evt_NCT02154529_v22_v23_987176824384

{
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    "/protocolSection/eligibilityModule/eligibilityCriteria",
    "/annotationSection",
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  ],
  "citation_text": "TrialDiff Evidence Record evt_NCT02154529_v22_v23_987176824384. ClinicalTrials.gov NCT02154529, versions 22-23. Evidence version 1.",
  "claims_not_supported": [
    "That the amendment was scientifically unjustified.",
    "That the change constitutes misconduct or wrongdoing.",
    "That sponsor intent can be inferred from this registry change.",
    "That the change caused or altered the trial's results.",
    "That the change was or was not disclosed in a manuscript.",
    "That TrialDiff determines regulatory compliance or non-compliance.",
    "That co-occurrence with results posting proves the outcome edit was harmless, administrative, or substantively benign.",
    "That event-class membership is a validated global review-priority ranking."
  ],
  "claims_supported": [
    "TrialDiff compared ClinicalTrials.gov record version 22 to version 23 for NCT02154529.",
    "The JSON Patch for this comparison has hash fca516ac36ad67f169765445213a90d380e28733b875606207f9c7f361a35f47.",
    "The active deterministic rule set hash was 318445b9ad266f51fd10ef378645c753ba7a098e3e4395c3c457750dc5f88d86.",
    "The deterministic triage label was high; before timing adjustment it was high.",
    "The triage label is uncalibrated metadata, not a validated review-priority finding.",
    "The patch satisfied these deterministic event-class predicates: outcome_edit_cooccurs_with_results_posting, secondary_outcome_removed_after_primary_completion.",
    "A registry field under the study design module changed between ClinicalTrials.gov versions 22 and 23.",
    "The timing context for the from-version record was post_recruitment.",
    "The deterministic rules that fired were: arms_or_interventions_change, design_info_change, eligibility_criteria_change.",
    "The changed JSON Pointer paths were: /protocolSection/statusModule/statusVerifiedDate, /protocolSection/statusModule/lastUpdateSubmitDate, /protocolSection/statusModule/lastUpdatePostDateStruct/date, /protocolSection/statusModule/resultsFirstSubmitDate, /protocolSection/statusModule/resultsFirstSubmitQcDate, /protocolSection/statusModule/resultsFirstPostDateStruct, /protocolSection/descriptionModule/detailedDescription, /protocolSection/designModule/designInfo/interventionModelDescription, /protocolSection/armsInterventionsModule/armGroups/0/label, /protocolSection/armsInterventionsModule/armGroups/0/description, /protocolSection/armsInterventionsModule/armGroups/1/label, /protocolSection/armsInterventionsModule/armGroups/1/description, /protocolSection/armsInterventionsModule/armGroups/2/label, /protocolSection/armsInterventionsModule/armGroups/2/description, /protocolSection/armsInterventionsModule/armGroups/3/label, /protocolSection/armsInterventionsModule/armGroups/3/description, /protocolSection/armsInterventionsModule/armGroups/4, /protocolSection/armsInterventionsModule/armGroups/4, /protocolSection/armsInterventionsModule/armGroups/4, /protocolSection/armsInterventionsModule/armGroups/4, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/0, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/1, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/2, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/3, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/0, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/1, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/2, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/3, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4, /protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4, /protocolSection/outcomesModule/primaryOutcomes/0/measure, /protocolSection/outcomesModule/primaryOutcomes/0/description, /protocolSection/outcomesModule/primaryOutcomes/0/timeFrame, /protocolSection/outcomesModule/primaryOutcomes/1, /protocolSection/outcomesModule/secondaryOutcomes/0/measure, /protocolSection/outcomesModule/secondaryOutcomes/0/description, /protocolSection/outcomesModule/secondaryOutcomes/0/timeFrame, /protocolSection/outcomesModule/secondaryOutcomes/1/measure, /protocolSection/outcomesModule/secondaryOutcomes/1/description, /protocolSection/outcomesModule/secondaryOutcomes/1/timeFrame, /protocolSection/outcomesModule/secondaryOutcomes/2/measure, /protocolSection/outcomesModule/secondaryOutcomes/2/description, /protocolSection/outcomesModule/secondaryOutcomes/2/timeFrame, /protocolSection/outcomesModule/secondaryOutcomes/3/measure, /protocolSection/outcomesModule/secondaryOutcomes/3/description, /protocolSection/outcomesModule/secondaryOutcomes/3/timeFrame, /protocolSection/outcomesModule/secondaryOutcomes/4/measure, /protocolSection/outcomesModule/secondaryOutcomes/4/description, /protocolSection/outcomesModule/secondaryOutcomes/4/timeFrame, /protocolSection/outcomesModule/secondaryOutcomes/5, /protocolSection/outcomesModule/otherOutcomes, /protocolSection/eligibilityModule/eligibilityCriteria, /annotationSection, /hasResults, /resultsSection.",
    "An outcome path changed between versions 22 and 23 in a patch that also carried a hasResults or resultsSection co-occurrence signal.",
    "The JSON Patch removed a whole secondary outcome item after primary completion between versions 22 and 23; when a TO-version outcome list is available, reindex-only removals are excluded."
