Trial Outcomes & Findings for Phase III Study Comparing the Efficacy and Safety of EP2006 and Filgrastim (NCT NCT01519700)

NCT ID: NCT01519700

Last Updated: 2015-05-06

Results Overview

Mean duration of severe neutropenia, defined as the mean number of consecutive days with Grade 4 neutropenia (ANC less than 0.5\*10\^9 cells/L)

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

218 participants

Primary outcome timeframe

21 days (Cycle 1 of chemotherapy treatment)

Results posted on

2015-05-06

Participant Flow

The study population consisted of women of 18 years or older with histologically proven breast cancer who were eligible for neoadjuvant or adjuvant treatment with TAC chemotherapy. The study was aimed to randomize a total of 192 patients in approximately 65 centers worldwide.

The study started with a screening period of up to 21 days. During the screening period, the eligibility of the patients to participate in the study was assessed based on safety evaluations. After completion of the screening period, the patients were randomized to either EP2006 or US-licensed Neupogen® in four groups (see below).

Participant milestones

Participant milestones
Measure
EP2006
Patients remained on EP2006 (their initial treatment) throughout the study daily dose of 5 mcg/kg body weight, subcutaneously
EP2006 + Neupogen
Patients received alternating treatment with EP2006 or Neupogen starting with the second cycle, daily dose of 5 mcg/kg body weight, subcutaneously
Neupogen + EP2006
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle, daily dose of 5 mcg/kg body weight, subcutaneously
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study, daily dose of 5 mcg/kg body weight, subcutaneously
Overall Study
STARTED
54
55
55
54
Overall Study
Treated Cycle 1 EP2006
53
54
0
0
Overall Study
Treated Cycle 1 Neupogen
0
0
55
52
Overall Study
Treated Cycle 2 EP2006
52
0
55
0
Overall Study
Treated Cycle 2 Neupogen
0
52
0
51
Overall Study
Treated Cycle 3 EP2006
51
51
0
0
Overall Study
Treated Cycle 3 Neupogen
0
0
54
51
Overall Study
Treated Cycle 4 EP2006
51
0
50
0
Overall Study
Treated Cycle 4 Neupogen
0
51
0
50
Overall Study
Treated Cycle 5 EP2006
46
49
0
0
Overall Study
Treated Cycle 5 Neupogen
0
0
48
50
Overall Study
Treated Cycle 6 EP2006
45
0
48
0
Overall Study
Treated Cycle 6 Neupogen
0
49
0
49
Overall Study
COMPLETED
45
49
48
47
Overall Study
NOT COMPLETED
9
6
7
7

Reasons for withdrawal

Reasons for withdrawal
Measure
EP2006
Patients remained on EP2006 (their initial treatment) throughout the study daily dose of 5 mcg/kg body weight, subcutaneously
EP2006 + Neupogen
Patients received alternating treatment with EP2006 or Neupogen starting with the second cycle, daily dose of 5 mcg/kg body weight, subcutaneously
Neupogen + EP2006
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle, daily dose of 5 mcg/kg body weight, subcutaneously
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study, daily dose of 5 mcg/kg body weight, subcutaneously
Overall Study
Death
1
0
0
0
Overall Study
Lost to Follow-up
0
0
1
1
Overall Study
Physician Decision
1
1
3
0
Overall Study
Withdrawal by Subject
5
3
3
2
Overall Study
Other Reason
2
2
0
4

Baseline Characteristics

Phase III Study Comparing the Efficacy and Safety of EP2006 and Filgrastim

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
EP2006
n=53 Participants
Patients remained on EP2006 (their initial treatment) throughout the study
EP2006 + Neupogen
n=54 Participants
Patients received alternating treatment with EP2006 or Neupogen starting with the second cycle
Neupogen + EP2006
n=55 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=52 Participants
Patients remained on Neupogen (their initial treatment) throughout the study
Total
n=214 Participants
Total of all reporting groups
Age, Continuous
51.5 years
STANDARD_DEVIATION 11.16 • n=5 Participants
47.5 years
STANDARD_DEVIATION 11.64 • n=7 Participants
49.7 years
STANDARD_DEVIATION 11.05 • n=5 Participants
46.9 years
STANDARD_DEVIATION 10.91 • n=4 Participants
48.9 years
STANDARD_DEVIATION 11.26 • n=21 Participants
Sex: Female, Male
Female
53 Participants
n=5 Participants
54 Participants
n=7 Participants
55 Participants
n=5 Participants
52 Participants
n=4 Participants
214 Participants
n=21 Participants
Sex: Female, Male
Male
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants

