Hepatocellular CarcinomaPhase 3REACHNCT01140347
A Study of Ramucirumab (IMC-1121B) Drug Product (DP) and Best Supportive Care (BSC) Versus Placebo and BSC as 2nd-Line Treatment in Participants With Hepatocellular Carcinoma After 1st-Line Therapy With Sorafenib
A Phase 3 study testing Ramucirumab DP (IMC-1121B) and BSC in people with Hepatocellular Carcinoma, run by Eli Lilly and Company at 146 sites in 27 countries.
Trial summary
This is a Phase 3 multicenter, randomized study evaluating the safety and efficacy of ramucirumab DP plus BSC as a double-blind, placebo-controlled (placebo plus BSC) comparison. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Hepatocellular Carcinoma
- What is being tested?
- Ramucirumab DP (IMC-1121B) and BSC
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 565 participants
- Where
- 146 sitesin 27 countries
- Study dates
- Oct 2010to Mar 2015
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0 or 1
- Child-Pugh score of <7 (Child-Pugh Class A only)
- Barcelona Clinic Liver Cancer (BCLC) Stage C or BCLC stage B not amenable to locoregional therapy or refractory to locoregional therapy
- Diagnosis of HCC (excluding fibrolamellar carcinoma) in the absence of histologic or cytologic confirmation
- There are either clinical, laboratory, or radiographic findings consistent with a diagnosis of liver cirrhosis
- Has a liver mass measuring at least 2 centimeters (cm) with characteristic vascularization seen on either triphasic computed tomography (CT) scan or magnetic resonance imaging (MRI) with gadolinium
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- At least 1 measurable or evaluable lesion that is viable [that is (i.e.), is vascularized], and has not been previously treated with locoregional therapy. A lesion that has been previously treated will qualify as a measurable or evaluable lesion if there was demonstrable progression following locoregional therapy
- Previously treated with sorafenib and has discontinued sorafenib treatment at least 14 days prior to randomization. Participants may have experienced:
- Radiographically documented disease progression during sorafenib therapy or after discontinuation of sorafenib therapy, or
- Discontinuation of sorafenib due to an adverse drug reaction, despite dose reduction by 1 level and BSC
- The participant has received sorafenib as the only systemic therapeutic intervention. Any hepatic locoregional therapy that has been administered prior to sorafenib is allowed, but not following sorafenib. Radiation to metastatic sites [for example (e.g.), bone] following sorafenib therapy is permitted.
- Resolution of clinically significant toxicity of any anti-cancer therapy to Grade ≤1 by the National Cancer Institute Common Terminology Criteria for Adverse Events volume 4.0 (NCI-CTCAE v. 4.0).
- Adequate Organ Function defined as:
- Total bilirubin <3.0 milligrams/deciliter (mg/dL) [51.3 micromole/liter (µmol/L)], aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤5 × upper limit of normal (ULN)
- Serum creatinine ≤1.2 × ULN or calculated creatinine clearance >50 milliliters/minute (mL/min)
- Absolute neutrophil count (ANC) ≥1.0 × 10^3/microliter (μL) (1.0 × 10^9/liter (L)]), hemoglobin ≥9 grams/deciliter (g/dL) [5.58 millimoles/liter (mmol/L)], and platelets ≥75 × 10^3/µL (75 × 10^9/L)
- International Normalized Ratio (INR) ≤1.5 and partial thromboplastin time (PTT) ≤5 seconds above ULN. Participants receiving prophylactic low-dose anticoagulant therapy are eligible provided that INR ≤1.5 and PTT ≤5 seconds above the ULN
- The participant's urinary protein is ≤1+ on dipstick or routine urinalysis. If urine dipstick or routine analysis indicates ≥2+ proteinuria, then a 24-hour urine must be collected and must demonstrate <1000 milligrams (mg) of protein in 24 hours to allow participation in the study
Who cannot join
- Major surgery within 28 days prior to randomization, or central venous access device placement within 7 days prior to randomization
- Hepatic locoregional therapy within 28 days prior to randomization
- Radiation to any nonhepatic (e.g., bone) site within 14 days prior to randomization
- Sorafenib within 14 days prior to randomization
- Received any investigational therapy or non-approved drug within 28 days prior to randomization
- Received any previous systemic therapy with vascular endothelial growth factor (VEGF) inhibitors or vascular endothelial growth factor receptor (VEGFR) inhibitors (including investigational agents) other than sorafenib for treatment of HCC
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- Fibrolamellar carcinoma
- Received any transfusion, blood component preparation, erythropoietin, albumin preparation, or granulocyte colony-stimulating factors (G-CSF) within 14 days prior to randomization
- Therapeutic anticoagulation with warfarin, low-molecular-weight heparin, or similar agents. Participants receiving prophylactic, low-dose anticoagulation therapy are eligible provided that the coagulation parameters defined in the inclusion criteria (INR ≤1.5 and PTT ≤5 seconds above the ULN) are met
- Receiving ongoing therapy with nonsteroidal anti-inflammatory agents (NSAIDs, e.g., indomethacin, ibuprofen, naproxen, nimesulide, celecoxib, etoricoxib, or similar agents) or other antiplatelet agents (e.g., clopidogrel, ticlopidine, prasugrel, dipyridamole, picotamide, indobufen, anagrelide, triflusal). Aspirin (ASA) at doses up to 100 milligrams/day (mg/day) is permitted
- Symptomatic congestive heart failure, unstable angina pectoris, or symptomatic or poorly controlled cardiac arrhythmia
- Any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack, within 6 months prior to randomization
- Uncontrolled arterial hypertension systolic ≥150 / diastolic ≥90 millimeters of mercury (mm Hg) despite standard medical management
- Grade 3-4 gastrointestinal bleeding or any variceal bleeding episode in the 3 months prior to randomization requiring transfusion, endoscopic or operative intervention (participants with any bleeding episode considered life-threatening during the 3 months prior to randomization are excluded, regardless of transfusion or intervention status)
- Esophageal or gastric varices that require immediate intervention (e.g., banding, sclerotherapy) or represent a high bleeding risk. Participants with evidence of portal hypertension (including splenomegaly) or any prior history of variceal bleeding must have had endoscopic evaluation within the 3 months immediately prior to randomization. Participants with evidence of portal hypertension are eligible for study participation if endoscopic evaluation does not indicate esophageal or gastric varices that require immediate intervention or represent a high bleeding risk; however, these eligible participants must receive supportive therapy (e.g., beta blocker therapy) according to institutional standards and clinical guidelines during study participation
- Central nervous system (CNS) metastases or carcinomatous meningitis
- History of or current hepatic encephalopathy or current clinically meaningful ascites
Trial locations and contacts
146 sites in 27 countries.
