Non-Small Cell Lung Cancer
Conditions
Brief summary
This study is a randomized Phase 3, double-blind study of maintenance pemetrexed plus best supportive care versus placebo plus best supportive care in NSCLC. Participants must have received 1 of 6 induction regimens for 4 cycles and did not have progressive disease prior to randomization (enrollment) into this trial.
Interventions
500 milligrams per square meter (mg/m\^2), intravenous (IV) administration, every (q) 21 days, until disease progression
IV administration, q 21 days
Treatment without a specific antineoplastic regimen, given with the intent to maximize quality of life, as judged by the treating physician.
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologic or cytologic diagnosis of NSCLC Stage IIIB (with pleural effusion and/or positive supraclavicular lymph nodes) or Stage IV prior to induction therapy. * Participants must have had 1 of the following induction therapies for treatment for Stage IIIB (with pleural effusion and/or positive supraclavicular lymph nodes) or IV NSCLC: Gemcitabine plus carboplatin, paclitaxel plus carboplatin, or docetaxel plus carboplatin, gemcitabine plus cisplatin, paclitaxel plus cisplatin or docetaxel plus cisplatin. * Participants must have received only 1 chemotherapeutic doublet lasting precisely 4 cycles. * Induction regimens must be based on 21-day cycles. * Documented evidence of a tumor response of complete response (CR), partial response (PR), or stable disease (SD). Tumor assessment must occur between Cycle 4 (Day 1) of induction therapy and the date of randomization. This response does not have to be confirmed in order for the participant to be randomized. Positron emission tomography (PET) scans and ultrasounds may not be used for lesion measurements for response determination.
Exclusion criteria
* With the exception of those chemotherapies listed as inclusion criterion, participants will not be included if they have received prior systemic anticancer therapy (including adjuvant early-stage treatment for NSCLC) or any systemic treatment for any other cancer. * Have received treatment within the last 30 days with a drug that has not received regulatory approval for any indication at the time of study entry. * Inability to comply with protocol or study procedures. * A serious concomitant systemic disorder that would compromise the participant's ability to complete the study. * A serious cardiac condition, such as myocardial infarction within 6 months, angina, or heart disease, as defined by the New York Heart Association Class III or IV.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) Time | Randomization to measured PD or death from any cause (up to 41 months) | PFS time was the elapsed time from the date of randomization to the first date of objective progression of disease or death from any cause. PFS was censored at the date of the participant's last tumor assessment for participants who were not known to have died or to have PD as of the data-inclusion cut-off date for analysis. PD, defined using Response Evaluation Criteria in Solid Tumors version 1.0 (RECIST v1.0), was at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as references the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Objective Progressive Disease (TPD) | Randomization to measured PD (up to 41 months) | TPD was the elapsed time from the date of randomization to the first date of objective PD. TPD was censored at the date of the participant's last tumor assessment for participants who were not known to have PD as of the data-inclusion cut-off date for analysis or who died without objective PD. PD, defined using RECIST v1.0, was at least a 20% increase in the sum of LD of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. |
| Time to Worsening of Symptoms (TWS) | Randomization to worsening of each LCSS item (up to 39 months) | TWS was the elapsed time from the date of randomization to the first date of worsening \[defined as a 15-millimeter (mm) increase from baseline based on a 100-mm scale\] of each symptom and summary item in the Lung Cancer Symptom Scale (LCSS). The participant-reported LCSS was a 9-item questionnaire. Six items were symptom-specific measures for lung cancer (loss of appetite, fatigue, cough, dyspnea, hemoptysis, and pain), and 3 summation items described total symptomatic distress, interference with activity level, and global quality of life. Participant (pt) responses to each item were measured using visual analogue scales (VAS) from 0 (for best outcome) to 100 (for worst outcome). TWS was censored at the date of the last LCSS assessment for pts who were not known to have LCSS worsening. |
| Overall Survival (OS) Time | Randomization to date of death from any cause (up to 41 months) | OS time was the elapsed time from the date of randomization to the date of death from any cause. OS was censored at the last date of contact for participants who were not known to have died as of the data-inclusion cut-off date for analysis. |
| Number of Participants With Adverse Events (AEs) | Baseline to study completion (up to 41 Months) | Clinically significant events were defined as serious adverse events (SAEs) and other non-serious AEs regardless of causality. A summary of serious and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module. |
| Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Baseline through 30 days post discontinuation of study treatment (up to 39 Months) | The participant-reported LCSS was a 9-item questionnaire. Six items were symptom-specific measures for lung cancer (loss of appetite, fatigue, cough, dyspnea, hemoptysis, and pain), and 3 summation items described total symptomatic distress, interference with activity level, and global quality of life. Participant responses to each item were measured using VAS from 0 (for best outcome) to 100 (for worst outcome). The average symptom burden index (ASBI) was the mean of the 6 symptom-specific items. The LCSS total score was the mean of the 9 items. |
| Percentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate) | Baseline to measured PD (up to 41 months) | Response was defined using RECIST v1.0 criteria. CR was defined as the disappearance of all target lesions. PR was defined either A) at least a 30% decrease in the sum of the LD of target lesions taking as reference the baseline sum LDs or B) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared. The percentage of participants with CR or PR=(Number of participants with CR or PR)/(Number of participants assessed)\*100. |
Countries
Australia, Austria, Brazil, Bulgaria, China, Croatia, Czechia, Germany, Greece, Hungary, India, Italy, Netherlands, Poland, Romania, South Korea, Spain, Taiwan, Turkey (Türkiye), United States
Participant flow
Pre-assignment details
Participants who signed the informed consent form (ICF) and completed the randomized process are presented in the participant flow by the treatment arm to which they were randomized. Participants who did not sign the ICF or complete the randomization process were removed from the database and excluded from all analyses.
