NCT02435433

Brief Summary

The purpose of this study is to evaluate the safety and efficacy of ramucirumab in participants with hepatocellular carcinoma (HCC) and elevated baseline alpha-fetoprotein. Participants will be randomized to ramucirumab or placebo in a 2:1 ratio (Main Global Cohort and China Maximized Extended Enrollment \[MEE\] Cohort). Participants may also receive ramucirumab if eligible to be enrolled in Open-Label Expansion (OLE) Cohort.

Trial Health

98
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Strong global presence with extensive site network
Enrollment
399

participants targeted

Target at P50-P75 for phase_3 hepatocellular-carcinoma

Timeline
Completed

Started Jul 2015

Typical duration for phase_3 hepatocellular-carcinoma

Geographic Reach
19 countries

129 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

May 1, 2015

Completed
5 days until next milestone

First Posted

Study publicly available on registry

May 6, 2015

Completed
3 months until next milestone

Study Start

First participant enrolled

July 20, 2015

Completed
2.7 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 15, 2018

Completed
1.2 years until next milestone

Results Posted

Study results publicly available

May 17, 2019

Completed
2.5 years until next milestone

Study Completion

Last participant's last visit for all outcomes

November 19, 2021

Completed
Last Updated

January 20, 2023

Status Verified

December 1, 2022

Enrollment Period

2.7 years

First QC Date

May 1, 2015

Results QC Date

April 8, 2019

Last Update Submit

December 22, 2022

Conditions

Keywords

liver cancer

Outcome Measures

Primary Outcomes (1)

  • Overall Survival (OS)

    OS time was measured from date of randomization to date of death from any cause. Participants who were not known to have died on or before the date of data cut-off, OS data was censored on the last date (on or before the cut-off date) the participant was known to be alive.

    From Date of Randomization to Death from Any Cause (Up to 28 Months)

Secondary Outcomes (9)

  • Progression Free Survival (PFS)

    From Randomization to Objective Progression or Death from Any Cause (Up to 28 Months)

  • Time to Radiographic Progression

    From Randomization to Objective Progression (Up to 28 Months)

  • Percentage of Participants With a Best Overall Response of Complete Response (CR) or Partial Response (PR): Objective Response Rate (ORR)

    From Randomization to Objective Progression (Up to 28 Months)

  • Pharmacokinetics (PK): Minimum Serum Concentration (Cmin) Before 2nd, 4th, 7th, and 10th Infusion

    Predose, Weeks 2, 6, 12 and 18, Day 1; Up to 3 Days Before Infusion (14-Day Cycles)

  • PK: Serum Concentration Maximum (Cmax) After 1st, 2nd, 4th, 7th and 10th Ram Infusion

    Weeks 0, 2, 6, 12 and 18, Day 1; 1 hour to 1.5 hours Post End of Infusion (14 day-Cycles)

  • +4 more secondary outcomes

Study Arms (5)

Ramucirumab + Best Supportive Care (BSC)

EXPERIMENTAL

8 milligrams per kilogram (mg/kg) ramucirumab administered as an intravenous (IV) injection on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.

Drug: Ramucirumab

Placebo + BSC

PLACEBO COMPARATOR

Placebo administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.

Drug: RamucirumabDrug: Placebo

Open Label Ramucirumab + BSC

EXPERIMENTAL

8 mg/kg ramucirumab administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.

Drug: Ramucirumab

Ramucirumab MEE Cohort + BSC

EXPERIMENTAL

8 mg/kg ramucirumab administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.

Drug: Ramucirumab

Placebo MEE Cohort + BSC

PLACEBO COMPARATOR

Placebo administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.

Drug: RamucirumabDrug: Placebo

Interventions

Administered IV

Also known as: Cyramza, LY3009806
Open Label Ramucirumab + BSCPlacebo + BSCPlacebo MEE Cohort + BSCRamucirumab + Best Supportive Care (BSC)Ramucirumab MEE Cohort + BSC