146 sites in 27 countries
United States18 sites
ImClone Investigational Site
Ann Arbor, Michigan, 48109
ImClone Investigational Site
Boston, Massachusetts, 02111
ImClone Investigational Site
Charleston, South Carolina, 29414
ImClone Investigational Site
Dayton, Ohio, 45420
ImClone Investigational Site
Jacksonville, Florida, 32207
ImClone Investigational Site
Lubbock, Texas, 79415
ImClone Investigational Site
Milwaukee, Wisconsin, 53226
ImClone Investigational Site
New Haven, Connecticut, 06520
ImClone Investigational Site
New Orleans, Louisiana, 70112
ImClone Investigational Site
New York, New York, 10029
ImClone Investigational Site
Newark, New Jersey, 07103
ImClone Investigational Site
Orange, California, 92868
ImClone Investigational Site
Philadelphia, Pennsylvania, 19141
ImClone Investigational Site
San Francisco, California, 94115
ImClone Investigational Site
Seattle, Washington, 98109
ImClone Investigational Site
St Louis, Missouri, 63110
ImClone Investigational Site
Winston-Salem, North Carolina, 27157
ImClone Investigational Site
Worcester, Massachusetts, 01655
Germany17 sites
ImClone Investigational Site
Berlin, 12203
ImClone Investigational Site
Bielefeld, 33611
ImClone Investigational Site
Bonn, 53105
ImClone Investigational Site
Düsseldorf, 40225
ImClone Investigational Site
Essen, 45122
ImClone Investigational Site
Frankfurt, 60596
ImClone Investigational Site
Freiburg im Breisgau, 79106
ImClone Investigational Site
Hamburg, 20246
ImClone Investigational Site
Hanover, 30625
ImClone Investigational Site
Homburg, 66421
ImClone Investigational Site
Leipzig, 04103
ImClone Investigational Site
Magdeburg, 39120
ImClone Investigational Site
Munich, 81377
ImClone Investigational Site
Münster, 48149
ImClone Investigational Site
Tübingen, 72076
ImClone Investigational Site
Ulm, 89081
ImClone Investigational Site
Weiden, 92637
France14 sites
ImClone Investigational Site
Amiens, 80054
ImClone Investigational Site
Angers, 49933
ImClone Investigational Site
Avignon, 84000
ImClone Investigational Site
Besançon, 25020
ImClone Investigational Site
Bordeaux, 33000
ImClone Investigational Site
Clermont-Ferrand, 63003
ImClone Investigational Site
La Roche-sur-Yon, 85925
ImClone Investigational Site
Limoges, 87042
ImClone Investigational Site
Marseille, 13385
ImClone Investigational Site
Nice, 06200
ImClone Investigational Site
Paris, 75674
ImClone Investigational Site
Poitiers, 86021
ImClone Investigational Site
Reims, 51092
ImClone Investigational Site
Saint-Etienne, 42055
Japan14 sites
ImClone Investigational Site
Chiba, 260-8677
ImClone Investigational Site
Fukuoka, 810-8563
ImClone Investigational Site
Hyōgo, 650-0046
ImClone Investigational Site
Ishikawa, 920-8641
ImClone Investigational Site
Kanagawa, 241-0815
ImClone Investigational Site
Kochi, 781-8555
ImClone Investigational Site
Kyoto, 606-8397
ImClone Investigational Site
Miyagi, 983-8520
ImClone Investigational Site
Osaka, 565-0871
ImClone Investigational Site
Osaka-Pref, 589
ImClone Investigational Site
Saga, 840
ImClone Investigational Site
Tochigi, 329-0498
ImClone Investigational Site
Tokushima, 770-8503
ImClone Investigational Site
Tokyo, 181-8611
Italy12 sites
ImClone Investigational Site
Bari, 70124
ImClone Investigational Site
Benevento, 82100
ImClone Investigational Site
Bologna, 40100
ImClone Investigational Site
Genova, 16132
ImClone Investigational Site
Lecce, 73100
ImClone Investigational Site
Milan, 20122
ImClone Investigational Site
Modena, 41100
ImClone Investigational Site
Padova, 35128
ImClone Investigational Site
Palermo, 90127
ImClone Investigational Site
Pavia, 27100
ImClone Investigational Site
Rome, 00168
ImClone Investigational Site
Udine, 33100
Brazil10 sites
ImClone Investigational Site
Belo Horizonte, 30110090
ImClone Investigational Site
Botucatu, 18618-970
ImClone Investigational Site
Brasília, 72115-700
