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The purpose of study is to evaluate the efficacy and safety of ONO-4538 with chemotherapy in unresectable advanced or recurrent gastric cancer (including esophagogastric junction cancer) not previously treated with the first-line therapy. Part 1 is intended to evaluate the tolerability, safety, and efficacy of ONO-4538 in combination with SOX therapy (Tegafur / gimeracil / oteracil potassium + Oxaliplatin) or CapeOX therapy (Capecitabine + Oxaliplatin). In part 2, the investigator or the subinvestigator will choose a chemotherapy (SOX or CapeOX therapy), taking into account the condition of each subject. Part 2 is planned to evaluate the efficacy and safety of ONO-4538 + chemotherapy in comparison with placebo + chemotherapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ONO-4538 + SOX Therapy Cohort (Part 1) | Experimental | ONO-4538 360 mg solution intravenously for 30 min in every 3 weeks. Oxaliplatin 130 mg/m2 (BSA) solution intravenously for 2 hours once-daily, followed by 20 days off. Tegafur-gimeracil-oteracil potassium combination drug 40 - 60 mg bid orally in 14 days, followed by 7 days off Each drug will be continued until documented disease progression, discontinuation due to toxicity, withdrawal of consent or the study ends. |
|
| ONO-4538 + CapeOX Therapy Cohort (Part 1) | Experimental | ONO-4538 360 mg solution intravenously for 30 min in every 3 weeks. Oxaliplatin 130 mg/m2 (body surface area) solution intravenously for 2 hours once-daily, followed by 20 days off. Capecitabine 1200 - 2100 mg bid orally in 14 days, followed by 7 days off. Each drug will be continued until documented disease progression, discontinuation due to toxicity, withdrawal of consent or the study ends. |
|
| ONO-4538 + chemotherapy group (Part 2) | Experimental | With regard to the ONO-4538 + chemotherapy group, either SOX therapy or CapeOX therapy will be selected as the chemotherapy by the investigator or the subinvestigator, taking into account the condition of each subject. ONO-4538 360 mg solution intravenously for 30 min in every 3 weeks. Oxaliplatin 130 mg/m2 (body surface area) solution intravenously for 2 hours once-daily, followed by 20 days off. Tegafur-gimeracil-oteracil potassium combination drug 40 - 60 mg bid or Capecitabine 1000 mg/ m2 (body surface area) bid orally in 14 days, followed by 7 days off. Each drug will be continued until documented disease progression, discontinuation due to toxicity, withdrawal of consent or the study ends. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ONO-4538 | Drug |
|
| Measure | Description | Time Frame |
|---|---|---|
| Progression-free survival (central assessment by IRRC) (only Part 2) | Up to study completion (estimated time frame: 48 months) | |
| Overall survival (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Objective response rate (only Part 2) | Up to study completion (estimated time frame: 54 months) | |
| Progression-free survival (assessment by the site investigator)(only Part 2) | Up to study completion (estimated time frame: 54 months) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mitsunobu Tanimoto | Ono Pharmaceutical Co., Ltd. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aichi Clinical Site | Nagoya | Aichi-ken | Japan | |||
