Efficacy, Safety, and Immunogenicity of HLX04 Versus Reference Bevacizumab in Combination with XELOX or mFOLFOX6 as First-Line Treatment for Metastatic Colorectal Cancer: Results of a Randomized, Double-Blind Phase III Study.
BioDrugs 2021;
35:445-458. [PMID:
34014555 PMCID:
PMC8295119 DOI:
10.1007/s40259-021-00484-9]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Background
HLX04 is a proposed biosimilar of bevacizumab.
Objective
This phase III study aimed to evaluate the efficacy, safety, and
immunogenicity of HLX04 compared with reference bevacizumab in combination with XELOX
or mFOLFOX6 as first-line treatment for recurrent/metastatic colorectal cancer
(CRC).
Methods
In this double-blind, parallel-group study, patients were randomized 1:1
to receive HLX04 or bevacizumab (7.5 mg/kg every 3 weeks when combined with XELOX; 5
mg/kg every 2 weeks when combined with mFOLFOX6). The primary endpoint was
progression-free survival rate at week 36 (PFSR36w) per
Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Prespecified equivalence
margins of PFSR36w were set as − 11 to 15% (rate difference)
and 0.8 to 1.25 (rate ratio). Secondary endpoints included efficacy, safety,
immunogenicity, and pharmacokinetics.
Results
A total of 677 patients were randomized (HLX04 n = 340; bevacizumab n = 337)
between April 2018 and April 2020. PFSR36w was 46.4% (95%
confidence interval [CI] 41.1–51.8) with HLX04 and 50.7% (95% CI 45.4–56.1) with
bevacizumab. The rate difference (− 4.2%; 90% CI − 10.6 to 2.1) and rate ratio (0.92;
90% CI 0.80–1.05) both fell within the prespecified equivalence margins. No notable
differences were observed between treatment groups in any efficacy endpoints or their
subgroup analyses. Safety, immunogenicity, and pharmacokinetic profiles were
comparable between the two treatment groups.
Conclusions
HLX04 demonstrated equivalent efficacy with similar safety and
immunogenicity profiles to reference bevacizumab among patients with
recurrent/metastatic CRC, thus offering an alternative treatment option to
patients.
Trial registration
Chinadrugtrials.org.cn, CTR20171503 (18 March 2018); ClinicalTrials.gov,
NCT03511963 (30 April 2018).
Supplementary Information
The online version contains supplementary material available at 10.1007/s40259-021-00484-9.
Colorectal cancer (CRC) is the third most common cancer worldwide. Approximately 20%
of patients with CRC have metastases at their first visit. Bevacizumab is a biologic
antibody approved in many countries for the treatment of metastatic CRC. However, high
treatment costs significantly limit patient access to bevacizumab. Therefore, HLX04, a
potential bevacizumab biosimilar, which is almost identical to bevacizumab but less
expensive and more accessible, has been developed. This randomized clinical trial was
designed to evaluate the efficacy (ability of a drug to produce the desired treatment
effects), safety, and immunogenicity (ability of a drug to induce immune response that
would affect its efficacy and safety) of HLX04 compared with the reference bevacizumab
in patients with recurrent/metastatic CRC. Efficacy of the tested drug was evaluated by
comparing the proportion of patients without disease progression or death at week 36
(PFSR36w). Safety was monitored using adverse events and other
clinical evaluations. Immunogenicity was assessed by the incidence of antidrug
antibodies. Of the 677 patients enrolled in the study, 340 received HLX04 and 337
received bevacizumab. Statistical analyses showed that HLX04 was equivalent to
bevacizumab in efficacy evaluations (the difference in PFSR36w
between the two treatment groups fell within the prespecified “equivalence margins”).
Moreover, the two treatments were similar with respect to safety and immunogenicity
evaluations. In summary, patients responded equally well to HLX04 and bevacizumab,
supporting the development of HLX04 as a proposed biosimilar to bevacizumab for patients
with recurrent/metastatic CRC.
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