Cancer, Carcinoma, Non-Small Cell Lung
Conditions
Keywords
NSCLC
Brief summary
The purpose of the study is to evaluate if BAY43-9006 has an effect on the tumors, how long the effect continues, if the patients receiving BAY43-9006 will live longer. * If BAY43-9006 has an effect on the quality of life of patients with non-small cell lung cancer. * If BAY43-9006 helps to slow the worsening of non-small cell lung cancer. * If BAY43-9006 prevents the growth of, or shrinks non-small cell lung tumors and/or their metastases.
Detailed description
In addition to the key secondary outcome parameters several potential biomarkers were evaluated as exploratory parameters. Issues on safety are addressed in the Adverse Event section. The following acronyms and abbreviations were used in the Adverse Event section and Limitations and Caveats section: * gastrointestinal (GI) * not otherwise specified (NOS) * central nervous system (CNS) * National Cancer Institute Common Terminology Criteria (NCI-CTC) * Medical Dictionary for Regulatory Activities (MedDRA) * System Organ Class (SOC) * interim analysis (IA)
Interventions
DRUGSorafenib (Nexavar, BAY43-9006)
BAY43-9006 400 mg bid X 28 day cycles \[Continuous treatment for a maximum of 2 years; potential for compassionate use and long term survival follow-up post drug discontinuation.
Sponsors
Amgen
Bayer
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age = 18 years * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2 * Life expectancy of at least 12 weeks at the pre-treatment evaluation * Patients with metastatic, measurable, histologically or cytologically documented NSCLC (includes squamous, large cell or adenocarcinoma). In case of unique metastatic site, histological confirmation is required in order to ensure proper diagnosis prior to study entry * Patients must have progressive non-small cell lung cancer (NSCLC) * No more than 2 prior systemic agent or regimen at least 28 days prior to study entry. (Prior therapy with gefitinib is allowed but not mandatory) * Patients must be considered appropriate for systemic anti-cancer therapy by the Investigator * Patients with at least one uni-dimensional measurable lesion by computed tomography (CT) scan or magnetic resonance imaging (MRI) according to Response Evaluation Criteria in Solid Tumors (RECIST) * Adequate bone marrow, liver and renal function, as assessed by the following laboratory: * Hemoglobin = 9.0 g/dl * Absolute granulocytes = 1.5 x 10E9/L * Platelet count = 100 x 10E9/L * Total bilirubin \< 1.5 x the upper limit of normal * alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 2.5 x upper limit of normal (\< 5 x upper limit of normal for patients with liver involvement of their cancer) * prothrombin time (PT) or International Normalized Ratio (INR) and partial thromboplastin time (PTT) \< 1.5 x upper limit of normal (except in patients who are on warfarin or heparin. Patients who receive anti-coagulation treatment with an agent such as warfarin or heparin, prophylactically or therapeutically, will be allowed to participate. For patients on warfarin, close monitoring of at least weekly evaluations will be performed until INR is stable based on a measurement at pre dose, as defined by the local standard of care) * Serum creatinine = 2.0 x upper limit of normal * Amylase and lipase \< 1.5 x the upper limit of normal
Exclusion criteria
* Cardiac arrhythmia requiring anti-arrhythmics (excluding beta-blockers or digoxin), symptomatic coronary artery disease (CAD) or ischemia (myocardial infarction (MI) within the last 6 months) or congestive heart failure (CHF) \> New York Heart Association (NYHA) Class II * Uncontrolled hypertension * Complete renal shut-down requiring hemo- or peritoneal dialysis * Mixed histologies * Active clinically serious infections (\> grade 2 on the National Cancer Institute \[NCI\] Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0) * Known history of HIV infection or chronic hepatitis B or C * Known metastatic brain or meningeal tumors, unless the patient is \> 6 months from definitive therapy, has a negative imaging study within 4 weeks of study entry and is clinically stable with respect to the tumor at the time of study entry. A head CT or MRI must be conducted to rule out brain metastasis or meningeal tumors. Also the patient must not be undergoing acute steroid therapy or taper (chronic steroid therapy is acceptable, provided that the dose is stable for one month prior to and following screening radiographic studies) * History of seizure disorder requiring medication (such as steroids or anti-epileptics) * History of organ allograft and bone marrow transplant * Previous malignancy (except for cervical carcinoma in situ, adequately treated basal cell carcinoma, or superficial bladder tumors \[Ta, Tis & T1\] or other malignancies curatively treated \> 3 years prior to entry) * Patients with clinically significant bleeding (e.g., gastrointestinal bleeding) within the past month prior to study entry are ineligible * Pregnant or breast-feeding patients. Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of treatment. Both men and women enrolled in this trial must use adequate barrier birth control measures (e.g. cervical cap, condom, and diaphragm) during the course of the trial. Oral birth control methods alone will not be considered adequate on this study, because of the potential pharmacokinetic interaction between BAY 43-9006 and oral contraceptives * Substance abuse, medical, psychological or social conditions that, in the judgment of the investigator, is likely to interfere with the patients participation in the study or evaluation of the study results * Known allergy to the investigational agent or any agent given in association with this trial * Any condition that is unstable or could jeopardize the safety of the patient and its compliance in the study, in the investigator's judgment * Anti cancer chemotherapy, immunotherapy, vaccines or investigational therapy during the study or within 4 weeks of study entry. * Radiotherapy during the study or within 4 weeks of study entry. Patients must have recovered from radiation-induced toxicity. However, palliative is allowed for local pain control. * Any surgical procedure within 4 weeks prior to the start of study drug. Autologous and/or allogenic including mini-allogenic bone marrow transplant or stem cell rescue. Use of biologic response modifiers, such as Granulocyte-Colony Stimulating Factor (G-CSF) or Granulocyte macrophage colony-stimulating factor (GM-CSF), during or within 3 weeks of study entry. G-CSF and other hematopoietic growth factors may only be used in the management of acute toxicity, when medically indicated, or at the discretion of the investigator. Patients taking chronic erythropoietin are permitted provided no dose adjustment is undertaken within 2 months prior to the study or during the study. Use of St. John's Wort. Use of rifampicin. Prior use of Raf-Kinase inhibitors, MAPK/ERK kinase (MEK) or Farnesyl Transferase Inhibitors. Prior use of Bevacizumab and all other drugs that target vascular endothelial growth factor (VEGF)/ vascular endothelial growth factor receptor (VEGFR). Use of any investigational drug therapy outside of this during or within 4 weeks of study entry.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment. | CR-disappearance of clinical/radiological tumor evidence (target/nontarget). PR- \>=30% decrease in sum longest diameter (LD) of target lesions from BL sum LD. Stable disease (SD)-no shrinkage for PR nor increase for PD. Progressive disease (PD) measurement proven- \>=20% increase in sum LD of lesions from smallest sum LD since start or new lesions. Progression by clinical judgement- \>clinically meaningful cancer-related deterioration as judged by the investigator. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Stable Disease | First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment. | Duration of stable disease was calculated as date of first treatment until date of documented progressive disease (PD) or last observation if subject did not progress. Stable disease (SD) defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Kaplan-Meier methodology, descriptive analysis. |
| Overall Survival | First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. | Overall survival was calculated from the date of the first treatment until death of the subject. Evaluation by Kaplan-Meier methodology, descriptive analysis. |
| Percentage of Subjects With Stable Disease (SD) | First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment. | Percentage of subjects with stable disease was calculated from date of first treatment until date of documented progressive disease (PD) or last observation if subject did not progress. Stable disease (SD) defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Descriptive summary of subjects with SD. |
| Change From Baseline of Health-Related Quality of Life (HRQOL) Score Assessed at Cycle 2, Cycle 4, and End of Treatment (EOT) | From first patient first treatment until date of last efficacy data collection (study period up to 62 weeks). HRQoL assessed at baseline (BL), end of treatment Cycles 2 and 4, and at end of treatment | HRQoL was assessed with the FACT-L questionnaire, a validated instrument for determining lung cancer HRQoL. The 36-item questionnaire includes 4 domains: Physical, functional, emotional, and social/family well-being, and a lung cancer-specific subscale. The FACT-L total score ranges from 1 to 136. Lower scores (negative change from baseline) demonstrate impaired HRQoL. |
Countries
Germany, United States
Participant flow
Recruitment details
Study conducted in Germany and USA (1 center each) from Apr 2004 to Jun 2005. Recruitment in 2 phases: Interim analysis (IA) to be performed after treatment of 29 patients; final analysis planned after additional 21 patients. Final analysis data cut-off date 30 Jun 2005; safety data collected for the 4 ongoing subjects until 11 Apr 2008.
Pre-assignment details
52 of 54 enrolled patients started treatment. The analysis population consisted of 52 subjects for the intent to treat (ITT) and safety analyses and 51 subjects in the evaluable subject analysis (1 had lung metastases from pancreatic cancer).
Participants by arm
| Arm | Count |
|---|---|
| Sorafenib Sorafenib (Nexavar, BAY43-9006) 400 mg twice daily (bid, bis in die) X 28 day cycles | 52 |
| Total | 52 |
Baseline characteristics
| Characteristic | Sorafenib |
|---|---|
| Age Continuous | 62 years |
| Age, Customized < 65 years | 31 participants |
| Age, Customized >=65 years | 21 participants |
| Histology Adenocarcinoma NSCLC | 28 participants |
| Histology Large cell carcinoma | 4 participants |
| Histology Squamous cell (epidermoid) carcinoma | 16 participants |
| Histology Undifferentiated carcinoma | 4 participants |
| Sex: Female, Male Female | 18 Participants |
| Sex: Female, Male Male | 34 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 51 / 52 |
| serious Total, serious adverse events | 28 / 52 |
Outcome results
Primary
Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC)
CR-disappearance of clinical/radiological tumor evidence (target/nontarget). PR- \>=30% decrease in sum longest diameter (LD) of target lesions from BL sum LD. Stable disease (SD)-no shrinkage for PR nor increase for PD. Progressive disease (PD) measurement proven- \>=20% increase in sum LD of lesions from smallest sum LD since start or new lesions. Progression by clinical judgement- \>clinically meaningful cancer-related deterioration as judged by the investigator.