Administered IV

Placebo + BSCPlacebo MEE Cohort + BSC

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • A diagnosis of HCC based on histopathologic findings, or a diagnosis of cirrhosis and a tumor with classical HCC imaging characteristics.
  • Sorafenib was the only systemic therapy for HCC and was discontinued for disease progression or intolerance (Main Global and MEE Cohorts only).
  • The participant received ≤2 prior systemic therapy regimen, excluding prior sorafenib or chemotherapy, for the treatment of HCC (OLE Cohort only).
  • ≥1 measurable lesion per Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1 that has not been previously treated with locoregional therapy. A participant with a lesion(s) that has previously been treated with locoregional therapy is also eligible, if the lesion has documented progression after locoregional treatment and is measureable.
  • Child-Pugh score \<7 (Child-Pugh Class A).
  • Barcelona Clinic Liver Cancer (BCLC) Stage C disease or BCLC Stage B disease not amenable to locoregional therapy or refractory to locoregional therapy.
  • Baseline AFP ≥400 nanograms/milliliter.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Resolution of all clinically significant toxic effects of prior therapy.
  • Total bilirubin ≤1.5 times upper limit of normal value (ULN), aspartate transaminase (AST) and alanine transaminase (ALT) ≤5 × ULN.
  • Creatinine clearance ≥60 milliliters/minute.
  • Urinary protein is ≤1+ on dipstick or routine urinalysis or 24-hour urine demonstrating \<1 gram of protein.
  • Absolute neutrophil count ≥1.0 × 10\^9/Liter, hemoglobin ≥9 grams/deciliter, and platelets ≥75 × 10\^9/Liter.
  • International Normalized Ratio (INR) ≤1.5 and a partial thromboplastin time (PTT) ≤5 seconds above the ULN.
  • Surgically sterile, postmenopausal, or compliant with a highly effective contraceptive method.
  • +2 more criteria

You may not qualify if:

  • Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma.
  • Concurrent malignancy. Participants with carcinoma in situ of any origin and participants with prior malignancies in remission may be eligible with sponsor approval.
  • Previous brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
  • History of or current hepatic encephalopathy or clinically meaningful ascites.
  • Ongoing or recent hepatorenal syndrome.
  • Liver transplant (Main Global and MEE cohorts only; Participants with prior liver transplant may be eligible for OLE cohort).
  • Hepatic locoregional therapy following prior systemic therapy or within 28 days prior to randomization.
  • Major surgical procedure, traumatic injury, non-healing wound, or peptic ulcer ≤28 days prior to randomization.
  • Received radiation to any nonhepatic (for example, bone) site within 14 days prior to randomization.
  • Placement of a subcutaneous venous access device within 7 days prior to the first dose of study treatment unless the procedure is judged of low risk of bleeding.
  • Enrolled in a clinical trial involving an investigational product or unapproved use of a drug or in medical research judged not to be scientifically or medically compatible with this study.
  • Discontinued from study treatment from another clinical trial within 28 days prior to randomization.
  • Known allergy to any of the treatment components.
  • Uncontrolled hypertension.
  • Any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack, \<6 months prior to randomization.
  • +18 more criteria

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (131)

Pacific Hematology and Oncology Associates

Daly City, California, 94115, United States

Location

UCLA Medical Center

Los Angeles, California, 90024, United States

Location

Georgetown University Medical Center

Washington D.C., District of Columbia, 20007, United States

Location

University of Iowa Hospital

Iowa City, Iowa, 52242, United States

Location

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

Location

Mount Sinai Medical Center

New York, New York, 10029, United States

Location

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, 73104, United States

Location

OREGON HEALTH and SCIENCE UNIVERSITY

Portland, Oregon, 97239, United States

Location

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Kurralta Park, 5037, Australia

Location

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Woodville, 5011, Australia

Location

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Linz, 4020, Austria

Location

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Vienna, 1090, Austria

Location

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Brussels, 1200, Belgium

Location

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Liège, 4000, Belgium

Location

Fundação PIO XII

Barretos, 14784-400, Brazil

Location

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Barretos, 14784700, Brazil

Location

Cenantron - Centro Avançado de Tratamento Oncológico

Belo Horizonte, 30130-090, Brazil

Location

Associação Hospital de Caridade Ijuí

Ijuí, 98700 000, Brazil

Location

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Porto Alegre, 90470-340, Brazil

Location

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São Paulo, 04039-901, Brazil

