Durvalumab and Tremelimumab in Treating Chemotherapy Naive Patients With Metastatic Castration-Resistant Prostate Cancer

• Sponsor: M.D. Anderson Cancer Center (Other)
• Overall Status: Completed
• CT.gov ID: NCT03204812
• Collaborator: National Cancer Institute (NCI) (NIH)
• Enrollment: 31
• Location: 1
• Arm: 1
• Actual Duration (Months): 45
• Patients Per Site Per Month: 0.7

Study Details

Study Description

Brief Summary

This phase II trial studies the safety, tolerability and how well durvalumab and tremelimumab work in treating participants with castration-resistant prostate cancer who have not received chemotherapy (chemotherapy naïve) and has spread to other places in the body (metastatic). Immunotherapy with monoclonal antibodies, such as durvalumab and tremelimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.

Condition or Disease	Intervention/Treatment	Phase
Castration-Resistant Prostate Carcinoma; Metastatic Malignant Neoplasm in the Bone; Prostate Adenocarcinoma; Stage IV Prostate Cancer AJCC v8; Stage IVA Prostate Cancer AJCC v8; Stage IVB Prostate Cancer AJCC v8	Biological: Durvalumab; Biological: Tremelimumab	Phase 2

Detailed Description

PRIMARY OBJECTIVE:

1. To evaluate the safety and tolerability of durvalumab plus tremelimumab in patients with metastatic castration-resistant prostate cancer.

SECONDARY OBJECTIVES:

1. To assess the efficacy of durvalumab plus tremelimumab in patients with metastatic castration-resistant prostate cancer. II. To explore immunological changes in peripheral blood and tissue (e.g. peripheral blood cluster of differentiation [CD] 4+ [Inducible COStimulator (ICOS)]+ T cells, CD3 expression in tissue) in response to durvalumab plus tremelimumab in patients with metastatic castration-resistant prostate cancer.

OUTLINE:

Patients receive tremelimumab intravenously (IV) over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30, 60, and 90 days, and then every 3 months thereafter.

Study Design

• Study Type: Interventional
• Actual Enrollment: 31 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Pilot Trial to Explore the Link Between Immunological Changes, Efficacy, Safety, and Tolerability of Durvalumab (MEDI4736) Plus Tremelimumab in Chemotherapy-Naïve Men With Metastatic Castration-Resistant Prostate Cancer (CRPC)
• Actual Study Start Date: Jul 14, 2017
• Actual Primary Completion Date: Apr 13, 2021
• Actual Study Completion Date: Apr 13, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Treatment (tremelimumab, durvalumab) Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.	Biological: Durvalumab; Given IV; Other Names: Imfinzi Immunoglobulin G1, Anti-(Human Protein B7-H1) (Human Monoclonal MEDI4736 Heavy Chain), Disulfide with Human Monoclonal MEDI4736 Kappa-chain, Dimer MEDI-4736 MEDI4736 ; Biological: Tremelimumab; Given IV; Other Names: Anti-CTLA4 Human Monoclonal Antibody CP-675,206 CP-675 CP-675,206 CP-675206 Ticilimumab

Outcome Measures

Primary Outcome Measures

1. Number of Adverse Events [from date of the first treatment, up to 43.6 months]

   Toxicity will be monitored in all patients who receive at least one dose of tremelimumab, even if the patient is not evaluable for the biomarker or efficacy endpoint. Will be assessed per Common Terminology Criteria for Adverse Events (CTCAE) version (v) 4.03.

Secondary Outcome Measures

1. Prostate-specific Antigen (PSA) Progression Free Survival (PFS) [from the first day of treatment, up to 43.6 months]

   PSA PFS is defined as per Prostate Cancer Working Group 3 (PCWG3) criteria: time from start of therapy to first PSA increase of 25% and ≥2 ng/mL above the nadir, and which is confirmed by a second value ≥3 weeks later. PSA PFS were calculated from the first day of treatment and summarized by Kaplan-Meier methods.

