Trial Outcomes & Findings for Bevacizumab and Sorafenib as First-Line Therapy in Treating Patients With Locally Advanced or Metastatic Liver Cancer (NCT NCT00867321)

NCT ID: NCT00867321

Last Updated: 2022-04-19

Results Overview

MTD is defined as the dose level below the lowest dose that induces dose limiting toxicity in at least one-third of patients (at least 2 of a maximum of 6 new patients). If dose level (-1) is not tolerable, but dose (-3) or (-2) is below or at MTD, testing of alternate dose levels (-2a, -3a, -3b) will occur as outlined in the table. The number of dose limiting toxicities will be reported here.

Recruitment status

COMPLETED

Study phase

PHASE1/PHASE2

Target enrollment

24 participants

Primary outcome timeframe

From baseline up to 3 years post treatment

Results posted on

2022-04-19

Participant Flow

Participant milestones

Participant milestones
Measure
Arm I (Phase II)
Patients receive oral sorafenib tosylate on days 1-28 twice daily and bevacizumab IV on days 1 and 15.
Arm II (Phase II)
Patients receive oral sorafenib tosylate twice daily on days 1-28.
Phase I: Dose Level 0
Patients receive:\> \> Oral 400 mg BID Sorafenib on days 1-28.\> \> 1.25 mg/kg Bevacizumab IV on days 1, 15.
Phase I: Dose Level -1
Patients receive:\> \> Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days\> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a
Patients receive:\> \> Oral 200 mg BID Sorafenib days 1-28\> \> 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
Patients receive:\> \> Oral 200 mg BID Sorafenib days 1-28\> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Overall Study
STARTED
4
3
3
6
5
3
Overall Study
COMPLETED
4
2
3
6
5
3
Overall Study
NOT COMPLETED
0
1
0
0
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Bevacizumab and Sorafenib as First-Line Therapy in Treating Patients With Locally Advanced or Metastatic Liver Cancer

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Arm I (Phase II)
n=4 Participants
Patients receive oral sorafenib tosylate on days 1-28 twice daily and bevacizumab IV on days 1 and 15.
Arm II (Phase II)
n=3 Participants
Patients receive oral sorafenib tosylate twice daily on days 1-28.
All Phase I Patients
n=17 Participants
This includes all patients who participated in the phase I dose escalation portion of the trial.
Total
n=24 Participants
Total of all reporting groups
Age, Continuous
58.5 years
n=93 Participants
55 years
n=4 Participants
66 years
n=27 Participants
60.5 years
n=483 Participants
Sex: Female, Male
Female
1 Participants
n=93 Participants
1 Participants
n=4 Participants
3 Participants
n=27 Participants
5 Participants
n=483 Participants
Sex: Female, Male
Male
3 Participants
n=93 Participants
2 Participants
n=4 Participants
14 Participants
n=27 Participants
19 Participants
n=483 Participants
Region of Enrollment
United States
4 participants
n=93 Participants
3 participants
n=4 Participants
17 participants
n=27 Participants
24 participants
n=483 Participants

PRIMARY outcome

Timeframe: From baseline up to 3 years post treatment

Population: All eligible patients were treated and analyzed.

MTD is defined as the dose level below the lowest dose that induces dose limiting toxicity in at least one-third of patients (at least 2 of a maximum of 6 new patients). If dose level (-1) is not tolerable, but dose (-3) or (-2) is below or at MTD, testing of alternate dose levels (-2a, -3a, -3b) will occur as outlined in the table. The number of dose limiting toxicities will be reported here.

Outcome measures

Outcome measures
Measure
Phase I: Dose Level 0
n=3 Participants
Patients receive: \> \> Oral 400 mg BID Sorafenib on days 1-28. \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15.
Phase I: Dose Level -1
n=6 Participants
Patients receive: \> \> Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a (Maximum Tolerated Dose)
n=5 Participants
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
n=3 Participants
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Maximum Tolerated Dose (Phase I)
2 Participants
3 Participants
0 Participants
0 Participants

PRIMARY outcome

Timeframe: From baseline up to 3 years post treatment

Population: 6 of 7 patients have had at least one post-baseline assessment of disease and were used for this endpoint.