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed and BSC Pemetrexed: 500 mg/m\^2, IV administration, q 21 days, until disease progression.
BSC: Treatment without a specific antineoplastic regimen, given with the intent to maximize quality of life, as judged by the treating physician. | 441 |
| Placebo and BSC Placebo: IV administration, q 21 days.
BSC: Treatment without a specific antineoplastic regimen, given with the intent to maximize quality of life, as judged by the treating physician. | 222 |
| Total | 663 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 37 | 3 |
| Overall Study | Alive, Receiving Treatment | 7 | 2 |
| Overall Study | Death | 5 | 6 |
| Overall Study | Enrollment Criteria Not Met | 6 | 0 |
| Overall Study | Lost to Follow-up | 4 | 1 |
| Overall Study | Physician Decision | 24 | 6 |
| Overall Study | Progressive Disease (PD) | 307 | 196 |
| Overall Study | Protocol Violation | 2 | 1 |
| Overall Study | Satisfactory Response | 2 | 0 |
| Overall Study | Sponsor Decision | 1 | 0 |
| Overall Study | Withdrawal by Subject | 46 | 7 |
Baseline characteristics
| Characteristic | Pemetrexed and BSC | Placebo and BSC | Total |
|---|---|---|---|
| Age, Continuous | 60.6 years | 60.4 years | 60.6 years |
| Race/Ethnicity, Customized Aboriginal | 0 participants | 1 participants | 1 participants |
| Race/Ethnicity, Customized African | 6 participants | 0 participants | 6 participants |
| Race/Ethnicity, Customized Caucasian | 279 participants | 149 participants | 428 participants |
| Race/Ethnicity, Customized East Asian | 104 participants | 50 participants | 154 participants |
| Race/Ethnicity, Customized Hispanic | 13 participants | 6 participants | 19 participants |
| Race/Ethnicity, Customized West Asian | 39 participants | 16 participants | 55 participants |
| Region of Enrollment Australia | 19 participants | 8 participants | 27 participants |
| Region of Enrollment Austria | 2 participants | 2 participants | 4 participants |
| Region of Enrollment Brazil | 24 participants | 10 participants | 34 participants |
| Region of Enrollment Bulgaria | 11 participants | 8 participants | 19 participants |
| Region of Enrollment China | 62 participants | 37 participants | 99 participants |
| Region of Enrollment Croatia | 10 participants | 3 participants | 13 participants |
| Region of Enrollment Czech Republic | 5 participants | 2 participants | 7 participants |
| Region of Enrollment Germany | 40 participants | 16 participants | 56 participants |
| Region of Enrollment Greece | 18 participants | 9 participants | 27 participants |
| Region of Enrollment Hungary | 8 participants | 6 participants | 14 participants |
| Region of Enrollment India | 39 participants | 16 participants | 55 participants |
| Region of Enrollment Italy | 18 participants | 16 participants | 34 participants |
| Region of Enrollment Korea, Republic of | 37 participants | 9 participants | 46 participants |
| Region of Enrollment Netherlands | 10 participants | 4 participants | 14 participants |
| Region of Enrollment Poland | 25 participants | 11 participants | 36 participants |
| Region of Enrollment Romania | 51 participants | 26 participants | 77 participants |
| Region of Enrollment Spain | 30 participants | 19 participants | 49 participants |
| Region of Enrollment Taiwan | 5 participants | 4 participants | 9 participants |
| Region of Enrollment Turkey | 7 participants | 4 participants | 11 participants |
| Region of Enrollment United States | 20 participants | 12 participants | 32 participants |
| Sex: Female, Male Female | 119 Participants | 61 Participants | 180 Participants |
| Sex: Female, Male Male | 322 Participants | 161 Participants | 483 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 386 / 438 | 178 / 218 |
| serious Total, serious adverse events | 83 / 438 | 31 / 218 |
Outcome results
Progression-Free Survival (PFS) Time
PFS time was the elapsed time from the date of randomization to the first date of objective progression of disease or death from any cause. PFS was censored at the date of the participant's last tumor assessment for participants who were not known to have died or to have PD as of the data-inclusion cut-off date for analysis. PD, defined using Response Evaluation Criteria in Solid Tumors version 1.0 (RECIST v1.0), was at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as references the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions.