ImClone Investigational Site
Campinas, 13083-970
ImClone Investigational Site
Ijuí, 98700 000
ImClone Investigational Site
Ribeirão Preto, 14049-900
ImClone Investigational Site
Rio de Janeiro, 21941-31
ImClone Investigational Site
Salvador, 41825-010
ImClone Investigational Site
Sao Jose Rio Preto, 15090-000
ImClone Investigational Site
São Paulo, 04039-901
Belgium7 sites
ImClone Investigational Site
Bonheiden, 2820
ImClone Investigational Site
Brussels, 01200
ImClone Investigational Site
Charleroi, 6000
ImClone Investigational Site
Edegem, 2650
ImClone Investigational Site
Leuven, 03000
ImClone Investigational Site
Liège, 4000
ImClone Investigational Site
Ottignies, 1340
Taiwan7 sites
ImClone Investigational Site
Changhua, 500
ImClone Investigational Site
Kuei Shan Hsiang, 33305
ImClone Investigational Site
Liouying/Tainan, 736
ImClone Investigational Site
Niaosung, 883
ImClone Investigational Site
Taichung, 404
ImClone Investigational Site
Tainan, 70403
ImClone Investigational Site
Taipei, 112
Australia5 sites
ImClone Investigational Site
Bankstown, New South Wales, 2200
ImClone Investigational Site
Kogarah, New South Wales, 2217
ImClone Investigational Site
Kurralta Park, South Australia, 5037
ImClone Investigational Site
Liverpool Bc, New South Wales, 1871
ImClone Investigational Site
Prahran, Victoria, 3181
Spain5 sites
ImClone Investigational Site
Ávila, 05004
ImClone Investigational Site
Girona, 17007
ImClone Investigational Site
Madrid, 28041
ImClone Investigational Site
Ourense, 320004
ImClone Investigational Site
Valencia, 46014
Austria4 sites
ImClone Investigational Site
Linz, 4021
ImClone Investigational Site
Salzburg, 5020
ImClone Investigational Site
Steyr, 4400
ImClone Investigational Site
Vienna, A1090
Czechia4 sites
ImClone Investigational Site
Brib, 656 53
ImClone Investigational Site
Hradec Králové, 500 05
ImClone Investigational Site
Olomouc, 775 20
ImClone Investigational Site
Prague, 150 06
South Korea4 sites
ImClone Investigational Site
Anyang, 431-070
ImClone Investigational Site
Incheon, 405-760
ImClone Investigational Site
Seodaemun-Gu, 120-752
ImClone Investigational Site
Seoul, 135-710
Bulgaria3 sites
ImClone Investigational Site
Plovdiv, 4004
ImClone Investigational Site
Sofia, 1527
ImClone Investigational Site
Varna, 9010
Hong Kong3 sites
ImClone Investigational Site
Kowloon
ImClone Investigational Site
Pokfulam
ImClone Investigational Site
Shatin
Israel3 sites
ImClone Investigational Site
Beersheba, 84101
ImClone Investigational Site
Petah Tikva, 49100
ImClone Investigational Site
Tel Aviv, 64239
Romania3 sites
ImClone Investigational Site
Bucharest, 022328
ImClone Investigational Site
Cluj-Napoca, 3400
ImClone Investigational Site
Craiova, 200535
Netherlands2 sites
ImClone Investigational Site
Amsterdam, 1105 AZ
ImClone Investigational Site
Rotterdam, 3000 CA
Portugal2 sites
ImClone Investigational Site
Lisbon, 1649-035
ImClone Investigational Site
Santa Maria da Feira, 4520-211
Thailand2 sites
ImClone Investigational Site
Bangkok, 10700
ImClone Investigational Site
Hat Yai, 90110
About this study
Official title: A Multicenter, Randomized, Double-Blind, Phase 3 Study of Ramucirumab (IMC-1121B) Drug Product and Best Supportive Care (BSC) Versus Placebo and BSC as Second-Line Treatment in Patients With Hepatocellular Carcinoma Following First-Line Therapy With Sorafenib (REACH)
This is a Phase 3 multicenter, randomized study evaluating the safety and efficacy of ramucirumab DP plus BSC as a double-blind, placebo-controlled (placebo plus BSC) comparison.
Approximately 544 participants, at least 18 years of age, with Child-Pugh score < 7 and diagnosed with hepatocellular carcinoma will be randomized. Participants must have received sorafenib as first-line systemic treatment for hepatocellular carcinoma (HCC), and must have discontinued sorafenib prior to entering the study.