PRIMARY outcome

Timeframe: 21 days (Cycle 1 of chemotherapy treatment)

Population: PP population

Mean duration of severe neutropenia, defined as the mean number of consecutive days with Grade 4 neutropenia (ANC less than 0.5\*10\^9 cells/L)

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=101 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=103 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study
Total
All patients
Mean Duration of Grade 4 Neutropenia During Cycle 1 of Chemotherapy
1.17 Days
Standard Deviation 1.11
1.2 Days
Standard Deviation 1.02

SECONDARY outcome

Timeframe: 21 weeks/ 6 cycles

Population: SAF-I (alternating safety) set: patients who received at least one dose of study medication after Cycle 1.

Incidence of febrile neutropenia by duraton within each cycle and across all cycles. Febrile neutropenia is defined as oral temperature greater than or equal 38.3°C while having an Absolute Neutrophil Count \< 0.5\*10\^9 cells/L (both measured on the same day)

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=52 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=52 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=55 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=51 Participants
Patients remained on Neupogen (their initial treatment) throughout the study
Total
n=210 Participants
All patients
Incidence of Febrile Neutropenia
Cycle 1 - 0 Days duration
50 participants
49 participants
54 participants
51 participants
204 participants
Incidence of Febrile Neutropenia
Cycle 1 - 1 Day duration
2 participants
3 participants
0 participants
0 participants
5 participants
Incidence of Febrile Neutropenia
Cycle 1 - 2 Days duration
0 participants
0 participants
1 participants
0 participants
1 participants
Incidence of Febrile Neutropenia
Cycle 2 - 0 Days duration
52 participants
51 participants
55 participants
51 participants
209 participants
Incidence of Febrile Neutropenia
Cycle 2 - 1 Day duration
0 participants
1 participants
0 participants
0 participants
1 participants
Incidence of Febrile Neutropenia
Cycle 3 - 0 Days duration
51 participants
51 participants
54 participants
51 participants
207 participants
Incidence of Febrile Neutropenia
Cycle 4 - 0 Days duration
51 participants
51 participants
50 participants
50 participants
202 participants
Incidence of Febrile Neutropenia
Cycle 5 - 0 Days duration
45 participants
48 participants
48 participants
50 participants
191 participants
Incidence of Febrile Neutropenia
Cycle 5 - 1 Day duration
0 participants
1 participants
0 participants
0 participants
1 participants
Incidence of Febrile Neutropenia
Cycle 6 - 0 Days duration
43 participants
48 participants
48 participants
49 participants
188 participants
Incidence of Febrile Neutropenia
Cycle 6 - 1 Day duration
1 participants
1 participants
0 participants
0 participants
2 participants
Incidence of Febrile Neutropenia
All Cycles - 0 Days duration
49 participants
46 participants
54 participants
51 participants
200 participants
Incidence of Febrile Neutropenia
All Cycles - 1 Day duration
3 participants
6 participants
0 participants
0 participants
9 participants
Incidence of Febrile Neutropenia
All Cycles - 2 Days duration
0 participants
0 participants
1 participants
0 participants
1 participants

SECONDARY outcome

Timeframe: 21 weeks/ 6 cycles

Population: PP-I (alternating Per-Protocol) set: randomized patients who completed all six chemotherapy cycles without major protocol violations.

Number of days of fever by cycle. Fever is defined as oral temperature greater than or equal to 38.3°C.

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=40 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=45 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=44 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=46 Participants
Patients remained on Neupogen (their initial treatment) throughout the study
Total
n=175 Participants
All patients
Number of Days of Fever
Cycle 6 - Yes
1 participants
1 participants
0 participants
0 participants
2 participants
Number of Days of Fever
Cycle 1 - No
39 participants
41 participants
42 participants
46 participants
168 participants
Number of Days of Fever
Cycle 1 - Yes
1 participants
4 participants
2 participants
0 participants
7 participants
Number of Days of Fever
Cycle 2 - No
36 participants
43 participants
44 participants
46 participants
169 participants
Number of Days of Fever
Cycle 2 - Yes
4 participants
2 participants
0 participants
0 participants
6 participants
Number of Days of Fever
Cycle 3 - No
40 participants
44 participants
44 participants
45 participants
173 participants
Number of Days of Fever
Cycle 3 - Yes
0 participants
1 participants
0 participants
1 participants
2 participants
Number of Days of Fever
Cycle 4 - No
40 participants
44 participants
43 participants
46 participants
173 participants
Number of Days of Fever
Cycle 4 - Yes
0 participants
1 participants
1 participants
0 participants
2 participants
Number of Days of Fever
Cycle 5 - No
40 participants
44 participants
43 participants
45 participants
172 participants
Number of Days of Fever
Cycle 5 - Yes
0 participants
1 participants
1 participants
1 participants
3 participants
Number of Days of Fever
Cycle 6 - No
39 participants
44 participants
44 participants
46 participants
173 participants