2. Radiographic Progressive Free Survival (rPFS) [from first day of treatment, up to 43.6 months]

   rPFS is measured from first dose to date of disease progression on CT and/or bone scan or death from any cause, whichever occurs first. Radiographic PFS will start at the first day of treatment and will be summarized by Kaplan-Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1),as a 20% increase in the sum of the longest diameter of target lesions, or ameasurable increase in a non-target lesion, or the appearance of new lesions

3. Number of Participants With PSA Decline of ≥50% From Start of Therapy [baseline, up to 43.6 months]

   PSA decline will start at the first day of treatment and will be summarized by Kaplan-Meier. The numeric PSA value at maximal decline will be summarized by a boxplot and as a scatter plot of maximal decline by baseline PSA. PSA is produced by normal and cancerous prostate tissue. PSA levels are often elevated in men with prostate cancer.

4. Median Overall Survival [from start of treatment, up to 43.6 months]

   Overall Survival is the time which begins at diagnosis (or at the start of treatment) and up to the time of death.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Written informed consent.

• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

• Life expectancy of >= 52 weeks.

• Hemoglobin >= 11.0 g/dL.

• Absolute neutrophil count (ANC) >= 1.5 x 10^{9/L (> 1500 per mm}3).

• Platelet count >= 100 x 10^{9/L (>100,000 per mm}3).

• Serum bilirubin =< 1.5 x institutional upper limit of normal (ULN). This will not apply to subjects with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of hemolysis or hepatic pathology), who will be allowed only in consultation with their physician.

• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]/alanine aminotransferase [ALT] serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal.

• Serum creatinine clearance (CL) > 40 mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour urine collection for determination of creatinine clearance.

• Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.

• Consent to MD Anderson laboratory protocol PA13-0291 and LAB02-152.

• Willing to have peripheral blood mononuclear cells and bone marrow biopsies to be collected prior to receiving the first dose of durvalumab and tremelimumab, after 2-doses and 4-doses of durvalumab and tremelimumab, after 2nd treatment administration and 4th treatment administration.

• Histologically or cytologically confirmed adenocarcinoma of the prostate.

• Evidence of metastatic disease to the bone seen on most recent bone scan, computed tomography (CT) scan and/or magnetic resonance imaging (MRI).

• Asymptomatic or minimally symptomatic patients (do not require narcotics for prostate cancer-related pain).

• Tumor progression while on hormone therapy with castrate levels serum testosterone (=< 1.7 nmol/L or 50 ng/dL) defined by prostate-specific antigen (PSA) and/or radiographic criteria according to the Prostate Cancer Working Group 3 (PCWG3). Castrate levels of testosterone must be maintained by surgical or medical means throughout the conduct of the study.

Exclusion Criteria:

• Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site), previous enrollment in the present study.

• Participation in another clinical study with an investigational product during the last 4 weeks.

• Any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab or an anti-CTLA4, including tremelimumab.

• History of another primary malignancy except for: 1) Malignancy treated with curative intent and with no known active disease >= 5 years before the first dose of study drug and of low potential risk for recurrence. 2) Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease. 3) Adequately treated carcinoma in situ without evidence of disease (e.g., superficial bladder cancer).

• Evidence of visceral metastasis to the liver.

• Prior use of taxane-based chemotherapy for treatment of castrate resistant prostate cancer.

• Receipt of the last dose of anti-cancer therapy (immunotherapy, endocrine therapy [e.g., abiraterone acetate, enzalutamide], targeted therapy, biologic therapy, tumor embolization, monoclonal antibodies, other investigational agent) =< 28 days prior to the first dose of study drug. (with the exception of any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab or an anti-CTLA4, including tremelimumab.)

• Major surgical procedure (as defined by the investigator) within 28 days prior to the first dose of durvalumab or tremelimumab. Note: Local surgery of isolated lesions for palliative intent is acceptable.

• QT interval corrected for heart rate using Fridericia's formula (QTcF) >= 470 ms. Any clinically significant abnormalities detected, require triplicate electrocardiogram (ECG) results and a mean QT interval corrected for heart rate using Fridericia's formula (QTcF) >= 470 ms calculated from 3 electrocardiograms (ECGs).

• Current or prior use of immunosuppressive medication within 28 days before the first dose of durvalumab or tremelimumab, with the exceptions of: intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid or steroids as pre-medication for hypersensitivity reactions (e.g. CT scan premedication).

• Any unresolved toxicity (Common Terminology Criteria for Adverse Events [CTCAE] grade

= 2) from previous anti-cancer therapy. Subjects with irreversible toxicity that is not reasonably expected to be exacerbated by the investigational product may be included (e.g., hearing loss, peripherally neuropathy).

• Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.]). The following are exceptions to this criterion:

• Patients with vitiligo or alopecia;

• Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement;

• Any chronic skin condition that does not require systemic therapy;

• Patients without active disease in the last 5 years may be included but only after consultation with the study physician;

• Patients with celiac disease controlled by diet alone.

• Subjects with history of diverticulitis may be included only after consultation and approval of the study physician.

• History of primary immunodeficiency.

• History of allogeneic organ transplant.

• History of hypersensitivity to the combination of durvalumab and tremelimumab.

• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diathesis including any subject known to have evidence of acute or chronic hepatitis B, hepatitis C or human immunodeficiency virus (HIV), or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent.

• Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). Known history of positive test for hepatitis B virus (HBV) using HBV surface antigen (HBV sAg) test or positive test for hepatitis C virus (HCV) using HCV ribonucleic acid (RNA) or HCV antibody test indicating acute or chronic infection.

• History of leptomeningeal carcinomatosis.

• Receipt of live attenuated vaccination within 30 days prior to study entry or within 30 days of receiving durvalumab or tremelimumab.

• Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.

• Brain metastases or spinal cord compression unless asymptomatic or treated and stable off steroids and anti-convulsants for at least 28 days prior to study treatment start. Patients with suspected brain metastases at screening should have a CT/MRI of the brain prior to study entry.

• Subjects with uncontrolled seizures.

• Male patients of reproductive potential who are not willing to employ effective birth control from screening to 180 days after the last dose of durvalumab + tremelimumab combination therapy or 90 days after the last dose of durvalumab monotherapy, whichever is the longer time period.

• A malignancy [other than the one treated in this study] which required radiotherapy or systemic treatment within the past 5 years, or has a >= 30% probability of recurrence within 24 months (except for non-melanoma skin cancer or Ta urothelial carcinomas)

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	M D Anderson Cancer Center	Houston	Texas	United States	77030

Sponsors and Collaborators

• M.D. Anderson Cancer Center
• National Cancer Institute (NCI)

Investigators

• Principal Investigator: Sumit K Subudhi, M.D. Anderson Cancer Center

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Jul 28, 2020

More Information

Additional Information:

• The University of Texas (UT) MD Anderson Cancer Center Official Website

Publications

None provided.

• Responsible Party: M.D. Anderson Cancer Center
• ClinicalTrials.gov Identifier: NCT03204812
• Other Study ID Numbers: 2016-0769; NCI-2018-01135; 2016-0769
• First Posted: Jul 2, 2017
• Last Update Posted: May 25, 2022
• Last Verified: Mar 1, 2022

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Additional relevant MeSH terms: Prostatic Neoplasms; Neoplasms; Durvalumab; Ipilimumab; Tremelimumab; Immunoglobulins; Antibodies, Monoclonal; Immunoglobulin G

Study Results

Participant Flow

Recruitment Details	Recruitment Details: July 2017- April 2019
Pre-assignment Detail	31 participants consented, 5 participants were inevaluable.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Period Title: Overall Study
STARTED	26
COMPLETED	23
NOT COMPLETED	3

Baseline Characteristics

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Overall Participants	26
Age (years) [Median (Full Range) ]
Median (Full Range) [years]	67.5
Sex: Female, Male (Count of Participants)
Female	0 0%
Male	26 100%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	3 11.5%
Not Hispanic or Latino	23 88.5%
Unknown or Not Reported	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%
Asian	0 0%
Native Hawaiian or Other Pacific Islander	0 0%
Black or African American	2 7.7%
White	22 84.6%
More than one race	0 0%
Unknown or Not Reported	2 7.7%
Region of Enrollment (participants) [Number]
United States	26 100%

Outcome Measures

1. Primary Outcome

Title	Number of Adverse Events
Description	Toxicity will be monitored in all patients who receive at least one dose of tremelimumab, even if the patient is not evaluable for the biomarker or efficacy endpoint. Will be assessed per Common Terminology Criteria for Adverse Events (CTCAE) version (v) 4.03.
Time Frame	from date of the first treatment, up to 43.6 months

Outcome Measure Data

Analysis Population Description

One patient received only one dose of combination therapy and was excluded from efficacy analysis.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Measure Participants	25
Adverse Events	236
Serious Adverse Events	14