Read more
Hypothesis: This sample size will allow differentiation of the expected increase in median overall survival (OS), from 8 months in the placebo arm to 10.67 months in the ramucirumab arm.
Upon registration and completion of screening procedures, eligible participants with HCC who have disease progression during or following first-line therapy with sorafenib, or were intolerant to this agent, will be randomized to receive either ramucirumab DP or placebo.
The treatment regimen will be continued until radiographic or symptomatic progression, the development of unacceptable toxicity, noncompliance or withdrawal of consent by the participant, or investigator decision.
- Conditions
- Hepatocellular Carcinoma
- Being tested
- Placebo, Ramucirumab DP (IMC-1121B), BSC
- Keywords
- Hepatocellular carcinoma (HCC), recombinant human immunoglobulin G, subclass 1 (IgG1) monoclonal antibody (MAb), Hepatocellular Carcinoma (HCC) following First-Line Therapy With Sorafenib
- Medical subject headings
- Carcinoma, Hepatocellular
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PlaceboBiological
8 mg/kg IV every 2 weeks
Ramucirumab DP (IMC-1121B)Biological
Also called IMC-1121B, LY3009806
8 milligrams/kilogram (mg/kg) intravenous (IV) every 2 weeks
BSCOther
Palliative and supportive care for disease-related symptoms and toxicity associated with treatment as deemed medically necessary and appropriate in the opinion of the investigator.
| Study group | Role | What they receive |
|---|---|---|
| Ramucirumab DP and BSC | Experimental | Not described Receives: Biological: Ramucirumab DP (IMC-1121B); Other: BSC |
| Placebo and BSC | Placebo comparator | Not described Receives: Biological: Placebo; Other: BSC |
What is being measured
The primary outcome is the main question the study is designed to answer.
Overall Survival (OS)
OS was defined as the time from the date of randomization to the date of death from any cause. Participants who were alive at the end of the follow-up period or were lost to follow-up were censored on the last date the participant was known to be alive.
Measured: Randomization to death from any cause (up to 37 months)
Secondary outcomes (10)
Progression-Free Survival (PFS)
PFS was defined as time from date of randomization until date of objectively determined progressive disease (PD) as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1 or death from any cause. PD was defined as ≥20% increase in sum of diameters (SOD) of target lesions, taking as reference smallest sum on study (including baseline sum if it was smallest). Sum must show a ≥5 millimeter (mm) increase. Appearance of ≥1 new lesions and unequivocal progression of existing non-target lesions were considered progression. In primary analysis, participants alive and without PD were censored at day of last adequate tumor assessment; progression or deaths without progression occurring immediately after ≥2 missed tumor assessments, were censored at day of the last adequate tumor assessment prior to missing assessments; participants who began new anticancer therapy were censored at day of the last adequate tumor assessment prior to start of new anticancer therapy.
Measured: Randomization to PD (up to 36 months)
Percentage of Participants With Complete Response (CR) or Partial Response (PR) [Objective Response Rate (ORR)]
ORR was defined, using RECIST v1.1 criteria, as the percentage of participants who achieved a best overall response of CR or PR. CR was defined as the disappearance of all lesions and any intratumor arterial enhancement in target lesions, the normalization of the tumor marker level and all lymph nodes short axis reduced to <10 mm. PR was defined as ≥30% decrease in the SOD of target lesions, including the short axes of any target lymph nodes, taking as reference the baseline SOD of target lesions, no new lesions and stable nontarget lesions. Percentage of participants was calculated as: (number of participants with CR or PR / number of participants randomized) * 100.
Measured: Baseline to the date of first evidence of confirmed CR or PR (up to 37 months)
Time to Radiographic Progression (TTP)
TTP was defined as the time from randomization to the first radiographically documented PD. PD was defined, using RECIST v1.1 criteria, as ≥20% increase in SOD of target lesions, taking as reference smallest sum on study (including baseline sum if it was the smallest). Sum must show an absolute increase of ≥5 mm. Appearance of ≥1 new lesions and unequivocal progression of existing non-target lesions were considered progression. Participants without PD were censored at the day of the last adequate tumor assessment. Progression occurred immediately after ≥2 missed tumor assessments and were censored at the day of the last adequate tumor assessment prior to the missing assessments. Participants who began new anticancer therapy were censored at the day of their last adequate tumor assessment prior to start of new anticancer therapy.
Measured: Randomization to PD (up to 36 months)
Change From Baseline in the Functional Assessment of Cancer Therapy (FACT) Hepatobiliary Symptom Index-8 (FHSI-8)
The FHSI-8 is a self-administered 8-item questionnaire that measures a participant's symptoms in the domains of jaundice, stomach pain/discomfort weight loss, and fatigue. Participants rated each item on a 5-point scale from 0 (not at all) to 4 (very much). Item scores were calculated as outlined in the FACIT manual. FHSI-8 total score was the sum of each item's score with a total score ranging from 0 (highly symptomatic) to 32 (asymptomatic).