| Aomori Clinical Site |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41766168 | Derived | Chen LT, Kang YK, Ryu MH, Oh DY, Oh SC, Rha SY, Lee KW, Omori T, Shitara K, Sakuramoto S, Chung IJ, Yamaguchi K, Kato K, Sym SJ, Kadowaki S, Tsuji K, Chen JS, Bai LY, Oh SY, Choda Y, Yasui H, Takeuchi K, Hirashima Y, Hagihara S, Boku N. Nivolumab plus chemotherapy in Asian people with advanced or recurrent stomach or gastroesophageal junction cancer (ATTRACTION-4 study): a plain language summary. Future Oncol. 2026 Mar;22(6):625-642. doi: 10.1080/14796694.2026.2622806. Epub 2026 Mar 1. | |
| 39162872 |
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|
| Placebo + Chemotherapy group (Part 2) | Placebo Comparator | With regard to the placebo + chemotherapy group, either SOX therapy or CapeOX therapy will be selected as the chemotherapy by the investigator or the subinvestigator, taking into account the condition of each subject. Placebo solution intravenously for 30 min in every 3 weeks. Oxaliplatin 130 mg/m2 (body surface area) solution intravenously for 2 hours once-daily, followed by 20 days off. Tegafur-gimeracil-oteracil potassium combination drug 40 - 60 mg bid or Capecitabine 1000 mg/ m2 (body surface area) bid orally in 14 days, followed by 7 days off. Each drug will be continued until documented disease progression, discontinuation due to toxicity, withdrawal of consent or the study ends. |
|
| Oxaliplatin | Drug |
|
| Tegafur- Gimeracil-Oteracil potassium | Drug |
|
| Capecitabine | Drug |
|
| Placebo | Drug |
|
| Duration of response (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Disease control rate (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Time to response (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Best overall response (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Percent change in the sum of diameters of target lesions (only Part 2) | Up to study completion (estimated time frame: 54 months) |
| Safety will be analyzed through the incidence of adverse events, serious adverse events | Up to 28 days from last dose |
| Safety will be analyzed through the incidence of laboratory abnormalities | Up to 28 days from last dose |
| Hirosaki |
| Aomori |
| Japan |
| Aomori Clinical Site | Misawa | Aomori | Japan |
| Chiba Clinical Site | Funabashi | Chiba | Japan |
| Chiba Clinical Site | Kamogawa | Chiba | Japan |
| Chiba Clinical Site | Kashiwa | Chiba | Japan |
| Ehime Clinical Site1 | Matsuyama | Ehime | Japan |
| Ehime Clinical Site2 | Matsuyama | Ehime | Japan |
| Fukuoka Clinical Site | Iizuka | Fukuoka | Japan |
| Fukuoka Clinical Site1 | Kitakyushu | Fukuoka | Japan |
| Fukuoka Clinical Site2 | Kitakyushu | Fukuoka | Japan |
| Fukuoka Clinical Site | Kurume | Fukuoka | Japan |
| Gifu Clinical Site | Gifu | Gifu | Japan |
| Gifu Clinical Site | Ōgaki | Gifu | Japan |
| Gumma Clinical Site | Maebashi | Gunma | Japan |
| Gunma Clinical Site | Ōta | Gunma | Japan |
| Gumma Clinical Site | Takasaki | Gunma | Japan |
| Hiroshima Clinical Site | Kure | Hiroshima | Japan |
| Hokkaido Clinical Site | Hakodate | Hokkaido | Japan |
| Hokkaido Clinical Site1 | Sapporo | Hokkaido | Japan |
| Hokkaido Clinical Site2 | Sapporo | Hokkaido | Japan |
| Hokkaido Clinical Site3 | Sapporo | Hokkaido | Japan |
| Hokkaido Clinical Site4 | Sapporo | Hokkaido | Japan |
| Hyogo Clinical Site | Akashi | Hyōgo | Japan |
| Hyogo Clinical Site | Amagasaki | Hyōgo | Japan |
| Hyogo Clinical Site | Kobe | Hyōgo | Japan |
| Hyogo Clinical Site | Nishinomiya | Hyōgo | Japan |
| Ibaraki Clinical Site | Higashiibaraki-gun | Ibaraki | Japan |
| Ibaraki Clinical Site | Tsuchiura-shi | Ibaraki | Japan |
| Ishikawa Clinical Site1 | Kanazawa | Ishikawa-ken | Japan |