2. Secondary Outcome

Title	Prostate-specific Antigen (PSA) Progression Free Survival (PFS)
Description	PSA PFS is defined as per Prostate Cancer Working Group 3 (PCWG3) criteria: time from start of therapy to first PSA increase of 25% and ≥2 ng/mL above the nadir, and which is confirmed by a second value ≥3 weeks later. PSA PFS were calculated from the first day of treatment and summarized by Kaplan-Meier methods.
Time Frame	from the first day of treatment, up to 43.6 months

Outcome Measure Data

Analysis Population Description

One patient received only one dose of combination therapy and was excluded from efficacy analysis.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Measure Participants	25
Median (95% Confidence Interval) [months]	0.9

3. Secondary Outcome

Title	Radiographic Progressive Free Survival (rPFS)
Description	rPFS is measured from first dose to date of disease progression on CT and/or bone scan or death from any cause, whichever occurs first. Radiographic PFS will start at the first day of treatment and will be summarized by Kaplan-Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1),as a 20% increase in the sum of the longest diameter of target lesions, or ameasurable increase in a non-target lesion, or the appearance of new lesions
Time Frame	from first day of treatment, up to 43.6 months

Outcome Measure Data

Analysis Population Description

One patient received only one dose of combination therapy and was excluded from efficacy analysis.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Measure Participants	25
Median (95% Confidence Interval) [months]	3.7

4. Secondary Outcome

Title	Number of Participants With PSA Decline of ≥50% From Start of Therapy
Description	PSA decline will start at the first day of treatment and will be summarized by Kaplan-Meier. The numeric PSA value at maximal decline will be summarized by a boxplot and as a scatter plot of maximal decline by baseline PSA. PSA is produced by normal and cancerous prostate tissue. PSA levels are often elevated in men with prostate cancer.
Time Frame	baseline, up to 43.6 months

Outcome Measure Data

Analysis Population Description

One patient received only one dose of combination therapy and was excluded from efficacy analysis.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Measure Participants	25
Count of Participants [Participants]	3 11.5%

5. Secondary Outcome

Title	Median Overall Survival
Description	Overall Survival is the time which begins at diagnosis (or at the start of treatment) and up to the time of death.
Time Frame	from start of treatment, up to 43.6 months

Outcome Measure Data

Analysis Population Description

One patient received only one dose of combination therapy and was excluded from efficacy analysis.

Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
Measure Participants	25
Median (95% Confidence Interval) [months]	28.1

