence to study procedures or study objectives.
Gender All
Ages 18 Years - N/A
Accepts Healthy Volunteers No
Contacts †† Judy Chen, 8055301550, judyc@advenchen.com
Location Countries † United States
Administrative Information
NCT ID † NCT03016819
Organization ID AL3818-US-004
Secondary IDs ††
Responsible Party Sponsor
Study Sponsor † Advenchen Laboratories, LLC
Collaborators ††
Investigators † : ,
Information Provided By
Verification Date June 2017
First Received Date † January 6, 2017
Last Updated Date June 15, 2017
† Required WHO trial registration data element.
†† WHO trial registration data element that is required only if it exists.
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