Time to progression is defined to be the length of time from study registration to a) date of disease progression as defined by section 11.0, or b) last follow-up. If a patient dies without documentation of disease progression, the patient will be considered to have had a tumor progression at the time of death unless there is sufficient documented evidence to conclude no progression occurred prior to death. Kaplan-Meier survival curves will be used to estimate the distribution of TTP.

Outcome measures

Outcome measures
Measure
Phase I: Dose Level 0
n=4 Participants
Patients receive: \> \> Oral 400 mg BID Sorafenib on days 1-28. \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15.
Phase I: Dose Level -1
n=2 Participants
Patients receive: \> \> Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a (Maximum Tolerated Dose)
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Time to Progression (TTP) (Phase II)
8.6 years
Interval 0.4 to 16.3
13.3 years
Interval 4.4 to
The upper confidence bound was non-estimable.

SECONDARY outcome

Timeframe: Up to 3 years post treatment

Overall survival (OS) is defined as the length of time from date of registration to a) date of death due to any cause or b) last follow-up. Kaplan-Meier survival curves will be used to estimate the distribution of OS.

Outcome measures

Outcome measures
Measure
Phase I: Dose Level 0
n=6 Participants
Patients receive: \> \> Oral 400 mg BID Sorafenib on days 1-28. \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15.
Phase I: Dose Level -1
Patients receive: \> \> Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a (Maximum Tolerated Dose)
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
Patients receive: \> \> Oral 200 mg BID Sorafenib days 1-28 \> \> 1.25 mg/kg Bevacizumab IV on days 1, 15
Overall Survival
13.3 Months
Interval 4.4 to
Upper confidence interval was not reached

SECONDARY outcome

Timeframe: 6 months

Population: No patients were analyzed for this endpoint because data was not collected for it

Tumor response (at 6 months) is defined as the number of responses (complete or partial response per Section 11) over the number of eligible patients observed for at least 6 months. Tumor response will be evaluated using simple estimates of proportions.

Outcome measures

Outcome data not reported

Adverse Events

Phase I: Dose Level 0

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Phase I: Dose Level -1

Serious events: 1 serious events
Other events: 6 other events
Deaths: 0 deaths

Phase I: Dose Level -2a

Serious events: 0 serious events
Other events: 5 other events
Deaths: 0 deaths

Phase I: Dose Level -2

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Arm I (Phase II)

Serious events: 0 serious events
Other events: 4 other events
Deaths: 0 deaths

Arm II (Phase II)

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Phase I: Dose Level 0
n=3 participants at risk
Patients receive: Oral 400 mg BID Sorafenib on days 1-28. 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -1
n=6 participants at risk
Patients receive: Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a
n=5 participants at risk
Patients receive: Oral 200 mg BID Sorafenib days 1-28 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
n=3 participants at risk
Patients receive: Oral 200 mg BID Sorafenib days 1-28 1.25 mg/kg Bevacizumab IV on days 1, 15
Arm I (Phase II)
n=4 participants at risk
Patients receive oral sorafenib tosylate on days 1-28 twice daily and bevacizumab IV on days 1 and 15.
Arm II (Phase II)
n=3 participants at risk
Patients receive oral sorafenib tosylate twice daily on days 1-28.
General disorders
Sudden death
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Investigations
Creatinine increased
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Metabolism and nutrition disorders
Acidosis
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Metabolism and nutrition disorders
Serum glucose decreased
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Nervous system disorders
Syncope
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3

