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A Study Comparing Abelacimab to Apixaban in the Treatment of Cancer-associated VTE

PHASE3RECRUITING

This is a Phase 3,multicenter, randomized, open-label, blinded endpoint evaluation study comparing the effect of abelacimab relative to apixaban on venous thromboembolism (VTE) recurrence and bleeding in patients with cancer associated VTE (ASTER).

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Study details:

Cancer associated thrombosis (CAT) is a severe medical condition which is characterized by high incidence of Venous thromboembolism (VTE) recurrence and high risk for bleeding. The two most common treatments today are low molecular weight heparin (LMWH) and direct anticoagulants (DOACs), in which each has limitations. DOACs are administered orally and are seen as a more convenient alternative though associated with bleeding risk; further, some cancer patients have difficulty swallowing or develop vomiting which leads to unpredictable pharmacodynamic effects with oral therapy.

The ANT-007 study will compare treatment with abelacimab monthly administration to apixaban twice daily administration over a 6-month treatment. The study outcomes include VTE recurrence, bleeding event and treatment discontinuation at 6 months.

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Eligibility criteria

Researchers look for people who fit a certain description, called eligibility criteria. See if you qualify.

Inclusion criteria

  • Male or female subjects ≥18 years old or other legal maturity age according to the country of residence
  • Confirmed diagnosis of cancer (by histology, adequate imaging modality), other than basal-cell or squamous-cell carcinoma of the skin alone with one of the following: * Active cancer, defined as either locally active, regionally invasive, or metastatic cancer at the time of randomization and/or * Currently receiving or having received anticancer therapy (radiotherapy, chemotherapy, hormonal therapy, any kind of targeted therapy or any other anticancer therapy) in the last 6 months.
  • Confirmed symptomatic or incidental proximal lower limb deep vein thrombosis (DVT) (i.e., popliteal, femoral, iliac, and/or inferior vena cava [IVC] thrombosis) and/or a confirmed symptomatic pulmonary embolism (PE), or an incidental PE in a segmental, or larger pulmonary artery.
  • Patients are eligible within 120 hours from diagnosis of the qualifying VTE
  • Anticoagulation therapy with a therapeutic dose of DOAC for at least 6 months is indicated
  • Able to provide written informed consent
  • Exclusion criteria

  • Thrombectomy, insertion of a caval filter or use of a fibrinolytic agent to treat the current (index) DVT and/or PE
  • More than 120 hours of pre-treatment with therapeutic doses of UFH, LMWH, fondaparinux, DOAC, or other anticoagulants
  • An indication to continue treatment with therapeutic doses of an anticoagulant other than that VTE treatment prior to randomization (e.g., atrial fibrillation [AF], mechanical heart valve, prior VTE)
  • Platelet count <50,000/mm3 at the screening visit
  • PE leading to hemodynamic instability (blood pressure [BP] <90 mmHg or shock)
  • Acute ischemic or hemorrhagic stroke or intracranial hemorrhage within the 4 weeks preceding screening
  • Brain trauma or a cerebral or spinal cord surgery or spinal procedures such as lumbar puncture or epidural/spinal anesthesia within 4 weeks of screening
  • Need for aspirin in a dosage of >100 mg/day or any other antiplatelet agent alone or in combination with aspirin
  • Primary brain cancer or untreated intracranial metastases at baseline
  • Acute myeloid or lymphoid leukemia
  • Bleeding requiring medical attention at the time of randomization or in the preceding 4 weeks
  • Planned brain, spinal cord, cardiac, vascular, major thoracic and/or major abdominal surgery in the 4 weeks following randomization
  • Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4 at screening
  • Life expectancy <3 months at randomization
  • Calculated creatinine clearance (CrCl) <30 mL/min (Cockcroft-Gault equation) at the screening visit
  • Hemoglobin <8 g/dL at the screening visit
  • Acute hepatitis, chronic active hepatitis, liver cirrhosis; or an alanine aminotransferase (ALT) ≥3 x and/or bilirubin ≥2 x upper limit of normal (ULN) at the screening visit in absence of clinical explanation
  • Uncontrolled hypertension (systolic BP>180 mm Hg or diastolic BP >100 mm Hg despite antihypertensive treatment)
  • Women of child-bearing potential (WOCBP) who are unwilling or unable to use highly effective contraceptive measures during the study from screening up to 3 days after last treatment of apixaban or 100 days after administration of abelacimab (See Section 5.3.6. for highly effective contraceptive measures)
  • Sexually active males with sexual partners of childbearing potential must agree to use a condom or other reliable contraceptive measure up to 3 days after last treatment of apixaban or 100 days after administration of abelacimab
  • Pregnant or breast-feeding women
  • Patients known to be receiving strong dual inducers or inhibitors of both CYP3A4 and P gp
  • History of hypersensitivity to any of the study drugs (including apixaban) or excipients, to drugs of similar chemical classes, or any contraindication listed in the label for apixaban
  • Subjects with any condition that in the Investigator's judgement would place the subject at increased risk of harm if he/she participated in the study
  • Use of other investigational (not registered) drugs within 5 half-lives prior to enrollment or until the expected pharmacodynamic(s) (PD) effect has returned to baseline, whichever is longer. Participation in academic non-interventional studies or interventional studies, comprising testing different strategies or different combinations of registered drugs is permitted
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    Eligibility