  ],
  "classification": {
    "calibration_status": "uncalibrated",
    "categories": [
      "design_change",
      "arm_intervention_change",
      "eligibility_change",
      "results_reconciliation"
    ],
    "category": "design_change",
    "deterministic_rules": [
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      "design_info_change",
      "eligibility_criteria_change"
    ],
    "event_class_rule_set_hash": "07957f8b90549d4f42387f51b471ecde9901b6db63bbc27b84c73631603407c0",
    "event_classes": [
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      "secondary_outcome_removed_after_primary_completion"
    ],
    "rule_set_hash": "318445b9ad266f51fd10ef378645c753ba7a098e3e4395c3c457750dc5f88d86",
    "severity": "high",
    "severity_pre_timing": "high",
    "timing_context": "post_recruitment",
    "triage_label": "high",
    "triage_rule_set_hash": "af5e5835e00a5fcfe2a17fd02b5fc244c2564104f93f78a1d77d7889f12a178b",
    "value_signals": [
      {
        "category": "results_reconciliation",
        "paths": [
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          "/protocolSection/outcomesModule/primaryOutcomes/0/measure",
          "/protocolSection/outcomesModule/primaryOutcomes/0/timeFrame",
          "/protocolSection/outcomesModule/primaryOutcomes/1",
          "/protocolSection/outcomesModule/secondaryOutcomes/0/description",
          "/protocolSection/outcomesModule/secondaryOutcomes/0/measure",
          "/protocolSection/outcomesModule/secondaryOutcomes/0/timeFrame",
          "/protocolSection/outcomesModule/secondaryOutcomes/1/description",
          "/protocolSection/outcomesModule/secondaryOutcomes/1/measure",
          "/protocolSection/outcomesModule/secondaryOutcomes/1/timeFrame",
          "/protocolSection/outcomesModule/secondaryOutcomes/2/description",
          "/protocolSection/outcomesModule/secondaryOutcomes/2/measure",
          "/protocolSection/outcomesModule/secondaryOutcomes/2/timeFrame",
          "/protocolSection/outcomesModule/secondaryOutcomes/3/description",
          "/protocolSection/outcomesModule/secondaryOutcomes/3/measure",
          "/protocolSection/outcomesModule/secondaryOutcomes/3/timeFrame",
          "/protocolSection/outcomesModule/secondaryOutcomes/4/description",
          "/protocolSection/outcomesModule/secondaryOutcomes/4/measure",
          "/protocolSection/outcomesModule/secondaryOutcomes/4/timeFrame",
          "/protocolSection/outcomesModule/secondaryOutcomes/5"
        ],
        "severity": "low",
        "signal": "results_reconciliation_outcome_suppression"
      }
    ]
  },
  "event_id": "evt_NCT02154529_v22_v23_987176824384",
  "evidence_version": 1,
  "patch": [
    {
      "op": "replace",
      "path": "/protocolSection/statusModule/statusVerifiedDate",
      "value": "2022-02"
    },
    {
      "op": "replace",
      "path": "/protocolSection/statusModule/lastUpdateSubmitDate",
      "value": "2022-02-28"
    },
    {
      "op": "replace",
      "path": "/protocolSection/statusModule/lastUpdatePostDateStruct/date",
      "value": "2022-03-24"
    },
    {
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      "value": "2022-01-04"
    },
    {
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      "value": "2022-02-28"
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    {
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      "value": {
        "date": "2022-03-24",
        "type": "ACTUAL"
      }
    },
    {
      "op": "add",
      "path": "/protocolSection/descriptionModule/detailedDescription",
      "value": "<p>This is a multicenter, Phase 1b&#x2F;2a, multiple ascending-dose, open-label study designed to assess the safety, tolerability, and efficacy of tesevatinib (KD019) in combination with trastuzumab in subjects with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer.\nThe study planned to include a Phase 2a expansion in which approximately 50 subjects would receive tesevatinib at the maximum tolerated dose (MTD) dose determined in Phase 1b.</p><p>The study employs a successive cohort dose-escalation designed to determine the MTD of tesevatinib in combination with trastuzumab.\nThe MTD dose is defined as the dose level below in which : (a) 2 of 3 subjects (or 2 of 6 subjects if Grade ≥ 3 tesevatinib related treatment emergent adverse event [TEAE] experience in 1 of the first 3 subjects).</p><p>In the Phase 1b portion of the study, tesevatinib is to be administered orally (PO) to successive cohorts of subjects at 150 mg, 250 mg, 300 mg, 350 mg, and 400 mg once daily (QD).</p><p>The following 4 dossing cohorts are initiated during the study:</p><ul><li>Cohort 1: 150 mg tesevatinib PO QD</li><li>Cohort 2: 250 mg tesevatinib PO QD</li><li>Cohort 3: 300 mg tesevatinib PO QD</li><li>Cohort 4: 350 mg tesevatinib PO QD</li></ul><p>[Note: the sponsor suspended the study before a cohort of subjects were enrolled at tesevatinib 400 mg PO QD.]</p><p>Trastuzumab is administered intravenously (IV) at 8 mg&#x2F;kg as an initial loading dose on Day 1 of Cycle 1, followed by 6 mg&#x2F;kg IV every 3 weeks thereafter, beginning Day 1 of Cycle 2. Subjects entering the study already on trastuzumab are not to receive the initial loading dose and instead receive trastuzumab 6 mg&#x2F;kg IV.\nThe first doses of trastuzumab and tesevatinib are administered in the clinic on Study Day 1. Subsequent doses of tesevatinib are to be taken on an outpatient basis for the remainder of each 21-day cycle.\nDuring Cycle 1, subjects are to be returned to the clinic for weekly safety and tolerability assessments.</p><p>Tumor response, both in the central nervous system (CNS) and peripheral to the CNS, is to be assessed after the second cycle of treatment and then at the end of every 2 cycles of treatment thereafter.\nSubjects are to be treated until disease progression or the subject experienced unacceptable toxicity.\nSubjects who demonstrated tumor progression are to stop study drug and followed for survival.\nAll subjects discontinuing tesevatinib therapy are to be followed for survival.</p><p>Safety assessments include adverse event monitoring, electrocardiograms (ECGs), laboratory testing, physical examinations, vital signs, and pregnancy testing.</p><p>An End-of-Treatment visit is to be conducted as soon as possible after the subject&#x27;s last dose of study drug.\nThis could occur at the visit when disease progression is diagnosed.\nSubjects are to be followed for disease progression and survival.</p><p>A follow-up visit planned for 30 days (± 5 days) after the last dose of study drug assessments is to include collection of AE (Adverse Event) and concomitant medication data.\nThis visit could occur prior to 30 days if a new therapy is started within 30 days of last dose of study drug.</p><p>For long-term follow-up, subjects are to be contacted by telephone every 8 weeks to assess survival status and any subsequent anti-cancer treatment.</p><p>The duration of treatment for subjects with tesevatinib in combination with trastuzumab is planned until the subject experiences disease progression or unacceptable toxicity.</p><p>[Note: Changes to the Planned Analysis: The study, planned to include a Phase 2a expansion in which approximately 50 subjects would have received tesevatinib at the MTD dose determined in Phase 1b, was terminated early.\nAlthough some patients had prolonged stable disease in the study, no clear treatment responses were observed.\nThe sponsor decided to suspend the study while gathering additional data from other tesevatinib oncology studies.\nThe study was subsequently terminated early because the sponsor stopped evaluations of tesevatinib as a treatment for HER2-positive metastatic breast cancer.]</p>"
    },
    {
      "op": "replace",
      "path": "/protocolSection/designModule/designInfo/interventionModelDescription",
      "value": "A phase 1b ascending dose-finding study for establishing the maximum tolerated dose (MTD) of tesevatinib (with trastuzumab)."
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/0/label",
      "value": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/0/description",
      "value": "Tesevatinib in combination with Trastuzumab: tesevatinib 150 mg PO QD in combination with trastuzumab 8 mg&#x2F;kg IV initially then 6 mg&#x2F;kg IV every 3 weeks thereafter."
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/1/label",
      "value": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/1/description",
      "value": "Tesevatinib in combination with Trastuzumab: tesevatinib 250 mg PO QD in combination with trastuzumab 8 mg&#x2F;kg IV initially then 6 mg&#x2F;kg IV every 3 weeks thereafter."
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/2/label",
      "value": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/2/description",
      "value": "Tesevatinib in combination with Trastuzumab: tesevatinib 300 mg PO QD in combination with trastuzumab 8 mg&#x2F;kg IV initially then 6 mg&#x2F;kg IV every 3 weeks thereafter."