Other adverse events

Other adverse events
Measure
Phase I: Dose Level 0
n=3 participants at risk
Patients receive: Oral 400 mg BID Sorafenib on days 1-28. 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -1
n=6 participants at risk
Patients receive: Oral 400 mg BID Sorafenib, 5 consecutive days out of each 7 days 1.25 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2a
n=5 participants at risk
Patients receive: Oral 200 mg BID Sorafenib days 1-28 2.5 mg/kg Bevacizumab IV on days 1, 15
Phase I: Dose Level -2
n=3 participants at risk
Patients receive: Oral 200 mg BID Sorafenib days 1-28 1.25 mg/kg Bevacizumab IV on days 1, 15
Arm I (Phase II)
n=4 participants at risk
Patients receive oral sorafenib tosylate on days 1-28 twice daily and bevacizumab IV on days 1 and 15.
Arm II (Phase II)
n=3 participants at risk
Patients receive oral sorafenib tosylate twice daily on days 1-28.
Cardiac disorders
Arrhythmia
33.3%
1/3 • Number of events 1
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Cardiac disorders
Atrial fibrillation
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Cardiac disorders
Cardiac disorder
33.3%
1/3 • Number of events 6
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Endocrine disorders
Endocrine disorder
33.3%
1/3 • Number of events 2
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Gastrointestinal disorders
Abdominal pain
66.7%
2/3 • Number of events 2
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Gastrointestinal disorders
Diarrhea
66.7%
2/3 • Number of events 2
66.7%
4/6 • Number of events 7
20.0%
1/5 • Number of events 1
33.3%
1/3 • Number of events 10
25.0%
1/4 • Number of events 1
66.7%
2/3 • Number of events 16
Gastrointestinal disorders
Ear, nose and throat examination abnormal
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Gastrointestinal disorders
Esophageal ulcer
0.00%
0/3
0.00%
0/6
0.00%
0/5
33.3%
1/3 • Number of events 1
0.00%
0/4
0.00%
0/3
Gastrointestinal disorders
Mucositis oral
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Gastrointestinal disorders
Nausea
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
33.3%
1/3 • Number of events 2
0.00%
0/4
33.3%
1/3 • Number of events 1
Gastrointestinal disorders
Proctitis
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 1
Gastrointestinal disorders
Rectal pain
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 1
Gastrointestinal disorders
Vomiting
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
General disorders
Chest pain
0.00%
0/3
0.00%
0/6
0.00%
0/5
33.3%
1/3 • Number of events 1
0.00%
0/4
0.00%
0/3
General disorders
Edema limbs
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 3
General disorders
Fatigue
100.0%
3/3 • Number of events 7
100.0%
6/6 • Number of events 14
80.0%
4/5 • Number of events 20
100.0%
3/3 • Number of events 8
100.0%
4/4 • Number of events 11
100.0%
3/3 • Number of events 15
General disorders
Localized edema
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 2
General disorders
Pain
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 2
0.00%
0/3
0.00%
0/4
0.00%
0/3
Infections and infestations
Pneumonia
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Infections and infestations
Sepsis
33.3%
1/3 • Number of events 1
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Infections and infestations
Upper respiratory infection
0.00%
0/3
0.00%
0/6
0.00%
0/5
33.3%
1/3 • Number of events 1
0.00%
0/4
0.00%
0/3
Infections and infestations
Urinary tract infection
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Injury, poisoning and procedural complications
Wound dehiscence
0.00%
0/3
16.7%
1/6 • Number of events 3
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Investigations
Alanine aminotransferase increased
0.00%
0/3
33.3%
2/6 • Number of events 2
0.00%
0/5
33.3%
1/3 • Number of events 1
25.0%
1/4 • Number of events 1
0.00%
0/3
Investigations
Alkaline phosphatase increased
66.7%
2/3 • Number of events 2
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Investigations
Aspartate aminotransferase increased
33.3%
1/3 • Number of events 2
33.3%
2/6 • Number of events 2
0.00%
0/5
33.3%
1/3 • Number of events 1
50.0%
2/4 • Number of events 2
33.3%
1/3 • Number of events 3
Investigations
Bilirubin increased
0.00%
0/3
16.7%
1/6 • Number of events 1
40.0%
2/5 • Number of events 2
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 7
Investigations
Electrocardiogram QTc interval prolonged
33.3%
1/3 • Number of events 4
16.7%
1/6 • Number of events 1
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
66.7%
2/3 • Number of events 2
Investigations
Leukocyte count decreased