| Ishikawa Clinical Site2 | Kanazawa | Ishikawa-ken | Japan |
| Iwate Clinical Site | Morioka | Iwate | Japan |
| Kagawa Clinical Site | Kita-gun | Kagawa-ken | Japan |
| Kanagawa Clinical Site | Isehara | Kanagawa | Japan |
| Kanagawa Clinical Site | Kamakura | Kanagawa | Japan |
| Kanagawa Clinical Site | Sagamihara | Kanagawa | Japan |
| Kanagawa Clinical Site1 | Yokohama | Kanagawa | Japan |
| Kanagawa Clinical Site2 | Yokohama | Kanagawa | Japan |
| Kanagawa Clinical Site3 | Yokohama | Kanagawa | Japan |
| Miyagi Clinical Site | Natori-shi | Miyagi | Japan |
| Miyagi Clinical Site | Ōsaki | Miyagi | Japan |
| Miyagi Clinical Site | Sendai | Miyagi | Japan |
| Nagano Clinical Site | Saku | Nagano | Japan |
| Nara Clinical Site | Ikoma | Nara | Japan |
| Nara Clinical Site | Kashihara-shi | Nara | Japan |
| Okayama Clinical Site | Kurashiki | Okayama-ken | Japan |
| Osaka Clinical Site | Izumi | Osaka | Japan |
| Osaka Clinical Site | Sakai | Osaka | Japan |
| Osaka Clinical Site | Sayama | Osaka | Japan |
| Osaka Clinical Site | Suita | Osaka | Japan |
| Osaka Clinical Site | Takatsuki | Osaka | Japan |
| Osaka Clinical Site | Toyonaka | Osaka | Japan |
| Saitama Clinical Site | Hidaka | Saitama | Japan |
| Saitama Clinical Site | Kitaadachi-gun | Saitama | Japan |
| Shizuoka Clinical Site | Hamamatsu | Shizuoka | Japan |
| Tochigi Clinical Site | Shimotsuke | Tochigi | Japan |
| Tochigi Clinical Site | Utsunomiya | Tochigi | Japan |
| Tokyo Clinical Site | Bunkyo-ku | Tokyo | Japan |
| Tokyo Clinical Site | Chuo-ku | Tokyo | Japan |
| Tokyo Clinical Site | Fuchū | Tokyo | Japan |
| Tokyo Clinical Site | Koto-ku | Tokyo | Japan |
| Tokyo Clinical Site | Minato-ku | Tokyo | Japan |
| Tokyo Clinical Site | Shinagawa-ku | Tokyo | Japan |
| Tokyo Clinical Site1 | Shinjuku-ku | Tokyo | Japan |
| Tokyo Clinical Site2 | Shinjuku-ku | Tokyo | Japan |
| Tokyo Clinical Site | Tachikawa | Tokyo | Japan |
| Tottori Clinical Site | Yonago | Tottori | Japan |
| Yamagata Clinical Site | Sakata | Yamagata | Japan |
| Akita Clinical Site | Akita | Japan |
| Chiba Clinical Site1 | Chiba | Japan |
| Chiba Clinical Site2 | Chiba | Japan |
| Fukui Clinical Site | Fukui | Japan |
| Fukuoka Clinical Site1 | Fukuoka | Japan |
| Fukuoka Clinical Site2 | Fukuoka | Japan |
| Fukuoka Clinical Site3 | Fukuoka | Japan |
| Fukuoka Clinical Site4 | Fukuoka | Japan |
| Fukushima Clinical Site | Fukushima | Japan |
| Hiroshima Clinical Site1 | Hiroshima | Japan |
| Hiroshima Clinical Site2 | Hiroshima | Japan |
| Hiroshima Clinical Site3 | Hiroshima | Japan |
| Kumamoto Clinical Site1 | Kumamoto | Japan |
| Kumamoto Clinical Site2 | Kumamoto | Japan |
| Kumamoto Clinical Site3 | Kumamoto | Japan |
| Kyoto Clinical Site1 | Kyoto | Japan |
| Kyoto Clinical Site2 | Kyoto | Japan |
| Kyoto Clinical Site3 | Kyoto | Japan |
| Niigata Clinical Site | Niigata | Japan |
| Okayama Clinical Site | Okayama | Japan |
| Osaka Clinical Site1 | Osaka | Japan |
| Osaka Clinical Site2 | Osaka | Japan |
| Osaka Clinical Site3 | Osaka | Japan |
| Osaka Clinical Site4 | Osaka | Japan |
| Shizuoka Clinical Site | Shizuoka | Japan |
| Tokushima Clinical Site | Tokushima | Japan |
| Toyama Clinical Site | Toyama | Japan |
| Wakayama Clinical Site | Wakayama | Japan |
| Yamagata Clinical Site | Yamagata | Japan |
| Gyeongnam Clinical Site | Gyeongnam | Gyeongsangnam-do | South Korea |
| Busan Clinical Site | Busan | South Korea |
| Daegu Clinical Site 1 | Daegu | South Korea |
| Daegu Clinical Site 2 | Daegu | South Korea |