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/3/label",
      "value": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/armGroups/3/description",
      "value": "Tesevatinib in combination with Trastuzumab: tesevatinib 350 mg PO QD in combination with trastuzumab 8 mg&#x2F;kg IV initially then 6 mg&#x2F;kg IV every 3 weeks thereafter."
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/armGroups/4"
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/armGroups/4"
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    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/armGroups/4"
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/armGroups/4"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/0",
      "value": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/1",
      "value": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/2",
      "value": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/3",
      "value": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4"
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    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4"
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    {
      "op": "remove",
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    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/4"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/0",
      "value": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/1",
      "value": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/2",
      "value": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "replace",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/3",
      "value": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4"
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    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4"
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    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4"
    },
    {
      "op": "remove",
      "path": "/protocolSection/armsInterventionsModule/interventions/1/armGroupLabels/4"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/primaryOutcomes/0/measure",
      "value": "Safety and Tolerability: Percentage of Subjects With Treatment Emergent Adverse Events (TEAEs) by Severity and&#x2F;or Relationship to Tesevatinib"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/primaryOutcomes/0/description",
      "value": "Percentage of subjects with at least 1 treatment-emergent adverse event of Grade 3 or greater or relationship with tesevatinib.\nTEAE grading was by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) where Grade 3 is severe and Grade 4 is life-threatening.\nTEAEs were considered related to study drug if the investigator assessed them as possibly related, probably related, or related."
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/primaryOutcomes/0/timeFrame",
      "value": "Up to 8 months: 1 month (28 days) Screening + 6 months treatment + 1 month follow-up"
    },
    {
      "op": "add",
      "path": "/protocolSection/outcomesModule/primaryOutcomes/1",
      "value": {
        "description": "Percentage of subjects with at least 1 serious adverse event considered related to study drug.\nSAEs were considered related to tesevatinib drug if the investigator assessed them as possibly related, probably related, or related.",
        "measure": "Safety and Tolerability: Percentage of Subjects With Serious Adverse Event (SAE) Related to Tesevatinib",
        "timeFrame": "Up to 8 months: 1 month (28 days) Screening + 6 months treatment + 1 month follow-up"
      }
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/0/measure",
      "value": "Pharmacokinetics (PK): Mean Serum Cmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/0/description",
      "value": "The mean of the maximum serum concentration (Cmax) for the combination of tesevatinib and trastuzumab after 1 cycle (Cycle 2 Day 1)."
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/0/timeFrame",
      "value": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/1/measure",
      "value": "Pharmacokinetics: Median Serum Tmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/1/description",
      "value": "The median time of the maximum serum concentration (Tmax) for the combination of tesevatinib and trastuzumab after 1 cycle (Cycle 2 Day 1)"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/1/timeFrame",
      "value": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/2/measure",
      "value": "Pharmacokinetics: Mean Serum AUC(0-t) (Area Under Curve) of Treatment With Tesevatinib + Trastuzumab"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/2/description",
      "value": "The mean area under the concentration-time curve during the period from 0 to a given time point &#x27;t&#x27; in the tesevatinib 150 mg QD, 250 mg QD, and 300 mg QD cohorts."
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/2/timeFrame",
      "value": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/3/measure",
      "value": "Pharmacokinetics: Mean AR Cmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/3/description",
      "value": "<p>The mean of the arithmetic mean accumulation ratio (AR) of the maximum concentration of tesevatinib.\nThe AR is defined as:</p><p>Cmax for Cycle 2 divided by Cmax of Cycle 1.</p>"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/3/timeFrame",
      "value": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/4/measure",
      "value": "Pharmacokinetics: Mean AR AUC(0-24hr) After 1 Cycle of Treatment With Tesevatinib + Trastuzumab"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/4/description",
      "value": "<p>The mean of the arithmetic mean accumulation ratio (AR) of the area under the concentration-time curve from 0 to 24 hours.\nThe AR is defined as:</p><p>AUC(0-24hr) for Cycle 2 divided by AUC(0-24hr) for Cycle 1.</p>"
    },
    {
      "op": "replace",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/4/timeFrame",
      "value": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1"
    },
    {
      "op": "remove",
      "path": "/protocolSection/outcomesModule/secondaryOutcomes/5"
    },
    {
      "op": "remove",
      "path": "/protocolSection/outcomesModule/otherOutcomes"
    },
    {
      "op": "replace",
      "path": "/protocolSection/eligibilityModule/eligibilityCriteria",
      "value": "<p>Inclusion Criteria</p><p>Subjects will be included if they meet the following criteria:</p><ol><li>Female ≥ 18 years old.</li><li>Females with histologically or cytologically confirmed HER2-positive breast cancer.\nHER2 positive is defined as 3+ staining by immunohistochemistry, or HER2 gene amplification by fluorescent in situ hybridization (FISH) or silver in situ hybridization (SISH) with HER2&#x2F;CEP17 ratio ≥ 2.0.</li><li>Metastatic disease that has progressed on previous therapy or previous therapy was not tolerated.</li><li><p>Subjects in the Phase 1b portion of the study and in Group 1 and Group 3 of the Phase 2a portion of the study may have received any number of prior therapies for breast cancer.\nSubjects in Group 2 of the Phase 2a portion of the study may have received up to 3 lines of therapy in the metastatic setting (not including adjuvant or neoadjuvant therapy).</p><ol><li>Previous therapies must have included trastuzumab, pertuzumab, and trastuzumab emtansine.\nHowever, subjects starting initial systemic therapy for HER2-positive breast cancer prior to June 2012, when pertuzumab was approved for initial treatment of patients with HER2-positive breast cancer, are not required to have had pertuzumab.</li><li>If the subject has ER+ breast cancer, prior therapy must have included at least 1 hormonal therapy.</li><li>Subjects with asymptomatic brain metastases found on screening MRI may be entered into Phase 1b or into Group 2 of the Phase 2a without prior radiation therapy to the brain.\nSubjects with minimally symptomatic brain metastases found on screening MRI may be entered into Phase 1b or into Group 2 of the Phase 2a without prior radiation therapy to the brain if they do not require immediate surgical or radiation therapy in the opinion of the treating investigator and in the opinion of a radiation therapy or neurosurgical consultant.</li><li>Subjects with brain metastases that are progressing in the brain after radiation therapy are eligible for enrollment in both Phase 1b and Group 1 of the Phase 2a, provided that there has been no further local therapy for the progressing brain metastases.\nThese subjects must have previously received trastuzumab, pertuzumab (if received initial systemic therapy for HER2-positive breast cancer prior to June 2012 when pertuzumab was approved for initial systemic therapy of HER2-positive, metastatic breast cancer), and trastuzumab emtansine.</li><li>Subjects with leptomeningeal metastases may or may not have brain metastases.\nWhen brain metastases are present, they do not need to have progressed after radiation therapy.</li></ol></li><li>Subjects with disease progression in the brain after prior brain radiation therapy may have extra-CNS metastases in any location or may have no extra-CNS metastases.</li><li><p>At least 1 measurable breast cancer lesion that is ≥ 10 mm in one dimension (or</p><p>≥ 15 mm in shortest axis for lymph nodes) by spiral CT scan or by brain MRI.\nAll brain metastases should be evaluated by T1-weighted, gadolinium-enhanced magnetic resonance imaging (MRI).\nSubjects with leptomeningeal metastases (Group 3) are not required to have measurable disease but must have cytologic confirmation of leptomeningeal disease.</p></li><li>Trastuzumab therapy and hormonal therapy for breast cancer treatment started prior to study entry may be continued.\nHowever, previous chemotherapy (including antibodies other than trastuzumab) for breast cancer treatment must have been discontinued at least 14 days before the start of study treatment.\nSurgical procedures other than port placement must have been performed at least 14 days prior to the start of study treatment.\nSubjects must have recovered from the reversible effects of prior breast cancer treatments, including surgery and radiation therapy (excluding alopecia).</li><li>No increase in corticosteroid dose during the week prior to screening brain MRI.</li><li>No history of another malignancy in the past 5 years, except treated non-melanoma skin cancer or superficial bladder cancer or carcinoma-in-situ of the cervix.