Time frame: Randomization to measured PD or death from any cause (up to 41 months)
Population: Participants who signed the ICF and completed the randomized process are reported according to the treatment arm to which they were randomized. Participants censored: N = 123, 36 participants in the pemetrexed and placebo treatment arms, respectively.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed and BSC | Progression-Free Survival (PFS) Time | 4.27 months |
| Placebo and BSC | Progression-Free Survival (PFS) Time | 2.60 months |
Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS
The participant-reported LCSS was a 9-item questionnaire. Six items were symptom-specific measures for lung cancer (loss of appetite, fatigue, cough, dyspnea, hemoptysis, and pain), and 3 summation items described total symptomatic distress, interference with activity level, and global quality of life. Participant responses to each item were measured using VAS from 0 (for best outcome) to 100 (for worst outcome). The average symptom burden index (ASBI) was the mean of the 6 symptom-specific items. The LCSS total score was the mean of the 9 items.
Time frame: Baseline through 30 days post discontinuation of study treatment (up to 39 Months)
Population: Participants who signed the ICF, completed the randomization process, had LCSS data at baseline and at least once postdose are reported according to the treatment arm to which they were randomized.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Dyspnea (n=400, 196) | 7.6 units on a scale | Standard Deviation 22.5 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Symptom distress (n=401, 196) | 6.5 units on a scale | Standard Deviation 21.13 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Cough (n=402, 197) | 7.6 units on a scale | Standard Deviation 20.09 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Interference with activity level (n=400, 197) | 10.8 units on a scale | Standard Deviation 27.08 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Pain (n=401, 197) | 5.4 units on a scale | Standard Deviation 20.96 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Global quality of life (n=401, 195) | 10.7 units on a scale | Standard Deviation 24.94 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Fatigue (n=403, 197) | 10.2 units on a scale | Standard Deviation 27.1 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | ASBI (n=392, 195) | 3.7 units on a scale | Standard Deviation 12.34 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Hemoptysis (n=402, 196) | 1.5 units on a scale | Standard Deviation 9.41 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Total LCSS (n=388, 193) | 4.07 units on a scale | Standard Deviation 12.76 |
| Pemetrexed and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Loss of appetite (n=403, 197) | 7.3 units on a scale | Standard Deviation 25.9 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Total LCSS (n=388, 193) | 4.04 units on a scale | Standard Deviation 13.03 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Loss of appetite (n=403, 197) | 10.6 units on a scale | Standard Deviation 25.25 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Fatigue (n=403, 197) | 10.4 units on a scale | Standard Deviation 23.92 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Cough (n=402, 197) | 6.7 units on a scale | Standard Deviation 23.81 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Dyspnea (n=400, 196) | 5.4 units on a scale | Standard Deviation 20.44 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Pain (n=401, 197) | 4.3 units on a scale | Standard Deviation 21.93 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Hemoptysis (n=402, 196) | 2.1 units on a scale | Standard Deviation 9.23 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Symptom distress (n=401, 196) | 8.2 units on a scale | Standard Deviation 22.5 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Interference with activity level (n=400, 197) | 9.3 units on a scale | Standard Deviation 25.5 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | Global quality of life (n=401, 195) | 10.5 units on a scale | Standard Deviation 22.98 |
| Placebo and BSC | Maximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSS | ASBI (n=392, 195) | 3.8 units on a scale | Standard Deviation 13.24 |
Number of Participants With Adverse Events (AEs)
Clinically significant events were defined as serious adverse events (SAEs) and other non-serious AEs regardless of causality. A summary of serious and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
Time frame: Baseline to study completion (up to 41 Months)
Population: Participants who signed the ICF, completed the randomized process and received at least 1 dose of study drug are reported according to the treatment to which they were received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed and BSC | Number of Participants With Adverse Events (AEs) | SAEs | 83 participants |
| Pemetrexed and BSC | Number of Participants With Adverse Events (AEs) | Other Non-Serious AEs | 386 participants |
| Placebo and BSC | Number of Participants With Adverse Events (AEs) | SAEs | 31 participants |
| Placebo and BSC | Number of Participants With Adverse Events (AEs) | Other Non-Serious AEs | 178 participants |
Overall Survival (OS) Time
OS time was the elapsed time from the date of randomization to the date of death from any cause. OS was censored at the last date of contact for participants who were not known to have died as of the data-inclusion cut-off date for analysis.