    Age eligible for study : 18 and older

    Healthy volunteers accepted : No

    Gender eligible for study: All

    Things to know

    Study dates

    Study start: 2022-05-05

    Primary completion: 2026-12-01

    Study completion finish: 2027-02-01

    study type

    Study type

    TREATMENT

    phase

    Phase

      PHASE3

    trial

    Trial ID

    NCT05171049

    Intervention or treatment

    BIOLOGICAL: Abelacimab

    DRUG: Apixaban

    Conditions

    • Venous Thromboembolism
    • Deep Venous Thrombosis
    • Pulmonary Embolism
    Image related to Venous Thromboembolism
    • Condition: Venous Thromboembolism, Deep Venous Thrombosis and more

    • BIOLOGICAL: Abelacimab and other drugs

    • Blacktown, New South Wales, Australia and more

    • Sponsor: Anthos Therapeutics, Inc.

    Find a site

    Closest Location:

    Blacktown Hospital

    Research sites nearby

    Select from list below to view details:

    • Blacktown Hospital

      Blacktown, New South Wales, Australia

    • Concord Repatriation General Hospital

      Concord, New South Wales, Australia

    • Westmead Hospital

      Westmead, New South Wales, Australia

    • Box Hill Hospital

      Box Hill, Victoria, Australia

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    Study Plan

    This section provides details of the study plan, including how the study is designed and what the study is measuring.

    How is the study designed?

    Participant Group/ArmIntervention/Treatment
    EXPERIMENTAL: Abelacimab
    • Abelacimab intravenous administration followed by monthly administration of the same dose subcutaneously
    BIOLOGICAL: Abelacimab
    • Abelacimab 150 mg
    ACTIVE_COMPARATOR: Apixaban
    • Apixaban administered orally twice a day
    DRUG: Apixaban
    • Apixaban 10 mg followed by 5 mg

    What is the study measuring?

    Primary outcome

    Primary Outcome MeasurePrimary Outcome DescriptionPrimary Outcome Time Frame
    Time to first event of centrally adjudicated VTE recurrence consisting of new proximal deep venous thrombosis, new pulmonary embolism (PE) or fatal PE, including unexplained death for which PE cannot be ruled outNot Specified6 months

    Secondary outcome

    Secondary Outcome MeasureSecondary Outcome DescriptionSecondary Outcome Time Frame
    Time to first event of ISTH-adjudicated major or clinically relevant non-major (CRNM) bleeding eventsNot Specified6 months
    Net clinical benefit defined as survival without VTE recurrence, or major or CRNM bleedingNot Specified6 months

    Frequently Asked Questions

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    References

    Clinical Trials Gov: A Study Comparing Abelacimab to Apixaban in the Treatment of Cancer-associated VTE

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