</li><li>ECOG (Eastern Cooperative Oncology Group) status of ≤ 1 (see Appendix C).\nHowever, subjects in Group 3 (leptomeningeal metastases) require ECOG status of ≤ 2.</li><li>Adequate organ and bone marrow functions as follows: (a) Serum creatinine ≤ 1.5 mg&#x2F;dL; (b) total bilirubin ≤ 1.5 × upper limit of normal (ULN); (c) alanine aminotransferase and aspartate aminotransferase ≤ 3× ULN; (d) white blood cell count &gt; 3000&#x2F;mm^3; (e) absolute neutrophil count ≥ 1500&#x2F;mm^3; (f) platelet count &gt; 100,000&#x2F;mm^3; and (g) hemoglobin &gt; 8 g&#x2F;dL</li><li>Serum potassium and magnesium levels within normal limits (WNL).</li><li>Cardiac ejection fraction WNL as measured by echocardiogram, as long as lower limit of normal (LLN) at the institution is ≥ 50%.</li><li>No coexisting medical problems of sufficient severity to limit compliance with the study.</li><li>Willing and able to sign written informed consent and be able to comply with the study protocol for the duration of the study.</li><li>Women of childbearing potential (ie, menstruating women) must have a negative urine pregnancy test (positive urine tests are to be confirmed by serum test).\nSexually active women of childbearing potential enrolled in the study must agree to use 2 forms of accepted methods of contraception during the course of the study and for 3 months after their last dose of study drug.\nEffective birth control includes: (a) Intrauterine Device (IUD) plus 1 barrier method; (b) on stable doses of hormonal contraception for at least 3 months (eg, oral, injectable, implant, transdermal) plus 1 barrier method; (c) 2 barrier methods where effective barrier methods are male or female condoms, diaphragms, and spermicides (creams or gels that contain a chemical to kill sperm); or (d) a vasectomized partner.</li></ol><p>Exclusion Criteria</p><p>A subject who meets any of the following criteria is ineligible for entry into the study:</p><ol><li>Any concurrent therapy for breast cancer other than the specified treatment in this study.\nConcurrent treatment with bisphosphonates or denosumab is allowed, if started prior to the start of tesevatinib administration.</li><li>Cerebrospinal fluid (CSF) cytology positive for malignant cells or symptomatic leptomeningeal carcinomatosis in the Phase 1b portion of the study.\nNote: In Group 3 of the Phase 2a portion of the study, subjects are required to have CSF cytology positive for malignant cells.</li><li>Taking any medication known to inhibit the CYP3A4 isozyme or any drugs that are CYP3A4 inducers (including phenytoin), or any drugs associated with torsades de pointes or known to prolong the QTc(f) interval, including anti-arrhythmic medications within 2 weeks prior to Day 1 of treatment in the study.\nA stable regimen (≥ 4 weeks) of antidepressants of the SSRI(selective serotonin reuptake inhibitor) class is allowed (common SSRIs include escitalopram oxalate, citalopram, fluvoxamine, paroxetine, sertraline, and fluoxetine).</li><li>Has evidence of active heart disease such as myocardial infarction within the 3 months prior to study entry; symptomatic coronary insufficiency or heart block; congestive heart failure; moderate or severe pulmonary dysfunction.</li><li>History of torsades de pointes, ventricular tachycardia or fibrillation, pathologic sinus bradycardia (&lt; 50 bpm), heart block (excluding first degree block, being PR(partial response) interval only), or congenital long QT syndrome.\nSubjects with a history of atrial arrhythmias should be discussed with the medical monitor.</li><li>Has an active infectious process.</li><li>Female subject who is pregnant or lactating.</li><li>Known contraindication to MRI, such as cardiac pacemaker, shrapnel, or ocular foreign body.</li><li>Has had major surgery without full recovery.</li><li>Has marked prolongation of QTc interval at screening or baseline (QTc interval &gt; 470 msec) using the Fridericia method of correction for heart rate.</li><li>History of gastrointestinal (GI) condition that might interfere with drug absorption</li></ol>"
    },
    {
      "op": "remove",
      "path": "/annotationSection"
    },
    {
      "op": "replace",
      "path": "/hasResults",
      "value": true
    },
    {
      "op": "add",
      "path": "/resultsSection",
      "value": {
        "adverseEventsModule": {
          "description": "<p>The Medical Dictionary of Regulatory Activities Summary of Classifications and Preferred Terms was used to describe AEs.</p><p>The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE; Version 4.03) was used for grading toxicities.\nSerious adverse events included those with Grade 4, life-threatening.</p>",
          "eventGroups": [
            {
              "deathsNumAffected": 1,
              "deathsNumAtRisk": 4,
              "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzunab every 3 weeks",
              "id": "EG000",
              "otherNumAffected": 4,
              "otherNumAtRisk": 4,
              "seriousNumAffected": 0,
              "seriousNumAtRisk": 4,
              "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "deathsNumAffected": 1,
              "deathsNumAtRisk": 3,
              "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzunab every 3 weeks",
              "id": "EG001",
              "otherNumAffected": 3,
              "otherNumAtRisk": 3,
              "seriousNumAffected": 1,
              "seriousNumAtRisk": 3,
              "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "deathsNumAffected": 5,
              "deathsNumAtRisk": 8,
              "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "EG002",
              "otherNumAffected": 8,
              "otherNumAtRisk": 8,
              "seriousNumAffected": 5,
              "seriousNumAtRisk": 8,
              "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "deathsNumAffected": 1,
              "deathsNumAtRisk": 2,
              "description": "Tesevatinib 350 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "EG003",
              "otherNumAffected": 2,
              "otherNumAtRisk": 2,
              "seriousNumAffected": 1,
              "seriousNumAtRisk": 2,
              "title": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "deathsNumAffected": 8,
              "deathsNumAtRisk": 17,
              "description": "Combination of subjects in Cohorts 1, 2, 3, and 4",
              "id": "EG004",
              "otherNumAffected": 17,
              "otherNumAtRisk": 17,
              "seriousNumAffected": 7,
              "seriousNumAtRisk": 17,
              "title": "All Patients"
            }
          ],
          "frequencyThreshold": "0",
          "otherEvents": [
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 3,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 2,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 7,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 2,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 14,
                  "numAtRisk": 17
                }
              ],
              "term": "Diarrhea"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 2,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 3,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 1,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 7,
                  "numAtRisk": 17
                }
              ],
              "term": "Nausea"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 2,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 5,
                  "numAtRisk": 17
                }
              ],
              "term": "Vomiting"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 2,
                  "numAtRisk": 17
                }
              ],
              "term": "Constipation"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 2,
                  "numAtRisk": 17
                }
              ],
              "term": "Dyspepsia"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 1,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Abdominal pain"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Dry mouth"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 1,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Duodenal ulcer"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Flatulence"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Gastritis"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Hemorrhoids"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 1,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Esophageal stenosis"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 0,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Oral pain"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Gastrointestinal disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 0,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 0,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Stomatitis"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Skin and subcutaneous tissue disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 2,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 3,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 3,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 1,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 9,
                  "numAtRisk": 17
                }
              ],
              "term": "Dermatitis acneiform"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Skin and subcutaneous tissue disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 3,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 5,
                  "numAtRisk": 17
                }
              ],
              "term": "Rash"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Skin and subcutaneous tissue disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 2,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 4,
                  "numAtRisk": 17
                }
              ],
              "term": "Pruritus"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Skin and subcutaneous tissue disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
                {
                  "groupId": "EG000",
                  "numAffected": 1,
                  "numAtRisk": 4
                },
                {
                  "groupId": "EG001",
                  "numAffected": 1,
                  "numAtRisk": 3
                },
                {
                  "groupId": "EG002",
                  "numAffected": 1,
                  "numAtRisk": 8