SECONDARY outcome

Timeframe: Cycle 1/ 21 days

Population: FAS (full analysis) set: all patients who received at least one dose of study medication, analyzed according to randomization allocation

Depth of Absolute Neutrophil Count Nadir, defined as the patient's lowest Absolute Neutrophil Count in cycle 1

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=107 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=107 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=214 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study
Total
All patients
Depth of Absolute Neutrophil Count Nadir
0.808 10^9 cells/L
Standard Deviation 1.3694
0.744 10^9 cells/L
Standard Deviation 1.2906
0.776 10^9 cells/L
Standard Deviation 1.3278

SECONDARY outcome

Timeframe: Cycle 1/ 21 days

Population: FAS (full analysis) set: all patients who received at least one dose of study medication, analyzed according to randomization allocation. In the EP2006 + EP2006 \& Neupogen group, one patient's time to Absolute Neutrophil Count recovery could not be measured as the nadir was the last measured timepoint.

Time to Absolute Neutrophil Count recovery, defined as the time in days from Absolute Neutrophil Count nadir until the patient's Absolute Neutrophil Count increases to more or equal to 2\*10\^9 cells/L after the nadir in cycle 1

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=106 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=107 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=213 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study
Total
All patients
Time to Absolute Neutrophil Count Recovery
2.0 Days
Interval 0.0 to 6.0
2.0 Days
Interval 0.0 to 4.0
2.0 Days
Interval 0.0 to 6.0

SECONDARY outcome

Timeframe: 21 Weeks/ 6 cycles

Population: SAF-I (alternating safety) set: patients who received at least one dose of study medication after Cycle 1. Comparison made for alternating versus non-alternating treatment groups.

Frequency of infections by cycle and across all cycles

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=103 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=107 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=210 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
Patients remained on Neupogen (their initial treatment) throughout the study
Total
All patients
Frequency of Infections
All Cycles - Yes
7 participants
10 participants
17 participants
Frequency of Infections
Cycle 1 - No
102 participants
104 participants
206 participants
Frequency of Infections
Cycle 1 - Yes
1 participants
3 participants
4 participants
Frequency of Infections
Cycle 2 - No
100 participants
102 participants
202 participants
Frequency of Infections
Cycle 2 - Yes
3 participants
5 participants
8 participants
Frequency of Infections
Cycle 3 - No
102 participants
107 participants
209 participants
Frequency of Infections
Cycle 3 - Yes
1 participants
0 participants
1 participants
Frequency of Infections
Cycle 4 - No
101 participants
104 participants
205 participants
Frequency of Infections
Cycle 4 - Yes
2 participants
3 participants
5 participants
Frequency of Infections
Cycle 5 - No
101 participants
106 participants
207 participants
Frequency of Infections
Cycle 5 - Yes
2 participants
1 participants
3 participants
Frequency of Infections
Cycle 6 - No
102 participants
106 participants
208 participants
Frequency of Infections
Cycle 6 - Yes
1 participants
1 participants
2 participants
Frequency of Infections
All Cycles - No
96 participants
97 participants
193 participants

SECONDARY outcome

Timeframe: 21 Weeks/ 6 cycles

Population: SAF-I (alternating safety) set: patients who received at least one dose of study medication after Cycle 1.

