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CC39/11-1
ZOMETA® in Prostate Cancer and
Solid Tumors Other Than Prostate Cancer and Breast Cancer:
Placebo-Controlled Trials Matthew Smith, MD, PhD
Massachusetts General Hospital Harvard Medical SchoolBoston, Massachusetts
Prof. Robert Coleman, MD, FRCPCancer Research Centre
Weston Park HospitalSheffield, England
C
CC39/11-2
Placebo-Controlled Trials Study Objective
Demonstrate that ZOMETA® is superior to placebo for the treatment of bone metastases
C
CC39/11-3
Placebo-Controlled Trials Study Endpoints (1)
Primary endpoint– Proportion (%) of patients experiencing any
skeletal-related event (SRE) not including hypercalcemia of malignancy (HCM)
C
CC39/11-4
Placebo-Controlled Trials Study Endpoints (2)
Secondary endpoints– Time to first SRE– Skeletal morbidity rate (SMR)– Andersen-Gill multiple event analysis
– Time to first SRE, SMR, and proportion (%) of patients with any SRE (+HCM)
– Pain/analgesic scores– Bone lesion response– Time to progression of disease– Safety (including survival)
• Additional 6 mo of survival and serum creatinine data
C
CC39/11-5
Placebo-Controlled Trials Skeletal-Related Events (SREs)
Pathologic fractures
Spinal cord compression
Radiation for bone pain or to treat or prevent pathologic fractures or spinal cord compression
Surgery to bone
Change of antineoplastic therapy for bone pain in prostate cancer
Hypercalcemia of malignancy (HCM)
C
CC39/11-6
Placebo-Controlled Trials Preplanned SRE Analysis
Proportion (%) of patients with an SRE
– Number of patients with SRE divided by number of patients in each treatment group
Time to first SRE
– Time from randomization to first SRE (days)
Skeletal morbidity rate (SMR)§
– Number of SREs divided by time at risk on trial (yr)
Andersen-Gill multiple event analysis
– Time from randomization to each occurrence of the events§
C
§Skeletal events occurring within 21 days counted as a single occurrence.
CC39/11-7
Clinical Trials History
Original study design– ZOMETA® (8 mg or 4 mg) versus placebo
infused over 5 min every 3 wk for 9 (–PC/BC) or 15 mo (prostate cancer)
Renal amendment 1 (June 1999)– Infusion time for ZOMETA increased from
5 min to 15 min– Infusion volume increased from 50 mL to 100 mL
Renal amendment 2 (June 2000)– 8 mg switched to 4 mg (8/4-mg group)– Renal function monitoring within 2 wk prior to
each dose Statistical amendment
– Primary efficacy analysis based on ZOMETA 4 mg versus placebo
C
CC39/11-8
Clinical Trial History Amendment/Patient Accrual Timeline
29
6/98 12/98 6/99 6/00 12/0012/99
Accrual
1/01
Treatment and follow-up
275275
578578
368368Prostate cancer
N = 643
195195N = 773
Solid tumors –PB/BC
Renal Renal amendment 1amendment 1(5 (5 15 min 15 min
Infusion)Infusion)
Renal Renal amendment 2amendment 2(8 mg (8 mg 4 mg 4 mg
Dose)Dose)
CC39/11-9
ZOMETA® in Prostate Cancer:
Placebo-Controlled Trial (039)
C
CC39/11-10
Prostate Cancer Trial Design (1)
Prostate carcinomaProstate carcinoma– Documented bone metastasesDocumented bone metastases