Location

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Montreal, H2X 3E4, Canada

Location

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Toronto, M5G 2M9, Canada

Location

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Beijing, 100032, China

Location

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Beijing, 100142, China

Location

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Beijing, China

Location

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Beijing, China

Location

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Changsha, 410011, China

Location

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Changsha, 410013, China

Location

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Chongqing, 400038, China

Location

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Guangdong, 510515, China

Location

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Guangzhou, 510080, China

Location

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Hangzhou, 310003, China

Location

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Hangzhou, 310009, China

Location

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Hangzhou, 310022, China

Location

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Hebei, 050011, China

Location

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Hefei, 230022, China

Location

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Heilongjiang, 150081, China

Location

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Henan, 450008, China

Location

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Hubei, 56456, China

Location

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Nanjing, 210002, China

Location

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Nanjing, 210006, China

Location

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Nanning, 530021, China

Location

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Qingdao, 266003, China

Location

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Shanghai, 200030, China

Location

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Shanghai, 200127, China

Location

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Shanghai, China

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Shanghai, China

Location

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Shenyang, 100042, China

Location

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Wuhan, 430030, China

Location

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Xi'an, 710032, China

Location

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Brno, 656 53, Czechia

Location

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Prague, 150 06, Czechia

Location

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Amiens, 80054, France

Location

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Avignon, 84918, France

Location

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Besançon, 25030, France

Location

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Caen, 14033, France

Location

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Clermont-Ferrand, 63003, France

Location

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Lyon, 69317, France

Location

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Montpellier, 34295, France

Location

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Nantes, 44093, France

Location

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Pessac, 33604, France

Location

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Rennes, 35042, France

Location

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Saint-Etienne, 42000, France

Location

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Bayern, 81377, Germany

Location

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Berlin, 13125, Germany

Location

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Essen, 45122, Germany

Location

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Frankfurt, 60590, Germany

Location

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Hamburg, 20246, Germany

Location

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Hanover, 30625, Germany

Location

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Leipzig, 04103, Germany

Location

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Magdeburg, 39120, Germany

Location

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Mainz, 55131, Germany

Location

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München, 81675, Germany

Location

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Tübingen, 72076, Germany

Location

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Hong Kong, Hong Kong

Location

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Hong Kong, Hong Kong

Location

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Kowloon, Hong Kong

Location

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Shatin, Hong Kong

Location

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Tuenmen, Hong Kong

Location

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Haifa, 3109601, Israel

Location

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Tel Aviv, 6423906, Israel

Location

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Benevento, 82100, Italy

Location

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Bologna, 40138, Italy

Location

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Cremona, 26100, Italy

Location

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Padua, 35128, Italy

Location

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Rome, 00168, Italy

Location

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Chūōku, 104-0045, Japan

Location

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Fukuoka, 810-8563, Japan

Location

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Fukuoka, 811-1395, Japan

Location

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Iizuka, 820-8505, Japan

Location

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Kanazawa, 920-8641, Japan

Location

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Kashiwa, 277 8577, Japan

Location

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Kyoto, 606-8507, Japan

Location

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Matsuyama, 791-0280, Japan

Location

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Osaka, 589-8511, Japan

Location

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Ōsaka, 541-8567, Japan

Location

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Shimotsuke, 329-0498, Japan

Location

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Suita-shi, 565-0871, Japan

Location

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Sunto-Gun, 411-8777, Japan

Location

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Tokyo, 101-0062, Japan

Location

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Yokohama, 241-8515, Japan

Location

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Gdansk, 80-219, Poland

Location

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Poznan, 61-866, Poland

Location

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Warsaw, 01-748, Poland

Location

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Incheon, 21565, South Korea

Location

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Seoul, 03080, South Korea

Location

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Seoul, 03722, South Korea

Location

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Seoul, 05505, South Korea

Location

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Seoul, 06351, South Korea

Location

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Ulsan, 44033, South Korea

Location

Hospital Universitari de Girona Dr. Josep Trueta

Girona, 17007, Spain

Location

Hospital Clínico San Carlos

Madrid, 28040, Spain

Location

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Santander, 39008, Spain

Location

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Valencia, 46026, Spain

Location

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Bern, 3010, Switzerland

Location

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Buzi, 61363, Taiwan

Location

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Kaohsiung City, 83301, Taiwan