Incidence of hospitalizations due to Febrile Neutropenia

Outcome measures

Outcome measures
Measure
EP2006 + EP2006 & Neupogen
n=52 Participants
All subjects randomized to receive either EP2006 in Cycle 1
Neupogen + Neupogen & EP2006
n=52 Participants
All subjects randomized to receive Neupogen in Cycle 1
Neupogen + EP2006
n=55 Participants
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=51 Participants
Patients remained on Neupogen (their initial treatment) throughout the study
Total
n=210 Participants
All patients
Incidence of Hospitalizations Due to Febrile Neutropenia
No
50 participants
50 participants
55 participants
51 participants
206 participants
Incidence of Hospitalizations Due to Febrile Neutropenia
Yes
2 participants
1 participants
0 participants
1 participants
4 participants

Adverse Events

EP2006

Serious events: 6 serious events
Other events: 50 other events
Deaths: 0 deaths

EP2006 + Neupogen

Serious events: 4 serious events
Other events: 51 other events
Deaths: 0 deaths

Neupogen + EP2006

Serious events: 1 serious events
Other events: 52 other events
Deaths: 0 deaths

Neupogen

Serious events: 3 serious events
Other events: 50 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
EP2006
n=53 participants at risk
Patients remained on EP2006 (their initial treatment) throughout the study
EP2006 + Neupogen
n=54 participants at risk
Patients received alternating treatment with EP2006 or Neupogen starting with the second cycle
Neupogen + EP2006
n=55 participants at risk
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=52 participants at risk
Patients remained on Neupogen (their initial treatment) throughout the study
Blood and lymphatic system disorders
Febrile Neutropenia
5.7%
3/53 • Number of events 3
7.4%
4/54 • Number of events 4
1.8%
1/55 • Number of events 1
1.9%
1/52 • Number of events 1
Blood and lymphatic system disorders
Anaemia
0.00%
0/53
0.00%
0/54
0.00%
0/55
1.9%
1/52 • Number of events 1
Blood and lymphatic system disorders
Leukopenia
1.9%
1/53 • Number of events 1
0.00%
0/54
0.00%
0/55
0.00%
0/52
Gastrointestinal disorders
Diarrhoea
0.00%
0/53
0.00%
0/54
0.00%
0/55
1.9%
1/52 • Number of events 1
Vascular disorders
Embolism
1.9%
1/53 • Number of events 1
0.00%
0/54
0.00%
0/55
0.00%
0/52
Vascular disorders
Hypertensive crisis
1.9%
1/53 • Number of events 1
0.00%
0/54
0.00%
0/55
0.00%
0/52