Time frame: First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment.
Population: The analysis population for the intent to treat (ITT) and safety analyses consisted of 52 subjects who received at least 1 treatment and had their disease re-evaluated. 51 subjects were considered evaluable since 1 of the 52 subjects had lung metastases from pancreatic cancer.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Complete response + Partial response | 0.0 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Complete response | 0.0 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Partial response | 0.0 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Stable disease | 58.8 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Progressive disease measurement proven | 23.5 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Progression by clinical judgement | 11.8 percentage of participants |
| Sorafenib | Anti-cancer Activity (eg, Percentage of Patients With Confirmed Complete Responses (CR) and Partial Responses (PR) Per RECIST (Response Evaluation Criteria in Solid Tumors) Criteria in Patients With Stage IV Non-small Cell Lung Carcinoma (NSCLC) | Not evaluated | 5.9 percentage of participants |
Secondary
Change From Baseline of Health-Related Quality of Life (HRQOL) Score Assessed at Cycle 2, Cycle 4, and End of Treatment (EOT)
HRQoL was assessed with the FACT-L questionnaire, a validated instrument for determining lung cancer HRQoL. The 36-item questionnaire includes 4 domains: Physical, functional, emotional, and social/family well-being, and a lung cancer-specific subscale. The FACT-L total score ranges from 1 to 136. Lower scores (negative change from baseline) demonstrate impaired HRQoL.
Time frame: From first patient first treatment until date of last efficacy data collection (study period up to 62 weeks). HRQoL assessed at baseline (BL), end of treatment Cycles 2 and 4, and at end of treatment
Population: The analysis population for the intent to treat (ITT) and safety analyses consisted of 52 subjects who received at least 1 treatment and had their disease re-evaluated. Of the 52 treated subjects, 50 subjects completed the FACT-L at baseline (screening) and post-treatment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sorafenib | Change From Baseline of Health-Related Quality of Life (HRQOL) Score Assessed at Cycle 2, Cycle 4, and End of Treatment (EOT) | Cycle 2 | -4.8 scores on a scale | Standard Deviation 21.2 |
| Sorafenib | Change From Baseline of Health-Related Quality of Life (HRQOL) Score Assessed at Cycle 2, Cycle 4, and End of Treatment (EOT) | Cycle 4 | 0.0 scores on a scale | Standard Deviation 14.4 |
| Sorafenib | Change From Baseline of Health-Related Quality of Life (HRQOL) Score Assessed at Cycle 2, Cycle 4, and End of Treatment (EOT) | End of treatment | -14.9 scores on a scale | Standard Deviation 23.2 |
Secondary
Duration of Stable Disease
Duration of stable disease was calculated as date of first treatment until date of documented progressive disease (PD) or last observation if subject did not progress. Stable disease (SD) defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Kaplan-Meier methodology, descriptive analysis.
Time frame: First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment.
Population: The analysis population for the intent to treat (ITT) and safety analyses consisted of 52 subjects who received at least 1 treatment and had their disease re-evaluated. 1 of the 52 subjects had lung metastases from pancreatic cancer and was excluded from analysis. 48 subjects had tumor evaluations post-baseline and were evaluable.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib | Duration of Stable Disease | 103 days |
Secondary
Overall Survival
Overall survival was calculated from the date of the first treatment until death of the subject. Evaluation by Kaplan-Meier methodology, descriptive analysis.
Time frame: First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks.
Population: The analysis population for the intent to treat (ITT) and safety analyses consisted of 52 subjects who received at least 1 treatment and had their disease re-evaluated. 51 subjects were considered evaluable since 1 of the 52 subjects had lung metastases from pancreatic cancer.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib | Overall Survival | 205 days |
Secondary
Percentage of Subjects With Stable Disease (SD)
Percentage of subjects with stable disease was calculated from date of first treatment until date of documented progressive disease (PD) or last observation if subject did not progress. Stable disease (SD) defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Descriptive summary of subjects with SD.
Time frame: First patient first treatment until date for last data collection for efficacy for a study period up to 62 weeks. Tumor assessed per RECIST at baseline (BL), every 8 weeks during treatment and at end of treatment.
Population: The analysis population for the intent to treat (ITT) and safety analyses consisted of 52 subjects who received at least 1 treatment and had their disease re-evaluated. 51 subjects were considered evaluable since 1 of the 52 subjects had lung metastases from pancreatic cancer.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sorafenib | Percentage of Subjects With Stable Disease (SD) | 58.8 Percentage of participants |