Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Initial Treatment of Advanced Ovarian Cancer
The safety of KYXATA in combination with cyclophosphamide for initial treatment of advanced ovarian cancer was evaluated in two randomized controlled studies conducted by NCIC and SWOG [see Clinical Studies (14.1)]. Patients in the carboplatin arm received carboplatin in combination with cyclophosphamide and patients in the active-comparator arm received cisplatin in combination with cyclophosphamide.
Tables 3 and 4 summarize the adverse reactions and laboratory abnormalities in the NCIC study, respectively.
Table 3: Adverse Reactions (≥ 5%) in Patients with Advanced Ovarian Cancer - NCIC Study |
Adverse Reaction
| Carboplatin in combination with cyclophosphamide (N=224) (%)*
| Cisplatin in combination with cyclophosphamide (N=223) (%)*
|
Gastrointestinal (GI)
|
Nausea and vomiting
| 93
| 98
|
Vomiting
| 84
| 97
|
Other GI adverse reactions
| 50
| 62
|
Mucositis
| 10
| 9
|
Skin and Subcutaneous Tissue
|
Alopecia
| 50
| 62
|
General
|
Asthenia
| 40
| 33
|
Pain
| 36
| 37
|
Cardiovascular
| 15
| 19
|
Infection
| 14
| 12
|
Hypersensitivity
| 12
| 9
|
Hemorrhage
| 10
| 4
|
Genitourinary
| 10
| 10
|
Respiratory
| 8
| 9
|
Neurologic
|
Central neurotoxicity
| 28
| 40
|
Peripheral neuropathies
| 16
| 42
|
Ototoxicity
| 13
| 33
|
Other sensory disorders
| 6
| 10
|
Table 4: Laboratory Abnormalities in Patients with Advanced Ovarian Cancer - NCIC Study |
Laboratory Abnormality
| Carboplatin in combination with cyclophosphamide (N=224)*
| Cisplatin in combination with cyclophosphamide (N=223)*
|
(%)
| (%)
|
Hematology
|
Decreased neutrophils <2000 cells/mm3
| 97
| 96
|
Decreased neutrophils <1000 cells/mm3
| 81
| 79
|
Decreased hemoglobin <11 g/dL
| 91
| 91
|
Decreased hemoglobin <8 g/dL
| 18
| 12
|
Decreased platelets <100,000/mm3
| 70
| 29
|
Decreased platelets <50,000/mm3
| 41
| 6
|
Chemistry
|
Decreased magnesium
| 63
| 88
|
Increased blood urea nitrogen
| 17
| 31
|
Increased AST
| 17
| 13
|
Decreased potassium
| 16
| 22
|
Decreased calcium
| 16
| 19
|
Decreased sodium
| 10
| 20
|
Increased serum creatinine
| 5
| 13
|
Increased bilirubin
| 5
| 3
|
Tables 5 and 6 summarize the adverse reactions and laboratory abnormalities in the SWOG study, respectively.