Measured: Baseline, Prior to infusion on Day 1 of Cycle 4, Cycle 10, and Cycle 16 (14-day cycles), and end of treatment (up to 34 months)
Change From Baseline in European Quality of Life Questionnaire-5 Dimensions (EQ-5D) Health State Score
The EQ-5D is a self-reported, 5-dimension (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) questionnaire related to the participant's current health state. Each question was scored using a 3 level scale (no problems, some problems, or extreme problems). EQ-5D health state was defined by combining responses from each of the 5 dimensions into a weighted health-state index score according to the United Kingdom (UK) population based algorithm where 0 = death and 1 = perfect health.
Measured: Baseline, Prior to infusion on Day 1 of Cycle 4, Cycle 10, and Cycle 16 (14-day cycles), end of treatment (up to 34 months)
Number of Participants With Adverse Events (AEs) and the Number of Participants Who Died
The number of participants with serious AEs (SAEs), other non-serious AEs and participants who died. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
Measured: Baseline to study completion (up to 37 months)
Maximum Concentration (Cmax) of Ramucirumab, Cycle 1
Measured: 1 hour following the completion of Cycle 1 (14-day cycle) infusion
Cmax of Ramucirumab, Cycle 4
Measured: 1 hour following completion of Cycle 4 (14-day cycles) infusion
Cmax of Ramucirumab, Cycle 7
Measured: 1 hour following completion of Cycle 7 (14-day cycles) infusion
Number of Participants With Treatment Emergent Positive Anti-Ramucirumab Response [Serum Anti-Ramucirumab Antibody Assessment (Immunogenicity)]
Participants were considered positive for anti-ramucirumab antibodies [anti-drug antibodies (ADA)] if the post-treatment sample had an increase of at least 4-fold in titer from the pretreatment values. If the pretreatment value was not detected or was not present, a 1:20 post-treatment titer was required to indicate treatment emergence of ADA.
Measured: Prior to treatment and 1 hour post end of infusion for Cycles 1, 4 and 7 (14-day cycles)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Jun 2010 (estimated)
- Study startOct 2010
- Primary completionMar 2014
- Study completionMar 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (11)Papers the sponsor has linked to this study.
- Other trials for Hepatocellular CarcinomaStudies of the same condition, open and under way.
- More trials run by Eli Lilly and CompanyThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 565 participants (actual)
Sponsor and investigators
- Lead sponsor
- Eli Lilly and Company
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST), Study director, Eli Lilly and Company
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01140347
- Sponsor's protocol ID
- 13895
- Other IDs
- CP12-0919, I4T-IE-JVBF, 2010-019318-26
- Acronym
- REACH
- Status last verified
- Nov 2015
- First submitted
- 2 Jun 2010
- Last updated
- 28 Dec 2015
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Publications
Llovet JM, Singal AG, Villanueva A, Finn RS, Kudo M, Galle PR, Ikeda M, Callies S, McGrath LM, Wang C, Abada P, Widau RC, Gonzalez-Gugel E, Zhu AX. Prognostic and Predictive Factors in Patients with Advanced HCC and Elevated Alpha-Fetoprotein Treated with Ramucirumab in Two Randomized Phase III Trials. Clin Cancer Res. 2022 Jun 1;28(11):2297-2305. doi: 10.1158/1078-0432.CCR-21-4000.
PubMed 35247922Mitani S, Chen Y, Inoue K, Mori J, Gao L, Long A, Wakabayashi S. Clinical Impact of a Shortened Infusion Duration of Ramucirumab in Japanese Patients -A Model-Based Approach. Gan To Kagaku Ryoho. 2021 Nov;48(11):1381-1387.
PubMed 34795131Zhu AX, Finn RS, Kang YK, Yen CJ, Galle PR, Llovet JM, Assenat E, Brandi G, Motomura K, Ohno I, Daniele B, Vogel A, Yamashita T, Hsu CH, Gerken G, Bilbruck J, Hsu Y, Liang K, Widau RC, Wang C, Abada P, Kudo M. Serum alpha-fetoprotein and clinical outcomes in patients with advanced hepatocellular carcinoma treated with ramucirumab. Br J Cancer. 2021 Apr;124(8):1388-1397. doi: 10.1038/s41416-021-01260-w. Epub 2021 Feb 3.
PubMed 33531690Reig M, Galle PR, Kudo M, Finn R, Llovet JM, Metti AL, Schelman WR, Liang K, Wang C, Widau RC, Abada P, Zhu AX. Pattern of progression in advanced hepatocellular carcinoma treated with ramucirumab. Liver Int. 2021 Mar;41(3):598-607. doi: 10.1111/liv.14731. Epub 2020 Dec 5.
PubMed 33188713Zhu AX, Nipp RD, Finn RS, Galle PR, Llovet JM, Blanc JF, Okusaka T, Chau I, Cella D, Girvan A, Gable J, Bowman L, Wang C, Hsu Y, Abada PB, Kudo M. Ramucirumab in the second-line for patients with hepatocellular carcinoma and elevated alpha-fetoprotein: patient-reported outcomes across two randomised clinical trials. ESMO Open. 2020 Aug;5(4):e000797. doi: 10.1136/esmoopen-2020-000797.
