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ThrombosisPhase 2NCT00320255

A Phase 2 Pilot Study of Apixaban for the Prevention of Thromboembolic Events in Patients With Advanced (Metastatic) Cancer

A Phase 2 study testing Apixaban in people with Thrombosis and Cancer, run by Bristol-Myers Squibb at 14 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to learn whether apixaban is well-tolerated and acceptable as anticoagulant therapy, when administered to patients with advanced or metastatic cancer and at increased risk for venous thromboembolic events. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Thrombosis, Cancer, Pulmonary Embolism
What is being tested?
Apixaban
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
130 participants
Where
14 sitesin 2 countries
Study dates
Jun 2006to Jan 2009
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Recipients of either first- or second-line chemotherapy for advanced or metastatic lung, breast, gastrointestinal, bladder, ovarian, or prostate cancer or myeloma, selected lymphomas, or cancer of unknown origin
  • Able to begin study medication ≤6 weeks of starting either first- or second-line chemotherapy.
  • Expected course of chemotherapy must have been ≥ 90 days after the start of chemotherapy
  • Per Protocol Amendment 5, patients receiving bevacizumab were eligible to participate, provided that bevacizumab was used for indications approved by local country law

Who cannot join

  • Women who are pregnant, breastfeeding
  • History of deep vein thrombosis or pulmonary embolism
  • Active bleeding or at high risk of bleeding
  • Metastatic brain cancer
  • Familial bleeding diathesis
  • Serious hemorrhage requiring hospitalization, transfusion, or surgical intervention within 4 weeks of study entry
Show all 11Show fewer
  • Expected survival <6 months or an Eastern Cooperative Oncology Group performance status ≥3.
  • Candidates for bone marrow transplantation within the 12-week treatment period or 30-day follow-up period
  • Uncontrolled hypertension (systolic blood pressure >200 mm Hg and/or diastolic blood pressure >110 mm Hg
  • Coagulopathy (international normalized ratio >1.5 or platelet count <100*10^9/L) if not yet receiving chemotherapy or <50*10^9/L if receiving chemotherapy). Platelet count must have been >100*10^9/L before starting study medication
  • One or more of the following: alanine aminotransferase >3 times the upper limit of normal (ULN), total bilirubin >2*ULN, or calculated creatinine clearance <30 mL/min.

Trial locations and contacts

14 sites in 2 countries.

14 sites in 2 countries

United States8 sites
  • Dana-Farber Cancer Inst

    Boston, Massachusetts, 02115

  • University Of Texas Md Anderson Cancer Ctr

    Houston, Texas, 77030

  • Nevada Cancer Institute

    Las Vegas, Nevada, 89135

  • Univ. Of Southern Calif. /Norris Comprehensive Cancer Center

    Los Angeles, California, 90033

  • Memorial Sloan-Kettering Cancer Center

    New York, New York, 10021

  • Mount Sinai School Of Medicine

    New York, New York, 10029

  • University Of Rochester

    Rochester, New York, 14642

  • Arizona Cancer Center

    Tucson, Arizona, 85724

Other trials in United States

Canada6 sites
  • Local Institution

    Hamilton, Ontario, L8V 2C5

  • Local Institution

    London, Ontario, N6A 4L6

  • Local Institution

    Montreal, Quebec, H1T 2M4

  • Local Institution

    Montreal, Quebec, H3G 1A4

  • Local Institution

    Toronto, Ontario, M4N 3M5

  • Local Institution

    Toronto, Ontario, M5G 2M9

Other trials in Canada

About this study

Official title: A Randomized, Double-blind, Placebo-controlled Study of Apixaban for the Prevention of Thromboembolic Events in Patients Undergoing Treatment for Advanced Cancer: A Phase 2 Pilot Study

The purpose of this study is to learn whether apixaban is well-tolerated and acceptable as anticoagulant therapy, when administered to patients with advanced or metastatic cancer and at increased risk for venous thromboembolic events. Demonstration of a favorable benefit:risk profile could lead to significant reduction in this serious and sometimes fatal complication of ongoing cancer and its treatment.

Being tested
Apixaban, Placebo
Keywords
anticoagulant
Medical subject headings
Thrombosis, Neoplasms, Pulmonary Embolism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ApixabanDrug

    Also called BMS-562247

    Oral tablets administered once daily in 5-, 10-, or 20-mg dose

  • PlaceboDrug

    Oral tablets administered once daily

Study groups in NCT00320255
Study groupRoleWhat they receive
Cohort 1: PlaceboPlacebo comparatorParticipants received placebo tablets once daily
Receives: Drug: Placebo
Cohort 1: Apixaban, 5 mgPlacebo comparatorParticipants received apixaban as tablet, 5 mg, once daily
Receives: Drug: Apixaban
Cohort 1: Apixaban, 10 mgActive comparatorParticipants received apixaban as tablet, 10 mg, once daily
Receives: Drug: Apixaban
Cohort 1: Apixaban, 20 mgActive comparatorParticipants received apixaban as tablet, 20 mg, once daily
Receives: Drug: Apixaban
Cohort 2: PlaceboPlacebo comparatorParticipants in this cohort were admitted to the trial following the addition of a protocol amendment (Amendment 5), which removed the prohibition of inclusion of patients receiving chemotherapy with concomitant antiangiogenic therapy with bevacizumab. Patients received placebo once daily.
Receives: Drug: Placebo
Cohort 2: Apixaban, 5 mgActive comparatorParticipants in this cohort were admitted to the trial following the addition of a protocol amendment (Amendment 5), which removed the prohibition of inclusion of patients receiving chemotherapy with concomitant antiangiogenic therapy with bevacizumab. Patients received apixaban as tablet, 5 mg, once daily.
Receives: Drug: Apixaban

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Composite of Confirmed Major Bleeding and Clinically Relevant Nonmajor (CRNM) Bleeding

    Major bleeding was defined as clinically overt bleeding accompanied by 1 or more of the following:

    • A decrease in hemoglobin of 20 g/L or more or
    • Required transfusion of 2 or more units of packed red blood cells or whole blood, or
    • Occurred in a critical site
    • Contributed to death.