                },
                {
                  "groupId": "EG003",
                  "numAffected": 0,
                  "numAtRisk": 2
                },
                {
                  "groupId": "EG004",
                  "numAffected": 3,
                  "numAtRisk": 17
                }
              ],
              "term": "Dry skin"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Skin and subcutaneous tissue disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG004",
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              "term": "Erythema"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG004",
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              "term": "Ingrowing nail"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG004",
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              "term": "Rash maculopapular"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Rash pruritic"
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Skin exfoliation"
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                  "groupId": "EG004",
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              "term": "Sunburn"
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
                  "numAffected": 5,
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              "term": "Fatigue"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Asthenia"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Non-cardiac chest pain"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG001",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Catheter site erythema"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG000",
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                  "groupId": "EG002",
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                  "groupId": "EG003",
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                  "groupId": "EG004",
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              "term": "Chills"
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                  "groupId": "EG004",
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              "term": "Face edema"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG004",
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              "term": "Influenza-like illness"
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                  "groupId": "EG004",
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              "term": "Pain"
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                  "groupId": "EG004",
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              "term": "Temperature intolerance"
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                  "groupId": "EG000",
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                  "groupId": "EG004",
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                  "groupId": "EG004",
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                  "groupId": "EG004",
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              "term": "Electrocardiogram QT prolonged"
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                  "groupId": "EG004",
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              "term": "Transaminases increased"
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              "term": "Hypomagnesemia"
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                  "groupId": "EG004",
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              "term": "Dehydration"
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              "term": "Hypokalemia"
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                  "groupId": "EG004",
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              "term": "Hyperuricemia"
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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                  "groupId": "EG004",
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              "assessmentType": "SYSTEMATIC_ASSESSMENT",
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              "term": "Diarrhea"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Metabolism and nutrition disorders",
              "sourceVocabulary": "MedDRA (13.0)",
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                  "groupId": "EG004",
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              ],
              "term": "Dehydration"
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            {
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              ],
              "term": "Brain edema"
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              ],
              "term": "Headache"
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              ],
              "term": "Metastases to Central Nervous System"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Cardiac disorders",
              "sourceVocabulary": "MedDRA (13.0)",
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                  "groupId": "EG004",
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                  "numAtRisk": 17
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              ],
              "term": "Cardiac arrest"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Infections and infestations",
              "sourceVocabulary": "MedDRA (13.0)",
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                  "groupId": "EG004",
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                  "numAtRisk": 17
                }
              ],
              "term": "Gastroenteritis viral"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Investigations",
              "sourceVocabulary": "MedDRA (13.0)",
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                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Blood bilirubin incrased"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Investigations",
              "sourceVocabulary": "MedDRA (13.0)",
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                },
                {
                  "groupId": "EG004",
                  "numAffected": 1,
                  "numAtRisk": 17
                }
              ],
              "term": "Transaminase increased"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Psychiatric disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
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                },
                {
                  "groupId": "EG004",
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                  "numAtRisk": 17
                }
              ],
              "term": "Mental status changes"
            },
            {
              "assessmentType": "SYSTEMATIC_ASSESSMENT",
              "organSystem": "Renal and urinary disorders",
              "sourceVocabulary": "MedDRA (13.0)",
              "stats": [
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                },
                {
                  "groupId": "EG004",
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                  "numAtRisk": 17
                }
              ],
              "term": "Acute kidney injury"
            }
          ],
          "timeFrame": "Assessed up to 8 months: 1 month screening + 6 months treatment + 1 month follow-up"
        },
        "baselineCharacteristicsModule": {
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            {
              "description": "Total of all reporting groups",
              "id": "BG004",
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          ],
          "measures": [
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              "classes": [
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                      "measurements": [
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                          "groupId": "BG000",
                          "spread": "8.66",
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                          "value": "50.3"
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                          "groupId": "BG002",
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                          "value": "51.0"
                        },
                        {
                          "groupId": "BG003",
                          "spread": "2.12",
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                }
              ],
              "dispersionType": "STANDARD_DEVIATION",
              "paramType": "MEAN",
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              "unitOfMeasure": "years"
            },
            {
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                  "categories": [
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                      "measurements": [
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                          "groupId": "BG000",
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                      ],
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                    {
                      "measurements": [
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                          "groupId": "BG004",
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              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
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              "unitOfMeasure": "Participants"
            },
            {
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                          "groupId": "BG004",
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                      ],
                      "title": "Hispanic or Latino"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG000",
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                          "groupId": "BG003",
                          "value": "2"
                        },
                        {
                          "groupId": "BG004",
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                      ],
                      "title": "Not Hispanic or Latino"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG000",
                          "value": "0"
                        },