| Daejeon Clinical Site | Daejeon | South Korea |
| Gyeonggi-Do Clinical Site1 | Gyeonggi-do | South Korea |
| Gyeonggi-Do Clinical Site2 | Gyeonggi-do | South Korea |
| Gyeonggi-Do Clinical Site3 | Gyeonggi-do | South Korea |
| Gyeonggi-Do Clinical Site4 | Gyeonggi-do | South Korea |
| Gyeonggi-Do Clinical Site5 | Gyeonggi-do | South Korea |
| Incheon Clinical Site | Incheon | South Korea |
| Jeollabuk-Do Clinical Site | Jeollabuk-Do | South Korea |
| Jeollanam-do Clinical Site | Jeollanam-do | South Korea |
| Seoul Clinical Site 1 | Seoul | South Korea |
| Seoul Clinical Site 2 | Seoul | South Korea |
| Seoul Clinical Site 3 | Seoul | South Korea |
| Seoul Clinical Site 4 | Seoul | South Korea |
| Seoul Clinical Site 5 | Seoul | South Korea |
| Seoul Clinical Site 6 | Seoul | South Korea |
| Seoul Clinical Site7 | Seoul | South Korea |
| Seoul Clinical Site8 | Seoul | South Korea |
| Seoul Clinical Site9 | Seoul | South Korea |
| Ulsan Clinical Site | Ulsan | South Korea |
| Kaohsiung Clinical Site1 | Kaohsiung City | Taiwan |
| Kaohsiung Clinical Site2 | Kaohsiung City | Taiwan |
| New Taipei Clinical Site 1 | New Taipei City | Taiwan |
| Taichung Clinical Site 1 | Taichung | Taiwan |
| Taichung Clinical Site2 | Taichung | Taiwan |
| Tainan Clinical Site1 | Tainan | Taiwan |
| Tainan Clinical Site2 | Tainan | Taiwan |
| Taipei Clinical Site1 | Taipei | Taiwan |
| Taipei Clinical Site2 | Taipei | Taiwan |
| Taoyuan Clinical Site | Taoyuan | Taiwan |
| Derived |
| Boku N, Omori T, Shitara K, Sakuramoto S, Yamaguchi K, Kato K, Kadowaki S, Tsuji K, Ryu MH, Oh DY, Oh SC, Rha SY, Lee KW, Chung IJ, Sym SJ, Chen LT, Chen JS, Bai LY, Nakada T, Hagihara S, Makino R, Nishiyama E, Kang YK. Nivolumab plus chemotherapy in patients with HER2-negative, previously untreated, unresectable, advanced, or recurrent gastric/gastroesophageal junction cancer: 3-year follow-up of the ATTRACTION-4 randomized, double-blind, placebo-controlled, phase 3 trial. Gastric Cancer. 2024 Nov;27(6):1287-1301. doi: 10.1007/s10120-024-01535-0. Epub 2024 Aug 20. |
| 35030335 | Derived | Kang YK, Chen LT, Ryu MH, Oh DY, Oh SC, Chung HC, Lee KW, Omori T, Shitara K, Sakuramoto S, Chung IJ, Yamaguchi K, Kato K, Sym SJ, Kadowaki S, Tsuji K, Chen JS, Bai LY, Oh SY, Choda Y, Yasui H, Takeuchi K, Hirashima Y, Hagihara S, Boku N. Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2022 Feb;23(2):234-247. doi: 10.1016/S1470-2045(21)00692-6. Epub 2022 Jan 11. |
| 30566590 | Derived | Boku N, Ryu MH, Kato K, Chung HC, Minashi K, Lee KW, Cho H, Kang WK, Komatsu Y, Tsuda M, Yamaguchi K, Hara H, Fumita S, Azuma M, Chen LT, Kang YK. Safety and efficacy of nivolumab in combination with S-1/capecitabine plus oxaliplatin in patients with previously untreated, unresectable, advanced, or recurrent gastric/gastroesophageal junction cancer: interim results of a randomized, phase II trial (ATTRACTION-4). Ann Oncol. 2019 Feb 1;30(2):250-258. doi: 10.1093/annonc/mdy540. |
| ID | Term |
|---|---|
| D013274 | Stomach Neoplasms |
| ID | Term |
|---|---|
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D013272 | Stomach Diseases |
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| ID | Term |
|---|---|
| D000077594 | Nivolumab |
| D000077150 | Oxaliplatin |
| D000069287 | Capecitabine |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D005472 | Fluorouracil |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D003853 | Deoxyribonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
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