Zolbetuximab plus mFOLFOX6 Trial Overview
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Questions and Answers

What is the minimum age requirement for eligible patients in the study?

  • 16 years
  • 18 years (correct)
  • 21 years
  • 25 years
  • What percentage of tumor cells must show CLDN18 staining for a patient to be eligible?

  • 90%
  • 60%
  • 50%
  • 75% (correct)
  • What statistical method was implemented to estimate the distribution of progression-free survival?

  • Kaplan-Meier method (correct)
  • Chi-square test
  • Stratified log-rank test
  • Cox proportional hazard model
  • What is the primary endpoint of the study?

    <p>Progression-free survival</p> Signup and view all the answers

    Which factor was included in the stratification of the Cox proportional hazard model?

    <p>Region of patients</p> Signup and view all the answers

    How were patients assigned to treatment groups?

    <p>Via interactive response technology</p> Signup and view all the answers

    What was the primary endpoint addressed in the ongoing survey study?

    <p>Confirmed deterioration in patient-reported outcomes</p> Signup and view all the answers

    What was the loading dose of zolbetuximab administered to the patients?

    <p>800 mg/m²</p> Signup and view all the answers

    What criteria were used to assess radiologically evaluable disease?

    <p>Response Evaluation Criteria in Solid Tumors version 1.1</p> Signup and view all the answers

    How many patients were initially assessed for eligibility in the study?

    <p>2735</p> Signup and view all the answers

    What does CLDN18.2-negative imply in the context of the patient selection?

    <p>The patient does not express the CLDN18.2 biomarker.</p> Signup and view all the answers

    What type of cancer were the eligible patients diagnosed with?

    <p>Gastric or gastro-oesophageal junction adenocarcinoma</p> Signup and view all the answers

    Which statistical measure quantifies the hazard associated with certain covariates in the study?

    <p>Hazard Ratio (HR)</p> Signup and view all the answers

    Which performance status score is required for patient eligibility in the study?

    <p>0 or 1</p> Signup and view all the answers

    What was the subsequent publication expected to disclose?

    <p>Clinically meaningful thresholds for outcomes</p> Signup and view all the answers

    What criteria were used for excluding potential participants from the study?

    <p>CLDN18.2 biomarker status</p> Signup and view all the answers

    What was the planned number of events required for the final analysis of progression-free survival?

    <p>300 patients with disease progression or death</p> Signup and view all the answers

    What is the assumed median progression-free survival for the treated group?

    <p>9 months</p> Signup and view all the answers

    What significance level was used for the overall analysis?

    <p>0.025</p> Signup and view all the answers

    What was the dropout rate considered in the sample size calculation?

    <p>10%</p> Signup and view all the answers

    Which group had the highest number of adverse events leading to discontinuation?

    <p>Placebo plus mFOLFOX6</p> Signup and view all the answers

    What was the threshold for the one-sided type I error rate in the study?

    <p>0.025</p> Signup and view all the answers

    What was the planned number of deaths for the final analysis of overall survival?

    <p>396</p> Signup and view all the answers

    How many patients were included in the efficacy analysis for the zolbetuximab group?

    <p>282</p> Signup and view all the answers

    What condition was required to test overall survival after the progression-free survival analysis?

    <p>Hypothesis for progression-free survival was rejected</p> Signup and view all the answers

    Which of the following represents the modified regimen mentioned in the analysis?

    <p>mFOLFOX6</p> Signup and view all the answers

    Which of the following was NOT a reason for patient discontinuation in the study?

    <p>Prior treatment with chemotherapy</p> Signup and view all the answers

    What was the significance of the HR value of 0.80 in the analysis?

    <p>Indicates a better progression-free survival outcome</p> Signup and view all the answers

    Which acronym refers to patients' performance status scoring in the study?

    <p>ECOG</p> Signup and view all the answers

    What percentage of patients in the zolbetuximab group showed an objective response?

    <p>53%</p> Signup and view all the answers

    How does the median duration of response compare between the zolbetuximab and placebo groups?

    <p>Zolbetuximab had a longer duration of response.</p> Signup and view all the answers

    What was the median duration of response for the placebo group?

    <p>8.05 months</p> Signup and view all the answers

    How many patients in the zolbetuximab group received subsequent anticancer therapies?

    <p>135</p> Signup and view all the answers

    What was the objective response observed in patients with measurable disease in the zolbetuximab group?

    <p>128 patients</p> Signup and view all the answers

    What is the median duration of exposure in the zolbetuximab group?

    <p>6·2 months</p> Signup and view all the answers

    What was the median duration of response for patients who received placebo with measurable disease?

    <p>8·11 months</p> Signup and view all the answers

    What was the statistical confidence interval (CI) for the objective response rate in the zolbetuximab group?