Rising PSARising PSA Baseline serum testosterone within the castrate Baseline serum testosterone within the castrate
range (range ( 50 ng/dL) 50 ng/dL) No strong opiate analgesicsNo strong opiate analgesics Serum creatinine 3.0 mg/dL (265 µmol/L) ECOG performance status 0, 1, 2 Appropriate antineoplastic therapy at
study entry
C
CC39/11-11
Prostate Cancer Trial Design (2)
StratificationStratification– Presence or absence of any distant metastases Presence or absence of any distant metastases
at initial diagnosis of cancerat initial diagnosis of cancer Patients received oral vitamin D 400 IU and
calcium 500 mg Dose and dosing regimen
– ZOMETA® 4 mg, 8/4 mg, and placebo– 5-min amended to 15-min infusion– Every 3 wk
15-mo follow-up15-mo follow-up
C
CC39/11-12
Prostate Cancer Demographics and Prognostic Factors
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Demographic factor N = 214 N = 221 N = 208
Mean age, yr 71.8 71.2 72.2
Gender, % male 100.0 100.0 100.0
Race,Caucasian,% 83.2 84.2 82.7Black, % 11.2 8.3 9.1
Performance status
ECOG 0 - 1, % 92.1 91.3 91.3
Mean FACT-G score 81.0 81.4 82.2
No metastases atdiagnosis, n 115 134 116
Metastases at diagnosis, n 99 87 92
Baseline PSA, median 82 89 61
31
CC39/11-13
Prostate Cancer Patient Disposition
ZOMETA® ZOMETADisposition 4 mg 8/4 mg Placebo
8IS
E
T2
-3,
4
Intent-to-treat, N 214 221 208
Completed studytherapy (15 mo)
n 81 62 65
% 37.9 28.1 31.3
CC39/11-14
Prostate Cancer Reasons for Early Discontinuation
Patients, %
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Reason for discontinuation N = 214 N = 221 N = 208
8IS
E
T2
-3,
4
Total discontinued prematurely 62.1 71.9 68.7
Death 11.7 18.1 15.4
Adverse events 17.8 19.9 13.9
Withdrew consent 19.2 22.6 16.8
Unsatisfactory therapeutic effect 8.9 7.7 16.3
Protocol violation 0.5 0.0 0.0
Lost to follow-up 1.9 0.0 2.4
Other 2.4 3.7 3.8
CC39/11-15
Prostate Cancer Proportion (%) of Patients With an SRE
3338
44
0
10
20
30
40
50
ZOMETA® 4 mg ZOMETA 8/4 mg Placebo
Per
cen
t o
f p
atie
nts
N = 214 221 208
12
P = .021P = .222
ZOMETA 4 mg versus placebo remained significant when fractures were excluded
CC39/11-16
Why Was No Dose Effect Observed?Percent Change From Baseline N-telopeptide (039)
Maximum target inhibition was achieved in the ZOMETA 4 mg group
-80
-60
-40
-20
0
20
40
1 3 6 9 12 15 End ofstudyTime, mo
Me
dia
n c
han
ge
fro
m b
ase
line
, %
ZOMETA® 4 mg ZOMETA 8/4 mg Placebo
CS
R 0
39
T 9
-13
22
CC39/11-17Prostate Cancer Combined AnalysisProportion (%) of Patients With an SRE
36
44
0
10
20
30
40
50
ZOMETA® 4 mg + 8/4 mg Placebo
Per
cen
t o
f p
atie
nts
N = 435 208
12
P = .041
CC39/11-18
Prostate Cancer Components of SRE by Month 15
23
13
5 42
24
15
85
3
29
22
7 7
3
0
5
10
15
20
25
30
35
Radiation tobone
All fractures Change ofantineoplastic
therapy
Spinal cordcompression
Surgery to bone
Per
cen
t o
f p
atie
nts
ZOMETA® 4 mg
ZOMETA 8/4 mg
Placebo
8IS
E T
2-1
5;C
SR
03
9 T
9-4
N
214
221
208
CC39/11-19
Prostate Cancer Time to First SRE
01
1 P
TF
9.2
-1p
3;
CS
R 0
39
T9
-2:
CS
R 0
11
T9
-3
ZOMETA 4 mg 214 149 97 70 45ZOMETA 8/4 mg 221 132 77 46 34Placebo 208 128 78 43 31
15