Table 5: Adverse Reactions (≥ 5%) in Patients with Ovarian Cancer – SWOG Study |
Adverse Reaction
| Carboplatin in combination with cyclophosphamide (N=171) (%)*
| Cisplatin in combination with cyclophosphamide (N=171) (%)*
|
Gastrointestinal (GI)
|
Nausea and vomiting
| 94
| 96
|
Vomiting
| 82
| 91
|
Other GI side effects
| 40
| 48
|
General
|
Pain
| 54
| 52
|
Alopecia
| 43
| 57
|
Asthenia
| 43
| 46
|
Cardiovascular
| 23
| 30
|
Respiratory
| 12
| 11
|
Genitourinary
| 11
| 13
|
Hypersensitivity
| 10
| 11
|
Mucositis
| 6
| 11
|
Neurologic
|
Central neurotoxicity
| 23
| 29
|
Peripheral neuropathies
| 13
| 28
|
Ototoxicity
| 12
| 30
|
Other sensory side effects
| -
| 6
|
Table 6: Laboratory Abnormalities in Patients with Advanced Ovarian Cancer - SWOG Study |
Laboratory Abnormality
| Carboplatin in combination with cyclophosphamide (N=171) (%)*
| Cisplatin in combination with cyclophosphamide (N=171) (%)*
|
Hematology
|
Decreased neutrophils <2000 cells/mm3
| 95
| 97
|
Decreased neutrophils <1000 cells/mm3
| 84
| 78
|
Decreased hemoglobin <11 g/dL
| 88
| 87
|
Decreased hemoglobin <8 g/dL
| 8
| 24
|
Decreased platelets <100,000/mm3
| 59
| 35
|
Decreased platelets <50,000/mm3
| 22
| 11
|
Chemistry
|
Decreased magnesium
| 58
| 77
|
Increased alkaline phosphatase
| 29
| 20
|
Increased AST
| 23
| 16
|
Increased serum creatinine
| 7
| 38
|
Increased bilirubin
| 5
| -
|
Recurrent Ovarian Cancer
The safety of carboplatin as a single agent for patients with ovarian carcinoma recurrent after prior chemotherapy was evaluated in two prospective, randomized controlled studies [see Clinical Studies (14.2)].
Tables 7 and 8 summarize the adverse reactions and laboratory abnormalities from these studies, respectively
Table 7: Adverse Reactions (≥5%) in Patients Treated with Carboplatin (Single-agent) for Advanced Ovarian Cancer in Two Controlled Studies Adverse Reaction
| Carboplatin as a Second Line Single-Agent Therapy N=553 (%)
|
Gastrointestinal (GI)
|
Nausea and vomiting
| 92
|
Vomiting
| 81
|
Other GI side effects
| 21
|
Neurologic
| |
Pain
| 23
|
Asthenia
| 11
|
Peripheral neuropathies
| 6
|
Central neurotoxicity
| 5
|
General
|
Cardiovascular
| 6
|
Respiratory
| 6
|
Infections
| 5
|
Bleeding
| 5
|
Clinically relevant adverse reactions in < 5% of patients who received carboplatin included allergic reactions, alopecia, mucositis, ototoxicity, and sensory disorders.
Table 8: Laboratory Abnormalities in Patients Treated with Carboplatin as a Single-agent for Secondary Treatment of Advanced Ovarian Cancer in Two Prospective, Randomized Controlled Studies Laboratory Abnormality
| Carboplatin as a Second Line Single-Agent Therapy N=553 (%)
|
Hematology
|
Decreased hemoglobin <11 g/dL
| 90
|
Decreased hemoglobin <8 g/dL
| 21
|
Decreased neutrophils <2000 cells/mm3
| 67
|
Decreased neutrophils <1000 cells/mm3
| 21
|
Decreased platelets <100,000/mm3
| 62
|
Decreased platelets <50,000/mm3
| 35
|
Chemistry
|
Decreased sodium
| 47
|
Decreased magnesium
| 43
|
Increased alkaline phosphatase
| 37
|
Decreased calcium
| 31
|
Decreased potassium
| 28
|
Increased blood urea
| 22
|
Increased AST
| 19
|
Increased serum creatinine
| 10
|
Increased bilirubin
| 5
|
Other Clinical Trials Experience
The following adverse reactions occurred in patients treated with carboplatin for ovarian cancer as a single agent or in combination with chemotherapy in clinical trials:
The following adverse reactions occurred in patients (n=1893) with solid tumors or hematological malignancies treated with single agent carboplatin in clinical trials:
Gastrointestinal Disorders: diarrhea (6%), constipation (6%), dysgeusia (1%)
Ocular Disorders: visual disturbances (1%).
The following adverse reactions occurred in patients treated with carboplatin for ovarian cancer in combination with chemotherapy in clinical trials:
Cardiovascular: arterial thromboembolic event, venous thromboembolic event
General: fatigue, febrile neutropenia
Musculoskeletal and Connective Tissue Disorders: fistula, wound-healing complication
Renal and Urinary Disorders: proteinuria
Respiratory: dyspnea