Apixaban or Dalteparin in Reducing Blood Clots in Patients With Cancer Related Venous Thromboembolism



Status:Active, not recruiting
Conditions:Cardiology, Cardiology, Cardiology, Cardiology, Cardiology
Therapuetic Areas:Cardiology / Vascular Diseases
Healthy:No
Age Range:18 - Any
Updated:2/22/2019
Start Date:November 20, 2015
End Date:November 20, 2019

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A Phase III, Randomized, Open Label Study Evaluating the Safety of Apixaban in Subjects With Cancer Related Venous Thromboembolism

This randomized phase III trial studies the side effects of and compares apixaban and
dalteparin in reducing blood clots in patients with cancer-related venous thromboembolism.
Venous thromboembolism is a condition in which a blood clot forms in a vein and then breaks
off and moves through the bloodstream. Patients with cancer are at increased risk for venous
thromboembolism. Apixaban and dalteparin are drugs used to prevent blood clots from forming
or to treat blood clots that have formed. It is not yet known whether apixaban or dalteparin
is more effective in reducing blood clots in patients with cancer related venous
thromboembolism.

ADAM-VTE

PRIMARY OBJECTIVES:

I. Any episode of major bleeding including fatal bleeding.

SECONDARY OBJECTIVES:

I. Venous thromboembolism (VTE) recurrence including deep vein thrombosis (DVT), pulmonary
embolism (PE), fatal PE, or arterial thromboembolism.

II. Any episode of major bleeding including fatal bleeding or any episode of clinically
relevant non-major bleeding.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive apixaban 10 mg orally (PO) twice daily (BID) on days 1-7 and
lower-dose apixaban 5 mg PO BID on days 8-180.

ARM II: Patients receive dalteparin 200 international units (IU)/kg/day subcutaneously (SC)
once daily (QD) on days 1-30 and lower-dose dalteparin 150 IU/kg/day SC QD on days 31-180.

After completion of study treatment, patients are followed up at 3 months.

Inclusion Criteria:

- Confirmed acute lower extremity or upper extremity (jugular, innominate, subclavian,
axillary, brachial) DVT, PE, splanchnic (hepatic, portal, splenic, mesenteric, renal,
gonadal), or cerebral vein thrombosis

- Active cancer defined as metastatic disease and/or any evidence of cancer on
cross-sectional or positron emission tomography (PET) imaging, cancer related surgery,
chemotherapy or radiation therapy within the past 6 months; note: non-melanoma skin
cancer does not meet the cancer requirement

- Life expectancy >= 60 days

- Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, 1, or 2

- Obtained =< 30 days prior to randomization: Platelet count >= 50,000/mm^3

- Obtained =< 30 days prior to randomization: Alanine aminotransferase (ALT) or
aspartate transaminase (AST) =< 3 x upper limit of normal (ULN)

- Obtained =< 30 days prior to randomization: International normalized ratio (INR) =<
1.6 (if not taking anticoagulant therapy)

- Obtained =< 30 days prior to randomization: Calculated creatinine clearance must be >=
30 ml/min using the Cockcroft-Gault formula

- Negative serum or urine pregnancy test done =< 24 hours prior to randomization, for
women of childbearing potential only; note: a women of childbearing potential (WOCBP)
is defined as any female who has experienced menarche and who has not undergone
surgical sterilization (hysterectomy or bilateral oophorectomy) and is not
postmenopausal; menopause is defined as 12 months of amenorrhea in a woman over age 45
years in the absence of other biological or physiological causes

- Ability to complete questionnaire(s) by themselves or with assistance

- Ability to provide informed written consent

- Willing to return to enrolling institution for follow-up (during the Active Monitoring
Phase of the study)

Exclusion Criteria:

- Any of the following:

- Pregnant women

- Nursing women

- Men or women of childbearing potential who are unwilling to employ adequate
contraception

- Note: women of child bearing potential must agree to follow instructions for
method(s) of contraception for the duration of treatment with study drug (s)
plus 33 days after finishing the last dose

- Males who are sexually active with WOCBP must agree to follow instructions
for method(s) of contraception for the duration of treatment with study drug
(s) plus 93 days after finishing the last dose

- Azoospermic males and WOCBP who are continuously not heterosexually active
are exempt from contraceptive requirements; however they must still undergo
pregnancy testing as described in this section

- Note: investigators shall counsel WOCBP and male subjects who are sexually active with
WOCBP on the importance of pregnancy prevention and the implications of an unexpected
pregnancy Investigators shall advise WOCBP and male subjects who are sexually active
with WOCBP on the use of highly effective methods of contraception; highly effective
methods of contraception have a failure rate of < 1% when used consistently and
correctly

- At a minimum, subjects must agree to the use of one method of highly effective
contraception as listed below:

- HIGHLY EFFECTIVE METHODS OF CONTRACEPTION

- Male condoms with spermicide

- Hormonal methods of contraception including combined oral contraceptive
pills, vaginal ring, injectables, implants and intrauterine devices (IUDs)
such as Mirena by WOCBP subject or male subject?s WOCBP partner