Location

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Taichung, 40705, Taiwan

Location

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Tainan, 704, Taiwan

Location

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Tainan, 71004, Taiwan

Location

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Tainan, 736, Taiwan

Location

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Taipei, 10048, Taiwan

Location

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Taipei, 11217, Taiwan

Location

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Taoyuan, 33305, Taiwan

Location

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Acton, W12 0HS, United Kingdom

Location

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Acton, w120hs, United Kingdom

Location

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Bebington, CH63 4JY, United Kingdom

Location

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Birmingham, B15 2TH, United Kingdom

Location

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London, NW3 2QG, United Kingdom

Location

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London, SE5 9RS, United Kingdom

Location

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Manchester, M20 4BX, United Kingdom

Location

Related Publications (9)

  • Shao G, Bai Y, Yuan X, Chen X, Gu S, Gu K, Hu C, Liang H, Guo Y, Wang J, Yen CJ, Lee VH, Wang C, Widau RC, Zhang W, Liu J, Zhang Q, Qin S. Ramucirumab as second-line treatment in Chinese patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein after sorafenib (REACH-2 China): A randomised, multicentre, double-blind study. EClinicalMedicine. 2022 Oct 6;54:101679. doi: 10.1016/j.eclinm.2022.101679. eCollection 2022 Dec.

  • 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.

  • Mitani 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.

  • Trojan J, Mollon P, Daniele B, Marteau F, Martin L, Li Y, Xu Q, Piscaglia F, Zaucha R, Sarker D, Lim HY, Venerito M. Comparative Efficacy of Cabozantinib and Ramucirumab After Sorafenib for Patients with Hepatocellular Carcinoma and Alpha-fetoprotein >/= 400 ng/mL: A Matching-Adjusted Indirect Comparison. Adv Ther. 2021 May;38(5):2472-2490. doi: 10.1007/s12325-021-01700-2. Epub 2021 Apr 6.

  • Zhu 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.

  • Reig 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.

  • Zhu 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.

  • Kudo 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.

  • Zhu AX, Kang YK, Yen CJ, Finn RS, Galle PR, Llovet JM, Assenat E, Brandi G, Pracht M, Lim HY, Rau KM, Motomura K, Ohno I, Merle P, Daniele B, Shin DB, Gerken G, Borg C, Hiriart JB, Okusaka T, Morimoto M, Hsu Y, Abada PB, Kudo M; REACH-2 study investigators. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased alpha-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019 Feb;20(2):282-296. doi: 10.1016/S1470-2045(18)30937-9. Epub 2019 Jan 18.

Related Links

MeSH Terms

Conditions

Carcinoma, HepatocellularLiver Neoplasms

Interventions

Ramucirumab

Condition Hierarchy (Ancestors)

AdenocarcinomaCarcinomaNeoplasms, Glandular and EpithelialNeoplasms by Histologic TypeNeoplasmsDigestive System NeoplasmsNeoplasms by SiteDigestive System DiseasesLiver Diseases

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, HumanizedAntibodies, MonoclonalAntibodiesImmunoglobulinsImmunoproteinsBlood ProteinsProteinsAmino Acids, Peptides, and ProteinsSerum GlobulinsGlobulins

Results Point of Contact

Title
Chief Medical Officer
Organization
Eli Lilly and Company

Study Officials

  • 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)

    Eli Lilly and Company

    STUDY DIRECTOR

Publication Agreements

PI is Sponsor Employee
No
Restriction Type
GT60
Restrictive Agreement
Yes

Study Design

Study Type
interventional
Phase
phase 3
Allocation
RANDOMIZED
Masking
DOUBLE
Who Masked
PARTICIPANT, INVESTIGATOR
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
INDUSTRY
Responsible Party
SPONSOR

Study Record Dates

First Submitted

May 1, 2015

First Posted

May 6, 2015

Study Start

July 20, 2015

Primary Completion

March 15, 2018

Study Completion

November 19, 2021

Last Updated

January 20, 2023

Results First Posted

May 17, 2019

Record last verified: 2022-12-01

Data Sharing

IPD Sharing
Will share

Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.

Shared Documents
STUDY PROTOCOL, SAP, CSR
Time Frame
Data are available 6 months after the primary publication and approval of the indication studied in the US and EU, whichever is later. Data will be indefinitely available for requesting.
Access Criteria
A research proposal must be approved by an independent review panel and researchers must sign a data sharing agreement.
More information

Locations