                        {
                          "groupId": "BG001",
                          "value": "0"
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                        {
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                          "groupId": "BG003",
                          "value": "0"
                        },
                        {
                          "groupId": "BG004",
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                      ],
                      "title": "Unknown or Not Reported"
                    }
                  ]
                }
              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
              "title": "Ethnicity (NIH&#x2F;OMB)",
              "unitOfMeasure": "Participants"
            },
            {
              "classes": [
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                  "categories": [
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                      "measurements": [
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                          "groupId": "BG000",
                          "value": "0"
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                          "groupId": "BG004",
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                      ],
                      "title": "American Indian or Alaska Native"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG004",
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                      ],
                      "title": "Asian"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG000",
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                        },
                        {
                          "groupId": "BG001",
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                        },
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                          "groupId": "BG004",
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                      ],
                      "title": "Native Hawaiian or Other Pacific Islander"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG000",
                          "value": "0"
                        },
                        {
                          "groupId": "BG001",
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                          "value": "1"
                        },
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                          "groupId": "BG004",
                          "value": "2"
                        }
                      ],
                      "title": "Black or African American"
                    },
                    {
                      "measurements": [
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                          "groupId": "BG000",
                          "value": "4"
                        },
                        {
                          "groupId": "BG001",
                          "value": "3"
                        },
                        {
                          "groupId": "BG002",
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                        },
                        {
                          "groupId": "BG003",
                          "value": "1"
                        },
                        {
                          "groupId": "BG004",
                          "value": "15"
                        }
                      ],
                      "title": "White"
                    },
                    {
                      "measurements": [
                        {
                          "groupId": "BG000",
                          "value": "0"
                        },
                        {
                          "groupId": "BG001",
                          "value": "0"
                        },
                        {
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                          "value": "0"
                        },
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                          "groupId": "BG003",
                          "value": "0"
                        },
                        {
                          "groupId": "BG004",
                          "value": "0"
                        }
                      ],
                      "title": "More than one race"
                    },
                    {
                      "measurements": [
                        {
                          "groupId": "BG000",
                          "value": "0"
                        },
                        {
                          "groupId": "BG001",
                          "value": "0"
                        },
                        {
                          "groupId": "BG002",
                          "value": "0"
                        },
                        {
                          "groupId": "BG003",
                          "value": "0"
                        },
                        {
                          "groupId": "BG004",
                          "value": "0"
                        }
                      ],
                      "title": "Unknown or Not Reported"
                    }
                  ]
                }
              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
              "title": "Race (NIH&#x2F;OMB)",
              "unitOfMeasure": "Participants"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
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                          "groupId": "BG000",
                          "value": "3"
                        },
                        {
                          "groupId": "BG001",
                          "value": "1"
                        },
                        {
                          "groupId": "BG002",
                          "value": "3"
                        },
                        {
                          "groupId": "BG003",
                          "value": "0"
                        },
                        {
                          "groupId": "BG004",
                          "value": "7"
                        }
                      ]
                    }
                  ],
                  "title": "Yes"
                },
                {
                  "categories": [
                    {
                      "measurements": [
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                          "groupId": "BG000",
                          "value": "1"
                        },
                        {
                          "groupId": "BG001",
                          "value": "2"
                        },
                        {
                          "groupId": "BG002",
                          "value": "5"
                        },
                        {
                          "groupId": "BG003",
                          "value": "2"
                        },
                        {
                          "groupId": "BG004",
                          "value": "10"
                        }
                      ]
                    }
                  ],
                  "title": "No"
                }
              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
              "title": "Childbearing potential",
              "unitOfMeasure": "Participants"
            }
          ],
          "populationDescription": "All subjects entered into study (Safety Population)"
        },
        "moreInfoModule": {
          "certainAgreement": {
            "otherDetails": "The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding results.\nThe sponsor cannot require changes to the study results in the communication except to remove sponsor&#x27;s confidential information.\nSponsor cannot unilaterally extend the embargo.",
            "piSponsorEmployee": false,
            "restrictionType": "OTHER",
            "restrictiveAgreement": true
          },
          "pointOfContact": {
            "email": "karin.herrera@kadmon.com",
            "organization": "Kadmon Corporation",
            "phone": "833-900-5366",
            "title": "Associate Vice President, Clinical Operations"
          }
        },
        "outcomeMeasuresModule": {
          "outcomeMeasures": [
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "value": "1"
                        },
                        {
                          "groupId": "OG001",
                          "value": "1"
                        },
                        {
                          "groupId": "OG002",
                          "value": "5"
                        },
                        {
                          "groupId": "OG003",
                          "value": "2"
                        },
                        {
                          "groupId": "OG004",
                          "value": "9"
                        }
                      ]
                    }
                  ],
                  "title": "Grade ≥ 3"
                },
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "value": "4"
                        },
                        {
                          "groupId": "OG001",
                          "value": "3"
                        },
                        {
                          "groupId": "OG002",
                          "value": "7"
                        },
                        {
                          "groupId": "OG003",
                          "value": "2"
                        },
                        {
                          "groupId": "OG004",
                          "value": "16"
                        }
                      ]
                    }
                  ],
                  "title": "Related to Tesevatinib"
                },
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "value": "1"
                        },
                        {
                          "groupId": "OG001",
                          "value": "1"
                        },
                        {
                          "groupId": "OG002",
                          "value": "2"
                        },
                        {
                          "groupId": "OG003",
                          "value": "2"
                        },
                        {
                          "groupId": "OG004",