- Female partners of male subjects participating in the study may use hormone
based contraceptives as one of the acceptable methods of contraception since
they will not be receiving study drug

- IUDs, such as ParaGard

- Tubal ligation

- Vasectomy

- Complete abstinence

- Complete abstinence is defined as complete avoidance of heterosexual
intercourse and is an acceptable form of contraception for all study
drugs; female subjects must continue to have pregnancy tests;
acceptable alternate methods of highly effective contraception must be
discussed in the event that the subject chooses to forego complete
abstinence

- Treatment with an anticoagulant for more than 7 days for the current blood clot, prior
to randomization

- Active bleeding

- Severe hypersensitivity reaction to apixaban, dalteparin, heparin or pork products
(e.g., anaphylactic reactions)

- Use of the following CYP3A4 inducers: rifampin, rifabutin, carbamazepine, efavirenz,
phenobarbital, phenytoin, fosphenytoin, primidone, and St. John?s wort)

- Thienopyridine therapy (clopidogrel, prasugrel, or ticagrelor) that will be continued
on study

- Severe liver disease (known cirrhosis Childs Pugh class B or C), or active hepatitis

- Use of a Factor Xa inhibitor (e.g. apixaban, rivaroxaban, or edoxaban) =< 3 months
prior to randomization

- Treatment of a thromboembolic event =< 6 months prior to randomization

- Documented venous thromboembolism while on therapeutic anticoagulation
(?anticoagulation failure?)

- Mechanical heart valve

- Documented hemorrhagic tendencies

- Bacterial endocarditis

- History of heparin induced thrombocytopenia

- Any of the following conditions:

- Intracranial bleeding =< 6 months prior to randomization

- Intraocular bleeding =< 6 months prior to randomization

- Gastrointestinal bleeding and/or endoscopically proven ulcer =< 6 months prior to
randomization

- Head trauma or major trauma =<1 month prior to randomization

- Neurosurgery =< 2 weeks prior to randomization

- Major surgery =< 1 week prior to randomization

- Overt major bleeding at the time of randomization

- Gross hematuria at the time of randomization
We found this trial at
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Columbus, Ohio 43215
Principal Investigator: Carolyn M. Kuebler
Phone: 614-488-2118
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Grand Rapids, Michigan 49503
Principal Investigator: Kathleen J. Yost
Phone: 616-391-1230
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200 Technology Drive
Hooksett, New Hampshire 03106
603-622-6484
Principal Investigator: Michael S. Buff
New Hampshire Oncology - Hematology, PA - Hooksett New Hampshire Oncology-Hematology, PA (NHOH) was founded...
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Iowa City, Iowa 52242
Principal Investigator: Usha S. Perepu
Phone: 319-356-2195
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4500 San Pablo Rd S
Jacksonville, Florida 32224
(904) 953-2000
Mayo Clinic Florida Thousands of people come to Mayo Clinic in Jacksonville, Fla., annually for...
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Emile St
Omaha, Nebraska 68198
(402) 559-4000
Principal Investigator: Krishna Gundabolu
Phone: 402-559-8052
Univ of Nebraska Med Ctr A vital enterprise in the nation’s heartland, the University of...
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8940 Wood Sage Rd
Peoria, Illinois 61615
(309) 243-3000
Principal Investigator: Madhuri Bajaj
Phone: 309-243-3000
Illinois CancerCare-Peoria Illinois CancerCare, P.C. is a comprehensive practice treating patients withcancer andblood diseases. Our...
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Pinehurst, North Carolina 28374
Principal Investigator: Charles S. Kuzma
Phone: 910-715-3500
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353 Fairmont Blvd
Rapid City, South Dakota 57701
(605) 719-1000
Principal Investigator: Joshua C. Lukenbill
Phone: 605-755-2301
Rapid City Regional Hospital Regional Health is an integrated health care system of more than...
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Rochester, Minnesota 55905
Principal Investigator: Robert D. McBane
Phone: 507-266-3964
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Saint Cloud, Minnesota 56303
Principal Investigator: Donald J. Jurgens
Phone: 320-229-4907
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Saint Louis Park, Minnesota 55416
Principal Investigator: Daniel M. Anderson
Phone: 952-993-1517
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Sayre, Pennsylvania 18840
Principal Investigator: Bradley W. Lash
Phone: 570-887-2141
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13400 E. Shea Blvd.
Scottsdale, Arizona 85259
480-301-8000
Principal Investigator: Kelly K. Curtis
Mayo Clinic Arizona Mayo Clinic in Arizona provides medical care for thousands of people from...
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Sioux City, Iowa 51101
Principal Investigator: Donald B. Wender
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4126 N. Holland Sylvania Road, Suite 105
Toledo, Ohio 43623
419-479-5605
Principal Investigator: Rex B. Mowat
Toledo Clinic Cancer Centers-Toledo Our doctors evaluate and make recommendations regarding cancer treatment for newly...
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