    <p>54–67</p> Signup and view all the answers

    What percentage of patients in the zolbetuximab plus mFOLFOX6 group experienced nausea?

    <p>82%</p> Signup and view all the answers

    Which treatment-emergent event had the highest percentage in the placebo plus mFOLFOX6 group?

    <p>Nausea</p> Signup and view all the answers

    What is the rate of treatment-emergent serious events in the zolbetuximab group?

    <p>45%</p> Signup and view all the answers

    Which treatment-emergent event led to discontinuation of study drugs for 106 patients in the zolbetuximab group?

    <p>Decreased appetite</p> Signup and view all the answers

    What was the percentage of patients in the placebo group who discontinued treatment due to treatment-related events?

    <p>29%</p> Signup and view all the answers

    What was the most common treatment-emergent event leading to death in the placebo group?

    <p>Neutropenia</p> Signup and view all the answers

    In terms of grade ≥3 treatment-emergent events, what was the percentage of patients affected in the zolbetuximab group?

    <p>87%</p> Signup and view all the answers

    What percentage of patients in the zolbetuximab group experienced treatment-related adverse events leading to discontinuation of the drug?

    <p>38%</p> Signup and view all the answers

    What was the rate of treatment-emergent events leading to death in the zolbetuximab group?

    <p>8%</p> Signup and view all the answers

    Which event had the highest grade ≥3 occurrence in the zolbetuximab group?

    <p>Neutropenia</p> Signup and view all the answers

    Which event affected 78 patients in the zolbetuximab group at all grades?

    <p>Fatigue</p> Signup and view all the answers

    What was the percentage of patients experiencing peripheral sensory neuropathy in the placebo group?

    <p>15%</p> Signup and view all the answers

    What percentage of patients experienced treatment-emergent fatigue in the placebo group?

    <p>33%</p> Signup and view all the answers

    Which treatment-related event led to discontinuation in the lowest percentage of patients in the placebo group?

    <p>Stomatitis</p> Signup and view all the answers

    Study Notes

    Zolbetuximab plus mFOLFOX6 Trial

    • Study Type: Multicentre, randomised, double-blind, phase 3 trial
    • Purpose: Investigated efficacy and safety of zolbetuximab (targets CLDN18.2) plus mFOLFOX6 (chemotherapy) versus placebo plus mFOLFOX6 in CLDN18.2-positive, HER2-negative, locally advanced unresectable or metastatic gastric or gastro-oesophageal junction adenocarcinoma.
    • Patient Eligibility: Aged 18 or older, CLDN18.2-positive (75% or more tumour cells showing moderate-to-strong CLDN18 staining), HER2-negative, previously untreated, locally advanced unresectable or metastatic adenocarcinoma, radiologically evaluable disease (measurable or non-measurable), ECOG performance status 0 or 1, and adequate organ function.
    • Randomisation: 1:1 ratio, stratified by region, number of organs with metastases, and prior gastrectomy.

    Study Findings

    • Participants: 565 patients, 283 in zolbetuximab group, 282 in placebo group.
    • Follow-up: Median 12.94 months (zolbetuximab) and 12.65 months (placebo).
    • Progression-Free Survival: Zolbetuximab significantly reduced the risk of disease progression or death (HR 0.75, 95% CI 0.60-0.94; p=0.0066). Median progression-free survival: 10.61 months (zolbetuximab) vs 8.67 months (placebo).
    • Overall Survival: Zolbetuximab significantly reduced the risk of death (HR 0.75, 95% CI 0.60-0.94; p=0.0053). Median overall survival: 18.23 months (zolbetuximab) vs. 15.54 months (placebo).
    • Adverse Events: Grade 3 or worse treatment-emergent adverse events occurred in 242 (87%) of 279 patients in the zolbetuximab group versus 216 (78%) of 278 patients in the placebo group; most frequent were nausea, vomiting, and decreased appetite. Treatment-related deaths: 5 (2%) in zolbetuximab group versus 4 (1%) in placebo group.

    Interpretation

    • Zolbetuximab significantly prolonged progression-free survival and overall survival when combined with mFOLFOX6 compared to placebo plus mFOLFOX6.
    • Zolbetuximab might represent a new first-line treatment for CLDN18.2-positive, HER2-negative gastric or gastro-oesophageal junction adenocarcinoma.

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    Description

    This quiz delves into a phase 3 trial investigating the efficacy and safety of zolbetuximab in combination with mFOLFOX6 for treating CLDN18.2-positive gastric adenocarcinoma. Participants included patients who were HER2-negative, previously untreated, and met specific eligibility criteria. Test your knowledge on study design, patient demographics, and key findings from this significant clinical trial.

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