PubMed 32817068Kudo M, Okusaka T, Motomura K, Ohno I, Morimoto M, Seo S, Wada Y, Sato S, Yamashita T, Furukawa M, Aramaki T, Nadano S, Ohkawa K, Fujii H, Kudo T, Furuse J, Takai H, Homma G, Yoshikawa R, Zhu AX. Ramucirumab after prior sorafenib in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein: Japanese subgroup analysis of the REACH-2 trial. J Gastroenterol. 2020 Jun;55(6):627-639. doi: 10.1007/s00535-020-01668-w. Epub 2020 Feb 27.
PubMed 32107609Arnold D, Fuchs CS, Tabernero J, Ohtsu A, Zhu AX, Garon EB, Mackey JR, Paz-Ares L, Baron AD, Okusaka T, Yoshino T, Yoon HH, Das M, Ferry D, Zhang Y, Lin Y, Binder P, Sashegyi A, Chau I. Meta-analysis of individual patient safety data from six randomized, placebo-controlled trials with the antiangiogenic VEGFR2-binding monoclonal antibody ramucirumab. Ann Oncol. 2017 Dec 1;28(12):2932-2942. doi: 10.1093/annonc/mdx514.
PubMed 28950290Chau I, Peck-Radosavljevic M, Borg C, Malfertheiner P, Seitz JF, Park JO, Ryoo BY, Yen CJ, Kudo M, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Okusaka T, Bowman L, Cui ZL, Girvan AC, Abada PB, Yang L, Zhu AX. Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib: Patient-focused outcome results from the randomised phase III REACH study. Eur J Cancer. 2017 Aug;81:17-25. doi: 10.1016/j.ejca.2017.05.001. Epub 2017 Jun 4.
PubMed 28591675Zhu AX, Baron AD, Malfertheiner P, Kudo M, Kawazoe S, Pezet D, Weissinger F, Brandi G, Barone CA, Okusaka T, Wada Y, Park JO, Ryoo BY, Cho JY, Chung HC, Li CP, Yen CJ, Lee KD, Chang SC, Yang L, Abada PB, Chau I. Ramucirumab as Second-Line Treatment in Patients With Advanced Hepatocellular Carcinoma: Analysis of REACH Trial Results by Child-Pugh Score. JAMA Oncol. 2017 Feb 1;3(2):235-243. doi: 10.1001/jamaoncol.2016.4115.
PubMed 27657674Kudo M, Hatano E, Ohkawa S, Fujii H, Masumoto A, Furuse J, Wada Y, Ishii H, Obi S, Kaneko S, Kawazoe S, Yokosuka O, Ikeda M, Ukai K, Morita S, Tsuji A, Kudo T, Shimada M, Osaki Y, Tateishi R, Sugiyama G, Abada PB, Yang L, Okusaka T, Zhu AX. Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma: Japanese subgroup analysis of the REACH trial. J Gastroenterol. 2017 Apr;52(4):494-503. doi: 10.1007/s00535-016-1247-4. Epub 2016 Aug 22.
PubMed 27549242Zhu AX, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Pfiffer TE, Okusaka T, Kubackova K, Trojan J, Sastre J, Chau I, Chang SC, Abada PB, Yang L, Schwartz JD, Kudo M; REACH Trial Investigators. Ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib (REACH): a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2015 Jul;16(7):859-70. doi: 10.1016/S1470-2045(15)00050-9. Epub 2015 Jun 18.
PubMed 26095784
Study at a glance
From the registry record, last updated by the sponsor on 28 Dec 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Multicenter, Randomized, Double-Blind, Phase 3 Study of Ramucirumab (IMC-1121B) Drug Product and Best Supportive Care (BSC) Versus Placebo and BSC as Second-Line Treatment in Patients With Hepatocellular Carcinoma Following First-Line Therapy With Sorafenib (REACH)
- ClinicalTrials.gov ID
- NCT01140347
- Acronym / sponsor ID
- REACH / 13895
- Conditions
- Hepatocellular Carcinoma
- Keywords
- Hepatocellular carcinoma (HCC), recombinant human immunoglobulin G, subclass 1 (IgG1) monoclonal antibody (MAb), Hepatocellular Carcinoma (HCC) following First-Line Therapy With Sorafenib
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 565 participants (actual)
- Lead sponsor
- Eli Lilly and CompanyIndustry (pharma, biotech, devices)
- Study start
- Oct 2010
- Primary completion
- Mar 2014 (actual)
- Study completion
- Mar 2015 (actual)
- First posted
- 9 Jun 2010 (estimated)
- Results
- Posted 26 Mar 2015
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a Phase 3 multicenter, randomized study evaluating the safety and efficacy of ramucirumab DP plus BSC as a double-blind, placebo-controlled (placebo plus BSC) comparison.
Approximately 544 participants, at least 18 years of age, with Child-Pugh score < 7 and diagnosed with hepatocellular carcinoma will be randomized. Participants must have received sorafenib as first-line systemic treatment for hepatocellular carcinoma (HCC), and must have discontinued sorafenib prior to entering the study.
Hypothesis: This sample size will allow differentiation of the expected increase in median overall survival (OS), from 8 months in the placebo arm to 10.67 months in the ramucirumab arm.
Upon registration and completion of screening procedures, eligible participants with HCC who have disease progression during or following first-line therapy with sorafenib, or were intolerant to this agent, will be randomized to receive either ramucirumab DP or placebo.