    CRNM bleeding was defined as bleeding that did not meet the criteria for major bleeding but that, in routine clinical practice, would be considered relevant and not trivial by a patient and physician. Such bleeding satisfied a priori criteria defined by the ICAC, including:

    • Skin hematoma
    • Epistaxis that lasted for longer than 5 minutes, was repetitive, or led to an intervention
    • Hematuria that was macroscopic and either spontaneous or lasted for longer than 24 hours after instrumentation of the urogenital tract
    • Any other bleeding type that was considered to have clinical consequences.

    Measured: From first dose to 2 days following last dose of study drug

Secondary outcomes (11)
  1. Number of Participants With Composite of Venous Thromboembolism (VTE) and All-cause Death

    VTE includes symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE). Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels more than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 2 days following last dose of study drug

  2. Number of Participants With Proximal Deep Vein Thrombosis (DVT), Nonfatal Pulmonary Embolism (PE), and All-cause Death

    Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments (popliteal vein or higher) of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels more than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan (nonhigh probability) with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 30 days following last dose of study drug

  3. Number of Participants With Composite of Venous Thromboembolism (VTE) and VTE-related Death

    VTE includes symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE). Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels more than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 2 days following last dose of study drug

  4. Number of Participants With Composite of Proximal Deep Vein Thrombosis (DVT), Nonfatal Pulmonary Embolism (PE), and Venous Thromboembolism (VTE)-Related Death

    VTE includes symptomatic DVT and PE. Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels more than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 2 days following last dose of study drug

  5. Number of Participants With All-Cause Death

    Measured: First dose to 2 days following last dose of study drug

  6. Number of Participants With Pulmonary Embolism (Fatal or Nonfatal)

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels of greater than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 2 days following last dose of study drug

  7. Number of Participants With Nonfatal Pulmonary Embolism

    Any 1 of the following was considered diagnostic for PE:

    • Constant intraluminal filling defects in 2 or more views on pulmonary angiography
    • Sudden contrast cutoff of 1 or more vessels more than 2.5 mm in diameter on a pulmonary angiogram
    • A high probability VQ lung scan showing 1 or more segmental perfusion defects with corresponding normal ventilation (mismatch defect)
    • An abnormal VQ lung scan with satisfaction of either criterion 1 or 2
    • Abnormal spiral computed tomography scan showing thrombus in pulmonary vessels.

    Measured: First dose to 2 days following last dose of study drug

  8. Number of Participants With Deep Vein Thrombosis

    Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Measured: First dose to 2 days following last dose of study drug

  9. Number of Participants With Distal Deep Vein Thrombosis

    Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Measured: First dose to 2 days following last dose of study drug

  10. Number of Participants With Proximal Deep Vein Thrombosis

    Any 1 of the following was considered diagnostic for DVT:

    • New or previously undocumented noncompressibility of 1 or more proximal venous segments of the legs on CUS
    • Constant intraluminal filling defects on 2 or more views on contrast venography in 1 or more venous segments in the legs or pelvis or involving the inferior vena cava.

    Measured: First dose to 2 days following last dose of study drug

  11. Number of Participants Who Died and With Adverse Events (AEs), Serious Adverse Events (SAEs), Bleeding AEs, and Discontinuations Due to AEs

    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization.

    Measured: First dose to 2 days following last dose of study drug

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 May 2006 (estimated)
  2. Study startJun 2006
  3. Primary completionJan 2009
  4. Study completionJan 2009

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
130 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00320255
Sponsor's protocol ID
CV185-027
Status last verified
Aug 2016
First submitted
28 Apr 2006
Last updated
16 Aug 2016
Data monitoring committee
Yes

Publications

  • Kahale LA, Matar CF, Tsolakian I, Hakoum MB, Barba M, Yosuico VE, Terrenato I, Sperati F, Schunemann H, Akl EA. Oral anticoagulation in people with cancer who have no therapeutic or prophylactic indication for anticoagulation. Cochrane Database Syst Rev. 2021 Oct 8;10(10):CD006466. doi: 10.1002/14651858.CD006466.pub7.

    PubMed 34622445
  • Rutjes AW, Porreca E, Candeloro M, Valeriani E, Di Nisio M. Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Cochrane Database Syst Rev. 2020 Dec 18;12(12):CD008500. doi: 10.1002/14651858.CD008500.pub5.

    PubMed 33337539

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Apixaban in people with Thrombosis and Cancer, run by Bristol-Myers Squibb at 14 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Aug 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 14 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Aug 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Composite of Confirmed Major Bleeding and Clinically Relevant Nonmajor (CRNM) Bleeding (time frame: From first dose to 2 days following last dose of study drug). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00320255, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Aug 2016.

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