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Investigations
Lipase increased
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
25.0%
1/4 • Number of events 1
33.3%
1/3 • Number of events 1
Investigations
Lymphocyte count decreased
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 2
Investigations
Neutrophil count decreased
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Investigations
Platelet count decreased
0.00%
0/3
16.7%
1/6 • Number of events 2
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 1
Investigations
Weight loss
33.3%
1/3 • Number of events 2
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 3
Metabolism and nutrition disorders
Anorexia
66.7%
2/3 • Number of events 2
16.7%
1/6 • Number of events 1
20.0%
1/5 • Number of events 1
33.3%
1/3 • Number of events 1
0.00%
0/4
0.00%
0/3
Metabolism and nutrition disorders
Blood glucose increased
0.00%
0/3
33.3%
2/6 • Number of events 3
40.0%
2/5 • Number of events 2
0.00%
0/3
0.00%
0/4
0.00%
0/3
Metabolism and nutrition disorders
Dehydration
0.00%
0/3
33.3%
2/6 • Number of events 2
20.0%
1/5 • Number of events 1
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Metabolism and nutrition disorders
Serum albumin decreased
33.3%
1/3 • Number of events 1
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 6
Metabolism and nutrition disorders
Serum calcium decreased
0.00%
0/3
33.3%
2/6 • Number of events 2
0.00%
0/5
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 1
Metabolism and nutrition disorders
Serum phosphate decreased
33.3%
1/3 • Number of events 1
33.3%
2/6 • Number of events 2
20.0%
1/5 • Number of events 1
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Metabolism and nutrition disorders
Serum potassium decreased
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Metabolism and nutrition disorders
Serum potassium increased
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Metabolism and nutrition disorders
Serum sodium decreased
33.3%
1/3 • Number of events 1
16.7%
1/6 • Number of events 2
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Musculoskeletal and connective tissue disorders
Arthritis
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Musculoskeletal and connective tissue disorders
Joint pain
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3
Musculoskeletal and connective tissue disorders
Muscle weakness
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 1
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Musculoskeletal and connective tissue disorders
Muscle weakness lower limb
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Musculoskeletal and connective tissue disorders
Muscle weakness upper limb
0.00%
0/3
16.7%
1/6 • Number of events 1
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Musculoskeletal and connective tissue disorders
Osteonecrosis
33.3%
1/3 • Number of events 1
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Musculoskeletal and connective tissue disorders
Pain in extremity
0.00%
0/3
0.00%
0/6
0.00%
0/5
0.00%
0/3
25.0%
1/4 • Number of events 1
0.00%
0/3
Nervous system disorders
Encephalopathy
33.3%
1/3 • Number of events 1
0.00%
0/6
0.00%
0/5
0.00%
0/3
0.00%
0/4
0.00%
0/3
Renal and urinary disorders
Protein urine positive
0.00%
0/3
16.7%
1/6 • Number of events 2
20.0%
1/5 • Number of events 7
0.00%
0/3
0.00%
0/4
33.3%
1/3 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Pharyngolaryngeal pain
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 2
0.00%
0/3
0.00%
0/4
0.00%
0/3
Respiratory, thoracic and mediastinal disorders
Voice alteration
0.00%
0/3
0.00%
0/6
20.0%
1/5 • Number of events 2
0.00%
0/3
0.00%
0/4
0.00%
0/3
Skin and subcutaneous tissue disorders
Hand-and-foot syndrome
33.3%
1/3 • Number of events 1
16.7%
1/6 • Number of events 1
40.0%
2/5 • Number of events 12
66.7%
2/3 • Number of events 14
50.0%
2/4 • Number of events 6
33.3%
1/3 • Number of events 1
Skin and subcutaneous tissue disorders
Rash desquamating
66.7%
2/3 • Number of events 4
16.7%
1/6 • Number of events 3
20.0%
1/5 • Number of events 1
33.3%
1/3 • Number of events 1
25.0%
1/4 • Number of events 1
66.7%
2/3 • Number of events 7
Vascular disorders
Hypertension
66.7%
2/3 • Number of events 3
16.7%
1/6 • Number of events 2
20.0%
1/5 • Number of events 1
33.3%
1/3 • Number of events 2
100.0%
4/4 • Number of events 8
100.0%
3/3 • Number of events 6
Vascular disorders
Thrombosis
0.00%
0/3
16.7%
1/6 • Number of events 1
20.0%
1/5 • Number of events 1
0.00%
0/3
0.00%
0/4
0.00%
0/3

Additional Information

Steven R. Alberts, MD MPH

Mayo Clinic

Phone: 507/284-4918

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place

Restriction type: LTE60