Time frame: Randomization to date of death from any cause (up to 41 months)
Population: Participants who signed the ICF and completed the randomized process are reported according to the treatment arm to which they were randomized. Participants censored: N = 138, 48 participants in the pemetrexed and placebo treatment arms, respectively.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed and BSC | Overall Survival (OS) Time | 13.37 months |
| Placebo and BSC | Overall Survival (OS) Time | 10.58 months |
Percentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate)
Response was defined using RECIST v1.0 criteria. CR was defined as the disappearance of all target lesions. PR was defined either A) at least a 30% decrease in the sum of the LD of target lesions taking as reference the baseline sum LDs or B) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared. The percentage of participants with CR or PR=(Number of participants with CR or PR)/(Number of participants assessed)\*100.
Time frame: Baseline to measured PD (up to 41 months)
Population: Participants who signed the ICF and completed the randomized process are reported according to the treatment arm to which they were randomized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed and BSC | Percentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate) | 6.8 percentage of participants |
| Placebo and BSC | Percentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate) | 1.8 percentage of participants |
Time to Objective Progressive Disease (TPD)
TPD was the elapsed time from the date of randomization to the first date of objective PD. TPD was censored at the date of the participant's last tumor assessment for participants who were not known to have PD as of the data-inclusion cut-off date for analysis or who died without objective PD. PD, defined using RECIST v1.0, was at least a 20% increase in the sum of LD of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions.
Time frame: Randomization to measured PD (up to 41 months)
Population: Participants who signed the ICF and completed the randomized process are reported according to the treatment arm to which they were randomized. Participants censored: N = 145, 40 participants in the pemetrexed and placebo treatment arms, respectively.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed and BSC | Time to Objective Progressive Disease (TPD) | 4.27 months |
| Placebo and BSC | Time to Objective Progressive Disease (TPD) | 2.60 months |
Time to Worsening of Symptoms (TWS)
TWS was the elapsed time from the date of randomization to the first date of worsening \[defined as a 15-millimeter (mm) increase from baseline based on a 100-mm scale\] of each symptom and summary item in the Lung Cancer Symptom Scale (LCSS). The participant-reported LCSS was a 9-item questionnaire. Six items were symptom-specific measures for lung cancer (loss of appetite, fatigue, cough, dyspnea, hemoptysis, and pain), and 3 summation items described total symptomatic distress, interference with activity level, and global quality of life. Participant (pt) responses to each item were measured using visual analogue scales (VAS) from 0 (for best outcome) to 100 (for worst outcome). TWS was censored at the date of the last LCSS assessment for pts who were not known to have LCSS worsening.
Time frame: Randomization to worsening of each LCSS item (up to 39 months)
Population: Pts who signed ICF and completed randomization, according to treatment randomized. Pts censored: Loss of appetite 236,140; fatigue 237,130; cough 274,146; dyspnea 271,143, hemoptysis 404,198; pain 271,135; symptom distress 247,141; interference with activity level 267,141, global quality of life 262,137 pts in pemetrexed, placebo arm, respectively.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Loss of appetite | 3.78 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Fatigue | 3.06 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Cough | 6.05 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Dyspnea | 5.36 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Hemoptysis | NA months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Symptomatic distress | 4.21 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Pain | 6.11 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Interference with activity level | 6.51 months |
| Pemetrexed and BSC | Time to Worsening of Symptoms (TWS) | Global quality of life | 5.75 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Global quality of life | 3.71 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Loss of appetite | 4.40 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Hemoptysis | NA months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Fatigue | 3.09 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Interference with activity level | 3.98 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Cough | 4.67 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Pain | 4.63 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Dyspnea | 4.40 months |
| Placebo and BSC | Time to Worsening of Symptoms (TWS) | Symptomatic distress | 3.78 months |