0102030405060708090
100
0 60 120 180 240 300 360 420Time after start of study drug, days
Pe
rce
nt
wit
ho
ut
ev
en
t
Median time, days P-value
ZOMETA® 4 mg NR .011ZOMETA 8/4 mg 363 .491Placebo 321
CC39/11-20
Prostate Cancer Mean SMR*
ZOMETA 8/4 mgZOMETA® 4 mg Placebo
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Me
an
SM
R/y
r
N = 214 221 208
P = .143
P = .006
* +HCM P < .05 for ZOMETA 4 mg versus placebo
C
0.81.06
1.49
CC39/11-21Prostate CancerAndersen-Gill Multiple Event Analysis Time to SRE up to Month 15
ZOMETA® 4 mg ZOMETA 8/4 mg
Hazard 95% CI for Hazard 95% CI forratio hazard ratio ratio hazard ratio
Placebo 0.643 (0.476, 0.870) 0.847 (0.640, 1.122)
CC39/11-22Prostate Cancer (039)Proportion of Patients With an SRE in Patients With Different Types of Bone Lesions
19
3933
5044
35
52 51
40
0
10
20
30
40
50
60
70
Lytic Other Blastic
Pe
rce
nt
wit
h S
RE
ZOMETA® 4 mgZOMETA 8/4 mgPlacebo
57
N = 26 26 59 63 129 15621 39 124
CC39/11-23
Prostate Cancer Disease-Related Endpoints
Median time, days
ZOMETA® ZOMETA P-value, 4 mg 8/4 mg Placebo ZOMETA 4 mg
Endpoint N = 214 N = 221 N = 208 vs placebo
Time to progressionof bone lesion, days 92 89 87 .275
Time to progressionof disease, days 84 84 84 .771
C
CC39/11-24
Prostate Cancer Quality-of-Life Endpoints
Change from baseline, mean SD
ZOMETA® ZOMETA 4 mg 8/4 mg Placebo
Endpoint (15 mo) N = 214 N = 221 N = 208
Brief pain inventory score§ 0.6 2.27 0.3 2.18 0.9 2.23
Analgesic score§ 1.0 1.33 0.9 1.40 1.1 1.49
Performance status (ECOG)§ 0.9 1.10 1.0 1.16 1.0 1.28
FACT-G total score|| –7.4 17.7 –7.4 15.4 –8.3 17.4
§Increased score = decline.||Increased score = improvement.
C
CC39/11-25
Prostate Cancer Efficacy Summary
ZOMETA decreases skeletal complications in men with prostate cancer and bone metastases
C
Time to MultipleProportion first SRE Mean skeletal event analysis
with SRE, % (hazard ratio) morbidity rate hazard ratio
ZOMETA® 4 mg 33 0.669 0.80 0.643N = 214P-value .021 .011 .006 .004
ZOMETA 8/4 mg 38 0.901 1.06 0.847N = 221P-value .222 .491 .143 .247
Placebo 44 1.49N = 208 — —
CC39/11-26
ZOMETA® in Prostate Cancer:
Placebo-Controlled Trial (039)
Safety
C
CC39/11-27Primary Cause of Death During theTrial or Within 28 Days After Study Drug Termination§
Patients, n (%)
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Cause of death N = 214 N = 218 N = 208
8
Neoplasms benign/malignant 15 (7.0) 18 (8.3) 14 (6.7)Respiratory/thoracic/mediastinal 3 (1.4) 2 (0.9) 5 (2.4)Cardiac 5 (2.3) 5 (2.3) 8 (3.8)General disorders/administration site 5 (2.3) 1 (0.5) 2 (1.0)Infections/infestations 2 (0.9) 2 (0.9) 4 (1.9)Renal/urinary 0 (0.0) 4 (1.8) 0 (0.0)
ISS
T5
-12
§6 mo additional data.
CC39/11-28
Prostate Cancer Survival – All Patients§
0102030405060708090
100
0 120 240 360 480 600 720 840 960
Time after start of study drug, days
Pe
rce
nt
su
rviv
ing
ZOMETA 4 mg 214 194 162 141 114 95 53 21 10ZOMETA 8/4 mg 218 197 166 121 91 75 42 12 5Placebo 208 190 148 119 94 75 37 17 4
Median time, days
ZOMETA® 4 mg 563 P = .087ZOMETA 8/4 mg 418 P = .765Placebo 469
03
9E
PT
F 1
0.5
-1p
335
§6 mo additional data.