                          "value": "6"
                        }
                      ]
                    }
                  ],
                  "title": "Grade ≥ 3 Related to Tesevatinib"
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              ],
              "denoms": [
                {
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                    {
                      "groupId": "OG000",
                      "value": "4"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "8"
                    },
                    {
                      "groupId": "OG003",
                      "value": "2"
                    },
                    {
                      "groupId": "OG004",
                      "value": "17"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "Percentage of subjects with at least 1 treatment-emergent adverse event of Grade 3 or greater or relationship with tesevatinib.\nTEAE grading was by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) where Grade 3 is severe and Grade 4 is life-threatening.\nTEAEs were considered related to study drug if the investigator assessed them as possibly related, probably related, or related.",
              "groups": [
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                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 350 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG003",
                  "title": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Combination of subjects in Cohorts 1, 2, 3, and 4",
                  "id": "OG004",
                  "title": "All Patients"
                }
              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
              "populationDescription": "All subjects who received at least 1 dose of study drug",
              "reportingStatus": "POSTED",
              "timeFrame": "Up to 8 months: 1 month (28 days) Screening + 6 months treatment + 1 month follow-up",
              "title": "Safety and Tolerability: Percentage of Subjects With Treatment Emergent Adverse Events (TEAEs) by Severity and&#x2F;or Relationship to Tesevatinib",
              "type": "PRIMARY",
              "unitOfMeasure": "Participants"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "value": "0"
                        },
                        {
                          "groupId": "OG001",
                          "value": "1"
                        },
                        {
                          "groupId": "OG002",
                          "value": "2"
                        },
                        {
                          "groupId": "OG003",
                          "value": "1"
                        },
                        {
                          "groupId": "OG004",
                          "value": "4"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "4"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "8"
                    },
                    {
                      "groupId": "OG003",
                      "value": "2"
                    },
                    {
                      "groupId": "OG004",
                      "value": "17"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "Percentage of subjects with at least 1 serious adverse event considered related to study drug.\nSAEs were considered related to tesevatinib drug if the investigator assessed them as possibly related, probably related, or related.",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 350 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG003",
                  "title": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Combination of subjects in Cohorts 1, 2, 3, and 4",
                  "id": "OG004",
                  "title": "All Patients"
                }
              ],
              "paramType": "COUNT_OF_PARTICIPANTS",
              "populationDescription": "All subjects who received at last 1 dose of study drug",
              "reportingStatus": "POSTED",
              "timeFrame": "Up to 8 months: 1 month (28 days) Screening + 6 months treatment + 1 month follow-up",
              "title": "Safety and Tolerability: Percentage of Subjects With Serious Adverse Event (SAE) Related to Tesevatinib",
              "type": "PRIMARY",
              "unitOfMeasure": "Participants"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "spread": "84.4",
                          "value": "276"
                        },
                        {
                          "groupId": "OG001",
                          "spread": "261",
                          "value": "614"
                        },
                        {
                          "groupId": "OG002",
                          "spread": "177",
                          "value": "394"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "3"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "7"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "The mean of the maximum serum concentration (Cmax) for the combination of tesevatinib and trastuzumab after 1 cycle (Cycle 2 Day 1).",
              "dispersionType": "Standard Deviation",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                }
              ],
              "paramType": "MEAN",
              "populationDescription": "Subjects who completed at least 1 cycle of study drug and had PK (pharmacokinetics) measurements performed on Cycle 2 Day 1. Stratified by tesevatinib dose level, not by initial 8 mg&#x2F;kg trastuzumab dosing level, i.e., 150 mg tesevatinib PO (by mouth) QD(once daily) &#x2F; 6 mg&#x2F;kg trastuzumab IV every 3 weeks.\nNote: Subjects in Cohort 350 mg tesevatinib received only 8 mg&#x2F;kg trastuzumab and so were not included in this analysis.",
              "reportingStatus": "POSTED",
              "timeFrame": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1",
              "title": "Pharmacokinetics (PK): Mean Serum Cmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab",
              "type": "SECONDARY",
              "unitOfMeasure": "ng&#x2F;mL"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "lowerLimit": "3.97",
                          "upperLimit": "4.00",
                          "value": "4.00"
                        },
                        {
                          "groupId": "OG001",
                          "lowerLimit": "4.05",
                          "upperLimit": "8.00",
                          "value": "5.98"
                        },
                        {
                          "groupId": "OG002",
                          "lowerLimit": "3.93",
                          "upperLimit": "8.00",
                          "value": "6.00"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "3"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "7"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "The median time of the maximum serum concentration (Tmax) for the combination of tesevatinib and trastuzumab after 1 cycle (Cycle 2 Day 1)",
              "dispersionType": "Full Range",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                }
              ],
              "paramType": "MEDIAN",
              "populationDescription": "Subjects who completed at least 1 cycle of study drug and had PK measurements performed on Cycle 2 Day 1. Stratified by tesevatinib dose level, not by initial 8 mg&#x2F;kg trastuzumab dosing level, i.e., 150, 250, and 300 mg tesevatinib with 6 mg&#x2F;kg trastuzumab.\nNote: Subjects in Cohort 350 mg tesevatinib received only 8 mg&#x2F;kg trastuzumab and so were not included in this analysis.",
              "reportingStatus": "POSTED",
              "timeFrame": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1",
              "title": "Pharmacokinetics: Median Serum Tmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab",
              "type": "SECONDARY",
              "unitOfMeasure": "hours"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "spread": "1530",
                          "value": "5120"
                        },
                        {
                          "groupId": "OG001",
                          "spread": "5750",
                          "value": "13000"
                        },
                        {
                          "groupId": "OG002",
                          "spread": "3390",
                          "value": "8200"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "3"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "7"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "The mean area under the concentration-time curve during the period from 0 to a given time point &#x27;t&#x27; in the tesevatinib 150 mg QD, 250 mg QD, and 300 mg QD cohorts.",
              "dispersionType": "Standard Deviation",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                }
              ],
              "paramType": "MEAN",
              "populationDescription": "Subjects who completed at least 1 cycle of study drug and had PK measurements performed on Cycle 2 Day 1. Stratified by tesevatinib dose level, not by initial 8 mg&#x2F;kg trastuzumab dosing level, i.e., 150, 250, and 300 mg tesevatinib with 6 mg&#x2F;kg trastuzumab.\nNote: Subjects in Cohort 350 mg tesevatinib received 8 mg&#x2F;kg trastuzumab and so were not included in this analysis.",
              "reportingStatus": "POSTED",
              "timeFrame": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1",
              "title": "Pharmacokinetics: Mean Serum AUC(0-t) (Area Under Curve) of Treatment With Tesevatinib + Trastuzumab",
              "type": "SECONDARY",
              "unitOfMeasure": "hr*ng&#x2F;mL"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "spread": "1.11",
                          "value": "3.46"
                        },
                        {
                          "groupId": "OG001",
                          "spread": "0.993",
                          "value": "3.38"
                        },
                        {
                          "groupId": "OG002",
                          "spread": "1.38",
                          "value": "2.21"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "3"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "7"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "<p>The mean of the arithmetic mean accumulation ratio (AR) of the maximum concentration of tesevatinib.\nThe AR is defined as:</p><p>Cmax for Cycle 2 divided by Cmax of Cycle 1.</p>",