The treatment regimen will be continued until radiographic or symptomatic progression, the development of unacceptable toxicity, noncompliance or withdrawal of consent by the participant, or investigator decision.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Ramucirumab DP and BSC | Experimental | Biological: Ramucirumab DP (IMC-1121B), Other: BSC |
| Placebo and BSC | Placebo comparator | Biological: Placebo, Other: BSC |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (18 listed)
- Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0 or 1
- Child-Pugh score of <7 (Child-Pugh Class A only)
- Barcelona Clinic Liver Cancer (BCLC) Stage C or BCLC stage B not amenable to locoregional therapy or refractory to locoregional therapy
- Diagnosis of HCC (excluding fibrolamellar carcinoma) in the absence of histologic or cytologic confirmation
- There are either clinical, laboratory, or radiographic findings consistent with a diagnosis of liver cirrhosis
Key exclusion criteria (17 listed)
- Major surgery within 28 days prior to randomization, or central venous access device placement within 7 days prior to randomization
- Hepatic locoregional therapy within 28 days prior to randomization
- Radiation to any nonhepatic (e.g., bone) site within 14 days prior to randomization
- Sorafenib within 14 days prior to randomization
- Received any investigational therapy or non-approved drug within 28 days prior to randomization
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Placebo8 mg/kg IV every 2 weeks | Biological | Placebo and BSC |
| Ramucirumab DP (IMC-1121B)Also: IMC-1121B, LY30098068 milligrams/kilogram (mg/kg) intravenous (IV) every 2 weeks | Biological | Ramucirumab DP and BSC |
| BSCPalliative and supportive care for disease-related symptoms and toxicity associated with treatment as deemed medically necessary and appropriate in the opinion of the investigator. | Other | Placebo and BSC, Ramucirumab DP and BSC |
Primary outcome
Overall Survival (OS)
Time frame: Randomization to death from any cause (up to 37 months)
OS was defined as the time from the date of randomization to the date of death from any cause. Participants who were alive at the end of the follow-up period or were lost to follow-up were censored on the last date the participant was known to be alive.
10 secondary outcomes
Progression-Free Survival (PFS)
Time frame: Randomization to PD (up to 36 months)
Percentage of Participants With Complete Response (CR) or Partial Response (PR) [Objective Response Rate (ORR)]
Time frame: Baseline to the date of first evidence of confirmed CR or PR (up to 37 months)
Time to Radiographic Progression (TTP)
Time frame: Randomization to PD (up to 36 months)
Change From Baseline in the Functional Assessment of Cancer Therapy (FACT) Hepatobiliary Symptom Index-8 (FHSI-8)
Time frame: Baseline, Prior to infusion on Day 1 of Cycle 4, Cycle 10, and Cycle 16 (14-day cycles), and end of treatment (up to 34 months)
Change From Baseline in European Quality of Life Questionnaire-5 Dimensions (EQ-5D) Health State Score
Time frame: Baseline, Prior to infusion on Day 1 of Cycle 4, Cycle 10, and Cycle 16 (14-day cycles), end of treatment (up to 34 months)
Number of Participants With Adverse Events (AEs) and the Number of Participants Who Died
Time frame: Baseline to study completion (up to 37 months)
Maximum Concentration (Cmax) of Ramucirumab, Cycle 1
Time frame: 1 hour following the completion of Cycle 1 (14-day cycle) infusion
Cmax of Ramucirumab, Cycle 4
Time frame: 1 hour following completion of Cycle 4 (14-day cycles) infusion
Cmax of Ramucirumab, Cycle 7
Time frame: 1 hour following completion of Cycle 7 (14-day cycles) infusion
Number of Participants With Treatment Emergent Positive Anti-Ramucirumab Response [Serum Anti-Ramucirumab Antibody Assessment (Immunogenicity)]
Time frame: Prior to treatment and 1 hour post end of infusion for Cycles 1, 4 and 7 (14-day cycles)
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Dec 2015.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 35247922Llovet JM, Singal AG, Villanueva A, Finn RS, Kudo M, Galle PR, Ikeda M, Callies S, McGrath LM, Wang C, Abada P, Widau RC, Gonzalez-Gugel E, Zhu AX. Prognostic and Predictive Factors in Patients with Advanced HCC and Elevated Alpha-Fetoprotein Treated with Ramucirumab in Two Randomized Phase III Trials. Clin Cancer Res. 2022 Jun 1;28(11):2297-2305. doi: 10.1158/1078-0432.CCR-21-4000.
- Derived from this study: PubMed 34795131Mitani S, Chen Y, Inoue K, Mori J, Gao L, Long A, Wakabayashi S. Clinical Impact of a Shortened Infusion Duration of Ramucirumab in Japanese Patients -A Model-Based Approach. Gan To Kagaku Ryoho. 2021 Nov;48(11):1381-1387.
- Derived from this study: PubMed 33531690Zhu AX, Finn RS, Kang YK, Yen CJ, Galle PR, Llovet JM, Assenat E, Brandi G, Motomura K, Ohno I, Daniele B, Vogel A, Yamashita T, Hsu CH, Gerken G, Bilbruck J, Hsu Y, Liang K, Widau RC, Wang C, Abada P, Kudo M. Serum alpha-fetoprotein and clinical outcomes in patients with advanced hepatocellular carcinoma treated with ramucirumab. Br J Cancer. 2021 Apr;124(8):1388-1397. doi: 10.1038/s41416-021-01260-w. Epub 2021 Feb 3.