CC39/11-29
Safety-evaluable patients, n (%)
ZOMETA® 4 mg ZOMETA 8/4 mg PlaceboPreferred term N = 214 N = 218 N = 208
Bone pain 108 (50.5) 133 (61.0) 127 (61.1)Nausea 77 (36.0) 115 (52.8) 77 (37.0)Constipation 72 (33.6) 85 (39.0) 72 (34.6)Fatigue 70 (32.7) 67 (37.0) 53 (25.5)Anemia NOS 57 (26.6) 60 (27.5) 37 (17.8)Myalgia 53 (24.8) 53 (24.3) 37 (17.8)Vomiting NOS 46 (21.5) 64 (29.4) 43 (20.7)Weakness 45 (21.0) 50 (22.9) 40 (19.2)Anorexia 43 (20.1) 55 (25.2) 36 (17.3)Pyrexia 43 (20.1) 48 (22.0) 27 (13.0)Edema lower limb 41 (19.2) 48 (22.0) 27 (13.0)Dizziness (except vertigo) 38 (17.8) 22 (10.1) 24 (11.5)Diarrhea NOS 36 (16.8) 35 (16.1) 32 (15.4)Weight decreased 36 (16.8) 38 (17.4) 26 (12.5)
Prostate Cancer Incidence of Adverse Events ( 15%)Regardless of Study Drug Relationship
NOS = Not otherwise specified.
CS
R 0
39
T1
0-2
C
CC39/11-30Prostate CancerNCI Grade 3/4 HematologyElectrolyte and Mineral Changes
Anemia – Incidence < 10% for all treatment groups with
a higher incidence in the ZOMETA® 8/4-mg treatment group
– Higher use of red blood cells and erythropoietin in the ZOMETA treatment groups
Electrolyte and mineral adverse events– Incidence of hypocalcemia < 2% for all
treatment groups – Higher incidence of hypophosphatemia and
hypermagnesemia in the ZOMETA treatment groups
8V
ol 1
66
IS
S P
TT
5.1
-5
CC39/11-31
Patients Enrolling After the 15-min Amendment NCI Grade 3/4 Serum Creatinine Changes§
Patients, n (%)N = 257
ZOMETA® ZOMETA 4 mg 8/4 mg Placebo
N = 92 N = 87 N = 78
Grade 3 5 (5.4) 2 (2.3) 1 (1.3)
Grade 4 0 (0.0) 0 (0.0) 0 (0.0)
C
§6 mo additional data.
CC39/11-32Prostate CancerKaplan-Meier Estimates of First Serum Creatinine Increase§
0
20
40
60
80
100
n Hazard ratio P-value ZOMETA® 4 mg 112 2.033 .048
ZOMETA 8/4 mg|| 121 4.016 .001Placebo 121
01
0E
1 P
TF
10
.6-2
p1
35
0
20
40
60
80
100
0 120 240 360 480 600
Time after start of study drug, days
n Hazard ratio P-value ZOMETA 4 mg 92 1.107 .802
ZOMETA 8/4 mg¶ 87 1.655 .199Placebo 78
§6 mo additional data.||53% of patients received only 8 mg.¶23% of patients received only 8 mg.
Percent ofpatients withoutincrease(randomizedprior to 15-mininfusionamendment)
Percent ofpatients withoutincrease(randomizedafter 15-mininfusionamendment)
CC39/11-33
Prostate Cancer Safety Summary
Adverse events commonly associated with bisphosphonates (fever, myalgias, anemias, hypophosphatemia, hypermagnesemia) were reported more frequently in the ZOMETA® treatment groups than in the placebo group
The risk of renal deterioration was similar between ZOMETA 4 mg (15-min infusion) and placebo
C
CC39/11-34
Prostate Cancer Overall Summary
ZOMETA® decreases skeletal complications in men with prostate cancer and bone metastases
C
CC39/11-35
ZOMETA® in Solid Tumors Other Than Prostate
Cancer and Breast Cancer (–PC/BC):Placebo-Controlled Trial (011)
Prof. Robert Coleman, MD, FRCPCancer Research Centre
Weston Park HospitalSheffield, England
C
CC39/11-36
Solid Tumors –PC/BC Trial Design (1)
Solid tumors other than prostate and Solid tumors other than prostate and breast cancer (–PC/BC)breast cancer (–PC/BC) 1 bone metastasis1 bone metastasis
Appropriate antineoplastic therapy at study entry
Serum creatinine 3.0 mg/dL (265 µmol/L)
ECOG performance status 0, 1, 2
C
CC39/11-37
Solid Tumors –PC/BC Trial Design (2)
StratificationStratification– Non-small cell lung cancerNon-small cell lung cancer– Other solid tumors (renal, small cell lung, Other solid tumors (renal, small cell lung,
cancer of unknown primary, bladder, colorectal, cancer of unknown primary, bladder, colorectal, head and neck, etc.)head and neck, etc.)