Adverse Events

Time Frame	From the first dose through 30 days after the last dose of medication, up to 43.6 months
Arm/Group Title	Treatment (Tremelimumab, Durvalumab)
Arm/Group Description	Patients receive tremelimumab IV over 60 minutes and durvalumab IV over 60 minutes on day 1. Treatment repeats every 28 days for up to 4 cycles for tremelimumab and up to 13 cycles for durvalumab in the absence of disease progression or unacceptable toxicity.
All Cause Mortality
	Treatment (Tremelimumab, Durvalumab)
	Affected / at Risk (%)	# Events
Total	14/26 (53.8%)
Serious Adverse Events
	Treatment (Tremelimumab, Durvalumab)
	Affected / at Risk (%)	# Events
Total	10/26 (38.5%)
Blood and lymphatic system disorders
Lipase increased	1/26 (3.8%)	1
Endocrine disorders
Diabetes type 1	1/26 (3.8%)	1
Gastrointestinal disorders
Colitis	2/26 (7.7%)	3
Enterocolitis	1/26 (3.8%)	1
General disorders
Pain	1/26 (3.8%)	1
Infections and infestations
Lung infection	1/26 (3.8%)	1
Urinary tract infection	1/26 (3.8%)	1
Musculoskeletal and connective tissue disorders
Spinal Cord Compression	1/26 (3.8%)	1
Myositis	1/26 (3.8%)	1
Nervous system disorders
Peripheral sensory neuropathy	1/26 (3.8%)	1
Respiratory, thoracic and mediastinal disorders
Pneumonitis	2/26 (7.7%)	2
Other (Not Including Serious) Adverse Events
	Treatment (Tremelimumab, Durvalumab)
	Affected / at Risk (%)	# Events
Total	26/26 (100%)
Blood and lymphatic system disorders
Anemia	10/26 (38.5%)	17
Cardiac disorders
Atrial fibrillation	1/26 (3.8%)	2
Endocrine disorders
Increased cortisol	5/26 (19.2%)	6
Decreased cortisol	4/26 (15.4%)	5
Hypophysitis	2/26 (7.7%)	2
Decreased ACTH	2/26 (7.7%)	2
Increased non-fasting blood glucose	2/26 (7.7%)	2
Diabetes Type 1	1/26 (3.8%)	1
T4 decrease	1/26 (3.8%)	1
Hyperthyroidism	2/26 (7.7%)	2
Hypothyroidism	5/26 (19.2%)	5
Eye disorders
Blurred vision	1/26 (3.8%)	1
Gastrointestinal disorders
Bloating	1/26 (3.8%)	3
Colitis	2/26 (7.7%)	4
Constipation	1/26 (3.8%)	1
Diarrhea	8/26 (30.8%)	13
Dry mouth	2/26 (7.7%)	2
Nausea	3/26 (11.5%)	3
Pancreatitis	1/26 (3.8%)	1
Vomiting	1/26 (3.8%)	1
General disorders
Edema limbs	1/26 (3.8%)	1
Fatigue	7/26 (26.9%)	7
Fever	1/26 (3.8%)	1
Gait disturbance	1/26 (3.8%)	1
Infections and infestations
Upper respiratory infection	1/26 (3.8%)	1
Investigations
Alanine aminotransferase increased	5/26 (19.2%)	7
Alkaline phosphatase increased	1/26 (3.8%)	1
Aspartate aminotransferase increased	6/26 (23.1%)	6
Cardiac troponin I increased	1/26 (3.8%)	1
Creatinine increased	3/26 (11.5%)	3
GGT increased	2/26 (7.7%)	4
Decreased sedimentation rate	1/26 (3.8%)	1
Increased sedimentation rate	4/26 (15.4%)	4
Increase CK	1/26 (3.8%)	1
Increase Aldolase	1/26 (3.8%)	1
Alkaline phosphate increase	1/26 (3.8%)	1
ACTH Elevated	1/26 (3.8%)	1
Lipase increased	6/26 (23.1%)	14
Lymphocyte count decreased	3/26 (11.5%)	9
Neutrophil count decreased	1/26 (3.8%)	2
Platelet count decreased	3/26 (11.5%)	3
Serum amylase increased	6/26 (23.1%)	11
Weight loss	1/26 (3.8%)	1
White blood cell decreased	2/26 (7.7%)	2
Metabolism and nutrition disorders
Anorexia	5/26 (19.2%)	8
Hypercalcemia	1/26 (3.8%)	2
Hyperglycemia	2/26 (7.7%)	7
Hypermagnesemia	1/26 (3.8%)	1
Hypernatremia	2/26 (7.7%)	2
Hypoalbuminemia	3/26 (11.5%)	4
Hypocalcemia	1/26 (3.8%)	5
Hypokalemia	1/26 (3.8%)	2
Hypomagnesemia	1/26 (3.8%)	1
Hypophosphatemia	1/26 (3.8%)	1
Musculoskeletal and connective tissue disorders
Arthralgia	2/26 (7.7%)	2
Generalized muscle weakness	2/26 (7.7%)	2
Myalgia	2/26 (7.7%)	2
Musculoskeletal and connective tissue disorder - Other, leg cramps	1/26 (3.8%)	1
Nervous system disorders
Dizziness	1/26 (3.8%)	1
Headache	1/26 (3.8%)	1
Lethargy	1/26 (3.8%)	1
Peripheral sensory neuropathy	1/26 (3.8%)	1
Renal and urinary disorders
Urinary incontinence	1/26 (3.8%)	1
Respiratory, thoracic and mediastinal disorders
Cough	4/26 (15.4%)	4
Dyspnea	2/26 (7.7%)	2
Hoarseness	1/26 (3.8%)	1
Hypoxia	1/26 (3.8%)	1
Pneumonitis	1/26 (3.8%)	1
Respiratory, thoracic and mediastinal disorders - Other, pneumonia	1/26 (3.8%)	1
Voice alteration	1/26 (3.8%)	1
Skin and subcutaneous tissue disorders
Dry skin	3/26 (11.5%)	3
Pruritus	2/26 (7.7%)	3
Rash maculo-papular	10/26 (38.5%)	14
Vascular disorders
Hypotension	1/26 (3.8%)	1

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.