- Derived from this study: PubMed 33188713Reig M, Galle PR, Kudo M, Finn R, Llovet JM, Metti AL, Schelman WR, Liang K, Wang C, Widau RC, Abada P, Zhu AX. Pattern of progression in advanced hepatocellular carcinoma treated with ramucirumab. Liver Int. 2021 Mar;41(3):598-607. doi: 10.1111/liv.14731. Epub 2020 Dec 5.
- Derived from this study: PubMed 32817068Zhu AX, Nipp RD, Finn RS, Galle PR, Llovet JM, Blanc JF, Okusaka T, Chau I, Cella D, Girvan A, Gable J, Bowman L, Wang C, Hsu Y, Abada PB, Kudo M. Ramucirumab in the second-line for patients with hepatocellular carcinoma and elevated alpha-fetoprotein: patient-reported outcomes across two randomised clinical trials. ESMO Open. 2020 Aug;5(4):e000797. doi: 10.1136/esmoopen-2020-000797.
- Derived from this study: PubMed 32107609Kudo M, Okusaka T, Motomura K, Ohno I, Morimoto M, Seo S, Wada Y, Sato S, Yamashita T, Furukawa M, Aramaki T, Nadano S, Ohkawa K, Fujii H, Kudo T, Furuse J, Takai H, Homma G, Yoshikawa R, Zhu AX. Ramucirumab after prior sorafenib in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein: Japanese subgroup analysis of the REACH-2 trial. J Gastroenterol. 2020 Jun;55(6):627-639. doi: 10.1007/s00535-020-01668-w. Epub 2020 Feb 27.
- Derived from this study: PubMed 28950290Arnold D, Fuchs CS, Tabernero J, Ohtsu A, Zhu AX, Garon EB, Mackey JR, Paz-Ares L, Baron AD, Okusaka T, Yoshino T, Yoon HH, Das M, Ferry D, Zhang Y, Lin Y, Binder P, Sashegyi A, Chau I. Meta-analysis of individual patient safety data from six randomized, placebo-controlled trials with the antiangiogenic VEGFR2-binding monoclonal antibody ramucirumab. Ann Oncol. 2017 Dec 1;28(12):2932-2942. doi: 10.1093/annonc/mdx514.
- Derived from this study: PubMed 28591675Chau I, Peck-Radosavljevic M, Borg C, Malfertheiner P, Seitz JF, Park JO, Ryoo BY, Yen CJ, Kudo M, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Okusaka T, Bowman L, Cui ZL, Girvan AC, Abada PB, Yang L, Zhu AX. Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib: Patient-focused outcome results from the randomised phase III REACH study. Eur J Cancer. 2017 Aug;81:17-25. doi: 10.1016/j.ejca.2017.05.001. Epub 2017 Jun 4.
- Derived from this study: PubMed 27657674Zhu AX, Baron AD, Malfertheiner P, Kudo M, Kawazoe S, Pezet D, Weissinger F, Brandi G, Barone CA, Okusaka T, Wada Y, Park JO, Ryoo BY, Cho JY, Chung HC, Li CP, Yen CJ, Lee KD, Chang SC, Yang L, Abada PB, Chau I. Ramucirumab as Second-Line Treatment in Patients With Advanced Hepatocellular Carcinoma: Analysis of REACH Trial Results by Child-Pugh Score. JAMA Oncol. 2017 Feb 1;3(2):235-243. doi: 10.1001/jamaoncol.2016.4115.
- Derived from this study: PubMed 27549242Kudo M, Hatano E, Ohkawa S, Fujii H, Masumoto A, Furuse J, Wada Y, Ishii H, Obi S, Kaneko S, Kawazoe S, Yokosuka O, Ikeda M, Ukai K, Morita S, Tsuji A, Kudo T, Shimada M, Osaki Y, Tateishi R, Sugiyama G, Abada PB, Yang L, Okusaka T, Zhu AX. Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma: Japanese subgroup analysis of the REACH trial. J Gastroenterol. 2017 Apr;52(4):494-503. doi: 10.1007/s00535-016-1247-4. Epub 2016 Aug 22.
- Derived from this study: PubMed 26095784Zhu AX, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Pfiffer TE, Okusaka T, Kubackova K, Trojan J, Sastre J, Chau I, Chang SC, Abada PB, Yang L, Schwartz JD, Kudo M; REACH Trial Investigators. Ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib (REACH): a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2015 Jul;16(7):859-70. doi: 10.1016/S1470-2045(15)00050-9. Epub 2015 Jun 18.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST) study director
Eli Lilly and Company
146 sites in 27 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Ramucirumab DP (IMC-1121B) and BSC in people with Hepatocellular Carcinoma, run by Eli Lilly and Company at 146 sites in 27 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 18 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Dec 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 146 sites in United States, Germany, France, Japan, Italy and 22 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 26 Mar 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Overall Survival (OS) (time frame: Randomization to death from any cause (up to 37 months)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01140347, which also lists 11 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Dec 2015.