Patients received oral vitamin D 400 IU and calcium 500 mg
Dose and dosing regimen– ZOMETA® 4 mg, 8/4 mg, and placebo– 5-min amended to 15-min infusion– Every 3 wk
9-mo follow-up9-mo follow-up
C
CC39/11-38
Solid Tumors –PC/BC Demographics and Prognostic Factors
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Demographic factor N = 257 N = 266 N = 250
Mean age, yr 62.2 60.8 62.3
Gender, % male 62.3 69.9 64.8
Race
Caucasian, % 89.1 89.5 90.4Black, % 5.9 5.7 4.9
Performance status
ECOG 0 - 1, % 83.1 82.3 87.0
Mean FACT-G score 70.1 69.3 70.8
NSCLC, n 134 139 130
Other solid tumors, n 123 127 120
31
CC39/11-39
Solid Tumors –PC/BC Patient Disposition
8IS
E
T2
-3,
4
ZOMETA® ZOMETA
Disposition 4 mg 8/4 mg Placebo
Intent-to-treat, N 257 266 250
Completed studytherapy (9 mo)
n 68 65 63
% 26.5 24.4 25.2
CC39/11-40
Solid Tumors –PC/BC Reasons for Early Discontinuation
Patients, %
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Reason for discontinuation N = 257 N = 266 N = 250
8IS
E
T2
-3,
4
Total discontinued prematurely 73.5 75.6 74.8
Death 25.7 28.2 26.4
Adverse events 19.1 24.4 20.8
Withdrew consent 17.9 13.5 16.8
Unsatisfactory therapeutic effect 7.0 5.3 8.0
Protocol violation 1.6 0.0 0.0
Lost to follow-up 0.8 1.5 0.0
Other 1.6 2.7 2.8
CC39/11-41Solid Tumors –PC/BC Proportion (%) of Patients With an SRETime to First SRE
3835
44
0
10
20
30
40
50
Pe
rce
nt
of
pa
tie
nts
ZOMETA® 4 mgZOMETA 8/4 mgPlacebo
N = 257 N = 266 N = 250
12
P = .127
P = .023
0
10
20
30
40
50
60
70
80
90
100
0 30 60 90 120 150 180 210 240Time after start of study drug, days
Pe
rce
nt
wit
ho
ut
ev
en
t Median time, days P-value
ZOMETA 4 mg 230 .023ZOMETA 8/4 mg 219 .034Placebo 163
ZOMETA 4 mg 257 107 62
468/4 mg 266 99 56
40Placebo 250 81 48
36
CC39/11-42
Solid Tumors –PC/BC Components of SRE by Month 9
27
16
4 3
26
12
53
32
21
4 4
0
5
10
15
20
25
30
35
Radiation tobone
All fractures Surgery to bone Spinal cordcompression
Per
cen
t o
f p
atie
nts
ZOMETA® 4 mg
ZOMETA 8/4 mg
Placebo
8IS
E T
2-1
5;
CS
R 0
11
T9
-7
N
257
266
250
CC39/11-43
Solid Tumors –PC/BC Mean SMR*
ZOMETA 8/4 mgZOMETA® 4 mg Placebo
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
N = 257 266 250
P = .005
P = .069
Mea
n S
MR
/yr
* + HCM P < .05 for ZOMETA 4 mg and 8/4 mg versus placebo.
