This is a multicenter, open label, randomized bioequivalence study of BEVZ92 (bevacizumab biosimilar) and Avastin® with 2 parallel arms to compare the pharmacokinetic (PK) profile of BEVZ92 and Avastin® in combination with FOLFOX (any) or FOLFIRI chemotherapy. FOLFOX (any) or FOLFIRI will be chosen as per investigator criteria based on the hospital standard of care.
Planned enrolment duration: 12 months. Pre-treatment period (included in enrolment period): 1 month. Treatment period: Patients will continue treatment until disease progression or unacceptable toxicity, or withdrawal of consent.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
142
Active ingredient Bevacizumab 25 mg/mL (strength = 100 mg/4 mL). 30-minute\* IV infusion (5 mg/kg) every 2 weeks, prior to chemotherapy (Folfox any or Folfiri). FOLFIRI = Folinic Acid + Fluorouracil + Irinotecan FOLFOX = Folinic Acid + Fluorouracil + Oxaliplatin Treatment will continue until disease progression, unacceptable toxicity, patient withdraws consent or death (whichever occurs first). \*The first infusion will be given over 90 minutes. If it is well tolerated, the second infusion can be given over 60 minutes. If it is well tolerated, subsequent infusions can be given over 30 minutes. The FOLFOX (any) or FOLFIRI regimen will be chosen as per investigator's criteria based on the hospital standard of care.
Active ingredient: Bevacizumab 25 mg/mL (strength: 100 mg/4 mL). 30-minute\* IV infusion (5 mg/kg) every 2 weeks, prior to administration of chemotherapy. Treatment will continue until disease progression, unacceptable toxicity, patient withdraws consent or death (whichever occurs first). \*The first infusion will be given over 90 minutes. If the first infusion is well tolerated, the second infusion can be given over 60 minutes. If this infusion is well tolerated, subsequent infusions can be given over 30 minutes. The FOLFOX (any) or FOLFIRI regimen will be chosen as per investigator's criteria based on the hospital standard of care.
Hospital de Gastroenterologia "Dr. Carlos Bonorino Udaondo"
Buenos Aires, Argentina
Instituto Oncológico de Rosario
Rosario, Argentina
Area Under the Concentration-versus-time Curve (AUC) at Cycle 1 (AUC0-336h) of BEVZ92 and Avastin®
To compare the pharmacokinetic (PK) profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated AUC calculated from start of the first infusion until start of the second infusion (i.e. at Cycle 1; AUC0-336h) For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% confidence interval (CI) of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.
Time frame: AUC0-336 hrs: 0 to 336 hours after start of the first infusion
AUC at Steady State (AUCss) of BEVZ92 and Avastin®
To compare the PK profile of BEVZ92 and Avastin®, both administered in combination with FOLFOX (any) or FOLFIRI, by means of comparing the truncated area under the concentration-versus-time curve calculated over a dosage interval at steady state (i.e. at Cycle 7; AUCss). For the PK similarity assessments, regulatory guidelines on bioequivalence were followed whereby two treatments are judged not to be different from one another if the 90% CI of the ratio of a log-transformed exposure measure (AUC) falls completely within the range 80-125%.
Time frame: AUCss: 0 to 336 hours after the administration of Cycle 7 infusion (Week 13).
Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Reported With BEVZ92 and Avastin®
Compare the safety profile by means of the frequency and severity of TEAEs and SAEs reported in each treatment arm.
Time frame: From first study dose and up to 30 days after the end of study treatment for each patient, for an average of 11 months
Anti-Drug Antibody (ADA) of BEVZ92 and Avastin®
Immunogenicity profile by means of measurement of ADA developed de novo (seroconversion) after cycle 5, cycle 8, and 12 months after first drug administration (pre-dose).
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Fundaçáo Pio XII - Hospital do Cancer de Barretos
Barretos, Brazil
Hospital Caridade
Ijuí, Brazil
Hospital Sao Lucas da Pucrs
Porto Alegre, Brazil
Centro de Pesquisa do Instituto Brasileiro de Controle do Câncer - IBCC
São Paulo, Brazil
Hosp. A.C Camargo
São Paulo, Brazil
Instituto do Cancer del estado de S. Paulo (ICEPS )
São Paulo, Brazil
M S Patel Cancer Centre- Shree Krishna Hospital
Karamsad, Gujarat, India
Sri Ramachandra Hospital
Chennai, India
...and 8 more locations
Time frame: At baseline, and on Day 1 (pre-dose) of Cycles: 1, 5 and 8, and 12 months after first drug administration
Objective Response Rate (ORR) of BEVZ92 and Avastin®
To compare efficacy in terms of ORR between arms. Clinical and radiological tumor assessments were performed according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 using computed tomography (CT) or magnetic resonance imaging (MRI) scans. Objective response (OR) is defined as a best overall response of partial response (PR) or complete response (CR) as defined by RECIST v1.1. All participants who did not meet the criteria for CR or PR by the end of the study were considered non-responders.
Time frame: Every four weeks. Up to 48 weeks
Cmax,sd of BEVZ92 and Avastin®
Secondary PK endpoints included the Cmax calculated at Cycle 1 (Cmax,sd )
Time frame: Cmax, sd: 0 to 336 hours after start of the first infusion.
Progression-free Survival (PFS) of BEVZ92 and Avastin®
Compare PFS between the randomized treatment arms. Progression-free survival (PFS) was defined as the time from the randomization date to the date of disease progression using RECIST v1.1, or death. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions plus 5 mm absolute increase, and/or unequivocal progression of known non-target lesion, and/or the appearance of new lesions".
Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 weeks.
Cmax,ss of BEVZ92 and Avastin®
Secondary PK endpoints included the Cmax calculated at Cycle 7 (Cmax, ss )
Time frame: Cmax, ss: 0 to 336 hours post-dose after the administration of Cycle 7 infusion (Week 13)
Ctrough,sd of BEVZ92 and Avastin®
Secondary PK endpoints included the Ctrough calculated at Cycle 1 (Ctrough,sd )
Time frame: Ctrough, sd: 0 to 336 hours after start of the first infusion.
Ctrough,ss of BEVZ92 and Avastin®
Secondary PK endpoints included the Ctrough calculated at Cycle 7 (Ctrough,ss)
Time frame: Ctrough, ss: 0 to 336 hours after the administration of the Cycle 7 infusion.
Elimination Half-life (t1/2) of BEVZ92 and Avastin®
Secondary PK endpoints included the t1/2 calculated at Cycle 7
Time frame: t1/2: 0 to 336 hours after the administration of the Cycle 7 infusion.
Elimination Rate Constant (Kel) of BEVZ92 and Avastin®
Secondary PK endpoints included the Kel calculated at Cycle 7 (Ctrough,ss)
Time frame: Kel: 0 to 336 hours after the administration of the Cycle 7 infusion.
Volume of Distribution (Vd) of BEVZ92 and Avastin®
Secondary PK endpoints included the Vd calculated at Cycle 7
Time frame: Vd: 0 to 336 hours after the administration of the Cycle 7 infusion.