Other adverse events

Other adverse events
Measure
EP2006
n=53 participants at risk
Patients remained on EP2006 (their initial treatment) throughout the study
EP2006 + Neupogen
n=54 participants at risk
Patients received alternating treatment with EP2006 or Neupogen starting with the second cycle
Neupogen + EP2006
n=55 participants at risk
Patients received alternating treatment with Neupogen or EP2006 starting with the 2nd cycle
Neupogen
n=52 participants at risk
Patients remained on Neupogen (their initial treatment) throughout the study
Skin and subcutaneous tissue disorders
Alopecia
77.4%
41/53 • Number of events 43
81.5%
44/54 • Number of events 45
78.2%
43/55 • Number of events 46
82.7%
43/52 • Number of events 44
Skin and subcutaneous tissue disorders
Erythema
9.4%
5/53 • Number of events 15
3.7%
2/54 • Number of events 3
10.9%
6/55 • Number of events 19
11.5%
6/52 • Number of events 23
General disorders
Asthenia
37.7%
20/53 • Number of events 66
51.9%
28/54 • Number of events 98
58.2%
32/55 • Number of events 111
53.8%
28/52 • Number of events 101
General disorders
Fatigue
32.1%
17/53 • Number of events 52
16.7%
9/54 • Number of events 17
20.0%
11/55 • Number of events 38
25.0%
13/52 • Number of events 38
General disorders
Hypothermia
0.00%
0/53
5.6%
3/54 • Number of events 6
1.8%
1/55 • Number of events 14
1.9%
1/52 • Number of events 1
General disorders
Pyrexia
11.3%
6/53 • Number of events 9
5.6%
3/54 • Number of events 8
1.8%
1/55 • Number of events 1
1.9%
1/52 • Number of events 2
Gastrointestinal disorders
Nausea
54.7%
29/53 • Number of events 103
61.1%
33/54 • Number of events 95
58.2%
32/55 • Number of events 116
71.2%
37/52 • Number of events 149
Gastrointestinal disorders
Diarrhoea
9.4%
5/53 • Number of events 8
20.4%
11/54 • Number of events 14
23.6%
13/55 • Number of events 21
15.4%
8/52 • Number of events 11
Gastrointestinal disorders
Vomiting
17.0%
9/53 • Number of events 27
18.5%
10/54 • Number of events 22
18.2%
10/55 • Number of events 21
17.3%
9/52 • Number of events 19
Gastrointestinal disorders
Abdominal pain upper
3.8%
2/53 • Number of events 3
0.00%
0/54
9.1%
5/55 • Number of events 10
3.8%
2/52 • Number of events 2
Gastrointestinal disorders
Abdominal pain
5.7%
3/53 • Number of events 8
3.7%
2/54 • Number of events 2
7.3%
4/55 • Number of events 7
5.8%
3/52 • Number of events 6
Gastrointestinal disorders
Stomatitis
5.7%
3/53 • Number of events 3
5.6%
3/54 • Number of events 3
0.00%
0/55
3.8%
2/52 • Number of events 4
Musculoskeletal and connective tissue disorders
Bone pain
24.5%
13/53 • Number of events 33
37.0%
20/54 • Number of events 46
34.5%
19/55 • Number of events 60
36.5%
19/52 • Number of events 60
Musculoskeletal and connective tissue disorders
Arthralgia
5.7%
3/53 • Number of events 8
7.4%
4/54 • Number of events 4
10.9%
6/55 • Number of events 8
5.8%
3/52 • Number of events 3
Musculoskeletal and connective tissue disorders
Myalgia
3.8%
2/53 • Number of events 5
5.6%
3/54 • Number of events 4
5.5%
3/55 • Number of events 5
5.8%
3/52 • Number of events 4
Musculoskeletal and connective tissue disorders
Musculosceletal pain
9.4%
5/53 • Number of events 6
1.9%
1/54 • Number of events 2
3.6%
2/55 • Number of events 3
1.9%
1/52 • Number of events 3
Blood and lymphatic system disorders
Neutropenia
9.4%
5/53 • Number of events 21
13.0%
7/54 • Number of events 18
10.9%
6/55 • Number of events 20
11.5%
6/52 • Number of events 22
Blood and lymphatic system disorders
Anaemia
11.3%
6/53 • Number of events 10
9.3%
5/54 • Number of events 9
7.3%
4/55 • Number of events 6
21.2%
11/52 • Number of events 24
Blood and lymphatic system disorders
Leucopenia
7.5%
4/53 • Number of events 21
7.4%
4/54 • Number of events 12
3.6%
2/55 • Number of events 3
5.8%
3/52 • Number of events 9
Blood and lymphatic system disorders
Febrile neutropenia
5.7%
3/53 • Number of events 3
9.3%
5/54 • Number of events 5
1.8%
1/55 • Number of events 1
1.9%
1/52 • Number of events 1
Nervous system disorders
Dizziness
5.7%
3/53 • Number of events 8
0.00%
0/54
5.5%
3/55 • Number of events 4
1.9%
1/52 • Number of events 1
Nervous system disorders
Headache
5.7%
3/53 • Number of events 6
5.6%
3/54 • Number of events 3
3.6%
2/55 • Number of events 2
1.9%
1/52 • Number of events 1
Nervous system disorders
Periferal sensory neur.
5.7%
3/53 • Number of events 3
0.00%
0/54
3.6%
2/55 • Number of events 2
1.9%
1/52 • Number of events 1
Metabolism and nutrition disorders
Decreased Appetite
15.1%
8/53 • Number of events 21
7.4%
4/54 • Number of events 8
5.5%
3/55 • Number of events 6
25.0%
13/52 • Number of events 32
Vascular disorders
Flushing
1.9%
1/53 • Number of events 3
5.6%
3/54 • Number of events 10
0.00%
0/55
3.8%
2/52 • Number of events 7

Additional Information

Dr. Roumen Nakov, Global Programme Medical Director

Sandoz

Phone: +49 8024 4764704

Results disclosure agreements

  • Principal investigator is a sponsor employee PI shall provide Sponsor with any presentation at least 15 working days prior to disclosure and any other publication at least 45 working days prior to disclosure. Sponsor may require amendments on reasonable grounds: (a) accuracy of publication; (b) confidentiality of proprietary information; (c) intellectual property protection; (d) to enable further information to be provided. Sponsor may require publications or presentations to be delayed up to four (4) months to enable patent application.
  • Publication restrictions are in place

Restriction type: OTHER