C
2.24
1.55
2.52
CC39/11-44Solid Tumors –PC/BC Andersen-Gill Multiple Event Analysis Time to SRE up to Month 9
ZOMETA® 4 mg ZOMETA 8/4 mg
Hazard 95% CI for Hazard 95% CI forStratum ratio hazard ratio ratio hazard ratio
NSCLC Placebo 0.729 (0.524, 1.015) 0.530 (0.377, 0.745)Other solid tumors Placebo 0.737 (0.493, 1.101) 0.886 (0.605, 1.298)
Total Placebo 0.732 (0.567, 0.946) 0.687 (0.531, 0.890)
C
CC39/11-45Other Solid Tumors (011)Proportion of Patients With an SRE in Patients With Different Types of Bone Lesions
4337
26
39
3229
52
3835
0
10
20
30
40
50
60
70
Lytic Other Blastic
Pe
rce
nt
wit
h S
RE
ZOMETA® 4 mg
ZOMETA 8/4 mgPlacebo
57
N = 111 119 104 82 42 51128 96 40
CC39/11-46
Solid Tumors –PC/BC Disease-Related Endpoints
Median time, days
ZOMETA® ZOMETA P-value, 4 mg 8/4 mg Placebo ZOMETA 4 mg
Endpoint N = 257 N = 266 N = 250 vs placebo
Time to progressionof bone lesion, days 145 238 109 .34
Time to progressionof disease, days 89 91 84 .117
C
CC39/11-47
Solid Tumors –PC/BC Quality-of-Life Endpoints
Change from baseline, mean SD
ZOMETA® ZOMETA 4 mg 8/4 mg Placebo
Endpoint (9 mo) N = 257 N = 266 N = 250
Brief pain inventory score§ 0.1 2.36 0.3 2.08 0.3 2.34
Analgesic score§ 0.3 1.20 0.3 1.18 0.3 1.08
Performance status (ECOG)§ 0.9 1.22 1.0 1.25 1.1 1.18
FACT-G total score|| –4.7 15.7 –2.8 16.7 –4.9 16.8
§Increased score = decline.||Increased score = improvement.
C
CC39/11-48
Solid Tumors –PC/BC Efficacy Summary
ZOMETA is the first bisphosphonate to demonstrate efficacy in decreasing skeletal complications in a broad range of solid tumors
C
Time to MultipleProportion first SRE Mean skeletal event analysis
with SRE. % (hazard ratio) morbidity rate hazard ratio
ZOMETA® 4 mg 38 0.728 2.24 0.732N = 257P-value .127 .023 .069 .017
ZOMETA 8/4 mg 35 0.741 1.55 0.687N = 266P-value .023 .034 .005 .004
Placebo 44 2.52 —N = 250
CC39/11-49
ZOMETA® in Solid Tumors Other Than Prostate
Cancer and Breast Cancer (–PC/BC):Placebo-Controlled Trial (011)
Safety
C
CC39/11-50Primary Cause of Death During theTrial or Within 28 Days After Study Drug Termination§
Patients, n (%)
ZOMETA® ZOMETA4 mg 8/4 mg Placebo
Cause of death N = 254 N = 265 N = 247
8
Neoplasms benign/malignant 33 (13.0) 43 (16.2) 52 (21.1)Respiratory/thoracic/mediastinal 15 (5.9) 10 (3.8) 8 (3.2)Cardiac 8 (3.1) 9 (3.4) 3 (1.2)General disorders/administration site 3 (1.2) 5 (1.9) 4 (1.6)Infections/infestations 6 (2.4) 6 (2.3) 4 (1.6)Renal/urinary 1 (0.4) 2 (0.8) 0 (0.0)Hepato-biliary disorders 0 (0.0) 1 (0.4) 0 (0.0)
ISS
T5
-12
§6 mo additional data.
CC39/11-51
Solid Tumors –PC/BC Survival – All Patients§
0102030405060708090
100
0 120 240 360 480 600
Time after start of study drug, days
Pe
rce
nt
su
rviv
ing
ZOMETA 4 mg 254 173 102 65 36 17ZOMETA 8/4 mg 265 177 107 73 38 13Placebo 247 155 92 62 31 18
Median time, days
ZOMETA® 4 mg 203 P = .947ZOMETA 8/4 mg 189 P = .471Placebo 183
01
1E
1 P
TF
10
.5-1
p3
35
§6 mo additional data.