              "dispersionType": "Standard Deviation",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                }
              ],
              "paramType": "MEAN",
              "populationDescription": "Subjects who completed at least 1 cycle of study drug and had PK measurements performed on Cycle 2 Day 1. Stratified by tesevatinib dose level, not by initial 8 mg&#x2F;kg trastuzumab dosing level, i.e., 150, 250, and 300 mg tesevatinib with 6 mg&#x2F;kg trastuzumab.\nNote: Subjects in Cohort 350 mg tesevatinib only received 8 mg&#x2F;kg trastuzumab and so were not included in this analysis.",
              "reportingStatus": "POSTED",
              "timeFrame": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1",
              "title": "Pharmacokinetics: Mean AR Cmax After 1 Cycle of Treatment With Tesevatinib + Trastuzumab",
              "type": "SECONDARY",
              "unitOfMeasure": "ratio (no units)"
            },
            {
              "classes": [
                {
                  "categories": [
                    {
                      "measurements": [
                        {
                          "groupId": "OG000",
                          "spread": "0.762",
                          "value": "4.04"
                        },
                        {
                          "groupId": "OG001",
                          "spread": "1.17",
                          "value": "4.23"
                        },
                        {
                          "groupId": "OG002",
                          "spread": "1.33",
                          "value": "2.80"
                        }
                      ]
                    }
                  ]
                }
              ],
              "denoms": [
                {
                  "counts": [
                    {
                      "groupId": "OG000",
                      "value": "3"
                    },
                    {
                      "groupId": "OG001",
                      "value": "3"
                    },
                    {
                      "groupId": "OG002",
                      "value": "7"
                    }
                  ],
                  "units": "Participants"
                }
              ],
              "description": "<p>The mean of the arithmetic mean accumulation ratio (AR) of the area under the concentration-time curve from 0 to 24 hours.\nThe AR is defined as:</p><p>AUC(0-24hr) for Cycle 2 divided by AUC(0-24hr) for Cycle 1.</p>",
              "dispersionType": "Standard Deviation",
              "groups": [
                {
                  "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG000",
                  "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG001",
                  "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                },
                {
                  "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg then 6 mg&#x2F;kg trastuzumab every 3 weeks",
                  "id": "OG002",
                  "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
                }
              ],
              "paramType": "MEAN",
              "populationDescription": "Subjects who completed at least 1 cycle of study drug and had PK measurements performed on Cycle 2 Day 1. Stratified by tesevatinib dose level, not by initial 8 mg&#x2F;kg trastuzumab dosing level, i.e., 150, 250, and 300 mg tesevatinib with 6 mg&#x2F;kg trastuzumab.\nNote: Subjects in Cohort 350 mg tesevatinib received only 8 mg&#x2F;kg trastuzumab and so were not included in this analysis.",
              "reportingStatus": "POSTED",
              "timeFrame": "PK samples taken pre-dose, and 1, 2, 4, 6, 8, and 24 hours post-dose on Cycle 1 Day 1 and Cycle 2 Day 1",
              "title": "Pharmacokinetics: Mean AR AUC(0-24hr) After 1 Cycle of Treatment With Tesevatinib + Trastuzumab",
              "type": "SECONDARY",
              "unitOfMeasure": "ratio (no units)"
            }
          ]
        },
        "participantFlowModule": {
          "groups": [
            {
              "description": "Tesevatinib 150 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "FG000",
              "title": "Arm 1: Tesevatinib 150 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "description": "Tesevatinib 250 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "FG001",
              "title": "Arm 2: Tesevatinib 250 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "description": "Tesevatinib 300 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "FG002",
              "title": "Arm 3: Tesevatinib 300 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            },
            {
              "description": "Tesevatinib 350 mg orally administered once daily in combination with Trastuzumab IV 8 mg&#x2F;kg initially then 6 mg&#x2F;kg trastuzumab every 3 weeks",
              "id": "FG003",
              "title": "Arm 4: Tesevatinib 350 mg PO QD + Trastuzumab 8 mg&#x2F;kg IV"
            }
          ],
          "periods": [
            {
              "dropWithdraws": [
                {
                  "reasons": [
                    {
                      "groupId": "FG000",
                      "numSubjects": "1"
                    },
                    {
                      "groupId": "FG001",
                      "numSubjects": "1"
                    },
                    {
                      "groupId": "FG002",
                      "numSubjects": "5"
                    },
                    {
                      "groupId": "FG003",
                      "numSubjects": "1"
                    }
                  ],
                  "type": "Death"
                },
                {
                  "reasons": [
                    {
                      "groupId": "FG000",
                      "numSubjects": "2"
                    },
                    {
                      "groupId": "FG001",
                      "numSubjects": "2"
                    },
                    {
                      "groupId": "FG002",
                      "numSubjects": "3"
                    },
                    {
                      "groupId": "FG003",
                      "numSubjects": "1"
                    }
                  ],
                  "type": "Termination of study by sponsor"
                },
                {
                  "reasons": [
                    {
                      "groupId": "FG000",
                      "numSubjects": "1"
                    },
                    {
                      "groupId": "FG001",
                      "numSubjects": "0"
                    },
                    {
                      "groupId": "FG002",
                      "numSubjects": "0"
                    },
                    {
                      "groupId": "FG003",
                      "numSubjects": "0"
                    }
                  ],
                  "type": "Lost to Follow-up"
                }
              ],
              "milestones": [
                {
                  "achievements": [
                    {
                      "groupId": "FG000",
                      "numSubjects": "4"
                    },
                    {
                      "groupId": "FG001",
                      "numSubjects": "3"
                    },
                    {
                      "groupId": "FG002",
                      "numSubjects": "8"
                    },
                    {
                      "groupId": "FG003",
                      "numSubjects": "2"
                    }
                  ],
                  "type": "STARTED"
                },
                {
                  "achievements": [
                    {
                      "comment": "Study terminated by sponsor",
                      "groupId": "FG000",
                      "numSubjects": "0"
                    },
                    {
                      "comment": "Study terminated by sponsor",
                      "groupId": "FG001",
                      "numSubjects": "0"
                    },
                    {
                      "comment": "Study terminated by sponsor",
                      "groupId": "FG002",
                      "numSubjects": "0"
                    },
                    {
                      "comment": "Study terminated by sponsor",
                      "groupId": "FG003",
                      "numSubjects": "0"
                    }
                  ],
                  "type": "COMPLETED"
                },
                {
                  "achievements": [
                    {
                      "groupId": "FG000",
                      "numSubjects": "4"
                    },
                    {
                      "groupId": "FG001",
                      "numSubjects": "3"
                    },
                    {
                      "groupId": "FG002",
                      "numSubjects": "8"
                    },
                    {
                      "groupId": "FG003",
                      "numSubjects": "2"
                    }
                  ],
                  "type": "NOT COMPLETED"
                }
              ],
              "title": "Overall Study"
            }
          ],
          "preAssignmentDetails": "Open-label, ascending-dose"
        }
      }
    }
  ],
  "provenance": {
    "from_snapshot_hash": "8f9847ffe93d262a32e48a63afae14d55fac5b1dd7b79038ff99e18063384baa",
    "materiality_event_hash": "4e8dcd43252fb01f96a7821e1b61ed14376071ea94b9895f760e19112bfe24e8",
    "patch_hash": "fca516ac36ad67f169765445213a90d380e28733b875606207f9c7f361a35f47",
    "patch_raw_hash": "5d6d8656814f0489db76cb806de315793e5a7827dac5ae85bc5f307783699dfc",
    "patch_source": "ctgov_internal_history",
    "patch_source_url": "https://clinicaltrials.gov/api/int/studies/NCT02154529/history/22?patchToVersion=23",
    "to_snapshot_hash": "cb15668b20c8788caadb73bce53d26dd90b9c3b7fb7e078e0f4456ad2a745274"
  },
  "review_question": "What source document explains this registry amendment, and does it change interpretation of the trial record?",
  "schema": "trialdiff.evidence_record",
  "trial": {
    "clinicaltrials_gov_url": "https://clinicaltrials.gov/study/NCT02154529",
    "nct_id": "NCT02154529"
  },
  "versions": {
    "from_version": 22,
    "submitted_date": "2022-02-28",
    "to_version": 23
  }
}