CC39/11-52
Safety-evaluable patients, n (%)
ZOMETA® 4 mg ZOMETA 8/4 mg PlaceboPreferred term N = 254 N = 265 N = 247
Bone pain 129 (50.8) 130 (49.1) 145 (58.7)Nausea 116 (45.7) 106 (40.0) 83 (33.6)Anemia NOS 94 (37.0) 82 (30.9) 82 (33.2)Vomiting NOS 91 (35.8) 83 (31.3) 71 (28.7)Constipation 85 (33.5) 76 (28.7) 89 (36.0)Dyspnea NOS 83 (32.7) 90 (34.0) 65 (26.3)Fatigue 79 (31.1) 78 (29.4) 72 (29.1)Pyrexia 67 (26.4) 70 (26.4) 56 (22.7)Weakness 66 (26.0) 67 (25.3) 65 (26.3)Anorexia 58 (22.8) 60 (22.6) 62 (25.1)Edema lower limb 56 (22.0) 53 (20.0) 49 (19.8)Malignant neoplasm aggravated 54 (21.3) 67 (25.3) 56 (22.7)Cough 47 (18.5) 44 (16.6) 38 (15.4)Diarrhea NOS 43 (16.9) 48 (18.1) 44 (17.8)Headache NOS 42 (16.5) 36 (13.6) 26 (10.5)Insomnia NEC 42 (16.5) 38 (14.3) 30 (12.1)Dehydration 40 (15.7) 48 (18.1) 41 (16.6)
Solid Tumors –PC/BC Incidence of Adverse Events ( 15%)Regardless of Study Drug Relationship
NOS = Not otherwise specified. NEC = Not elsewhere classified.
C
CC39/11-53Solid Tumors –PC/BC NCI Grade 3/4 HematologyElectrolyte and Mineral Changes
Anemia – Incidence < 5% for all treatment groups, with a
slightly higher incidence in the ZOMETA® treatment groups
– Use of red blood cells and erythropoietin was similar for all treatment groups
Electrolyte and mineral adverse events– Incidence of hypocalcemia < 2% for all
treatment groups– Higher incidence of hypophosphatemia in the
ZOMETA treatment groups
8V
ol 1
66
IS
S P
TT
5.1
-5
CC39/11-54
Patients Enrolling After the 15-min Amendment NCI Grade 3/4 Serum Creatinine Changes§
Patients, n (%)
N = 509
ZOMETA® ZOMETA 4 mg 8/4 mg Placebo
N = 165 N = 181 N = 163
Grade 3 1 (0.6) 2 (1.1) 3 (1.8)
Grade 4 2 (1.2) 0 (0.0) 0 (0.0)
C
§6 mo additional data.
CC39/11-55Solid Tumors –PC/BC Kaplan-Meier Estimates of First Serum Creatinine Increase§
01
1E
1 P
TF
10
.6-2
p1
35
§6 mo additional data.||24% of patients received only 8-mg.¶51% of patients received only 8 mg.
0
20
40
60
80
100
n Hazard ratio P-valueZOMETA® 4 mg 61 3.836 .050ZOMETA 8/4 mg|| 55 2.883 .132Placebo 54
0
20
40
60
80
100
0 120 240 360
Time after start of study drug, days
n Hazard ratio P-valueZOMETA 4 mg 165 1.587 .228ZOMETA 8/4 mg¶ 181 1.907 .079Placebo 163
Percent ofpatients(randomizedprior to 15-mininfusionamendment)
Percent ofpatients(randomizedafter 15-mininfusionamendment)
CC39/11-56
Solid Tumors –PC/BC Safety Summary
Adverse events commonly associated with bisphosphonates (hypophosphatemia, anemias) were reported more frequently in the ZOMETA® treatment groups
Risk of renal deterioration was moderately higher in the ZOMETA 4-mg treatment group(15-min infusion) than in the placebo group
C
CC39/11-57
Solid Tumors –PC/BC Overall Summary
ZOMETA® is the first bisphosphonate to demonstrate efficacy in decreasing skeletal complications in a broad range of solid tumors
ZOMETA (4 mg via 15-min infusion) has a safety profile similar to i.v. pamidronate 90 mg (historical)
C