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Pemetrexed and Best Supportive Care Versus Placebo and Best Supportive Care in Non-Small Cell Lung Cancer (NSCLC)

A Phase 3, Double-Blind, Placebo-Controlled Study of Maintenance Pemetrexed Plus Best Supportive Care Versus Best Supportive Care Immediately Following Induction Treatment for Advanced Non-Small Cell Lung Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00102804
Enrollment
663
Registered
2005-02-02
Start date
2005-03-31
Completion date
2013-12-31
Last updated
2014-12-29

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Non-Small Cell Lung Cancer

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

DRUGPemetrexed

500 milligrams per square meter (mg/m\^2), intravenous (IV) administration, every (q) 21 days, until disease progression

DRUGPlacebo

IV administration, q 21 days

OTHERBest Supportive Care

Treatment without a specific antineoplastic regimen, given with the intent to maximize quality of life, as judged by the treating physician.

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Progression-Free Survival (PFS) TimeRandomization 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

MeasureTime frameDescription
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) TimeRandomization 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 LCSSBaseline 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

ArmCount
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
Total663

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event373
Overall StudyAlive, Receiving Treatment72
Overall StudyDeath56
Overall StudyEnrollment Criteria Not Met60
Overall StudyLost to Follow-up41
Overall StudyPhysician Decision246
Overall StudyProgressive Disease (PD)307196
Overall StudyProtocol Violation21
Overall StudySatisfactory Response20
Overall StudySponsor Decision10
Overall StudyWithdrawal by Subject467

Baseline characteristics

CharacteristicPemetrexed and BSCPlacebo and BSCTotal
Age, Continuous60.6 years60.4 years60.6 years
Race/Ethnicity, Customized
Aboriginal
0 participants1 participants1 participants
Race/Ethnicity, Customized
African
6 participants0 participants6 participants
Race/Ethnicity, Customized
Caucasian
279 participants149 participants428 participants
Race/Ethnicity, Customized
East Asian
104 participants50 participants154 participants
Race/Ethnicity, Customized
Hispanic
13 participants6 participants19 participants
Race/Ethnicity, Customized
West Asian
39 participants16 participants55 participants
Region of Enrollment
Australia
19 participants8 participants27 participants
Region of Enrollment
Austria
2 participants2 participants4 participants
Region of Enrollment
Brazil
24 participants10 participants34 participants
Region of Enrollment
Bulgaria
11 participants8 participants19 participants
Region of Enrollment
China
62 participants37 participants99 participants
Region of Enrollment
Croatia
10 participants3 participants13 participants
Region of Enrollment
Czech Republic
5 participants2 participants7 participants
Region of Enrollment
Germany
40 participants16 participants56 participants
Region of Enrollment
Greece
18 participants9 participants27 participants
Region of Enrollment
Hungary
8 participants6 participants14 participants
Region of Enrollment
India
39 participants16 participants55 participants
Region of Enrollment
Italy
18 participants16 participants34 participants
Region of Enrollment
Korea, Republic of
37 participants9 participants46 participants
Region of Enrollment
Netherlands
10 participants4 participants14 participants
Region of Enrollment
Poland
25 participants11 participants36 participants
Region of Enrollment
Romania
51 participants26 participants77 participants
Region of Enrollment
Spain
30 participants19 participants49 participants
Region of Enrollment
Taiwan
5 participants4 participants9 participants
Region of Enrollment
Turkey
7 participants4 participants11 participants
Region of Enrollment
United States
20 participants12 participants32 participants
Sex: Female, Male
Female
119 Participants61 Participants180 Participants
Sex: Female, Male
Male
322 Participants161 Participants483 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
386 / 438178 / 218
serious
Total, serious adverse events
83 / 43831 / 218

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed and BSCProgression-Free Survival (PFS) Time4.27 months
Placebo and BSCProgression-Free Survival (PFS) Time2.60 months
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSDyspnea (n=400, 196)7.6 units on a scaleStandard Deviation 22.5
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSSymptom distress (n=401, 196)6.5 units on a scaleStandard Deviation 21.13
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSCough (n=402, 197)7.6 units on a scaleStandard Deviation 20.09
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSInterference with activity level (n=400, 197)10.8 units on a scaleStandard Deviation 27.08
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSPain (n=401, 197)5.4 units on a scaleStandard Deviation 20.96
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSGlobal quality of life (n=401, 195)10.7 units on a scaleStandard Deviation 24.94
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSFatigue (n=403, 197)10.2 units on a scaleStandard Deviation 27.1
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSASBI (n=392, 195)3.7 units on a scaleStandard Deviation 12.34
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSHemoptysis (n=402, 196)1.5 units on a scaleStandard Deviation 9.41
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSTotal LCSS (n=388, 193)4.07 units on a scaleStandard Deviation 12.76
Pemetrexed and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSLoss of appetite (n=403, 197)7.3 units on a scaleStandard Deviation 25.9
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSTotal LCSS (n=388, 193)4.04 units on a scaleStandard Deviation 13.03
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSLoss of appetite (n=403, 197)10.6 units on a scaleStandard Deviation 25.25
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSFatigue (n=403, 197)10.4 units on a scaleStandard Deviation 23.92
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSCough (n=402, 197)6.7 units on a scaleStandard Deviation 23.81
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSDyspnea (n=400, 196)5.4 units on a scaleStandard Deviation 20.44
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSPain (n=401, 197)4.3 units on a scaleStandard Deviation 21.93
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSHemoptysis (n=402, 196)2.1 units on a scaleStandard Deviation 9.23
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSSymptom distress (n=401, 196)8.2 units on a scaleStandard Deviation 22.5
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSInterference with activity level (n=400, 197)9.3 units on a scaleStandard Deviation 25.5
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSGlobal quality of life (n=401, 195)10.5 units on a scaleStandard Deviation 22.98
Placebo and BSCMaximum Improvement Over Baseline in Individual Symptom Scores and Quality of Life Using the LCSSASBI (n=392, 195)3.8 units on a scaleStandard Deviation 13.24
Secondary

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.

ArmMeasureGroupValue (NUMBER)
Pemetrexed and BSCNumber of Participants With Adverse Events (AEs)SAEs83 participants
Pemetrexed and BSCNumber of Participants With Adverse Events (AEs)Other Non-Serious AEs386 participants
Placebo and BSCNumber of Participants With Adverse Events (AEs)SAEs31 participants
Placebo and BSCNumber of Participants With Adverse Events (AEs)Other Non-Serious AEs178 participants
Secondary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed and BSCOverall Survival (OS) Time13.37 months
Placebo and BSCOverall Survival (OS) Time10.58 months
Secondary

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.

ArmMeasureValue (NUMBER)
Pemetrexed and BSCPercentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate)6.8 percentage of participants
Placebo and BSCPercentage of Participants With a Complete Response (CR) or Partial Response (PR) (Objective Tumor Response Rate)1.8 percentage of participants
Secondary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed and BSCTime to Objective Progressive Disease (TPD)4.27 months
Placebo and BSCTime to Objective Progressive Disease (TPD)2.60 months
Secondary

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.

ArmMeasureGroupValue (MEDIAN)
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Loss of appetite3.78 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Fatigue3.06 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Cough6.05 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Dyspnea5.36 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)HemoptysisNA months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Symptomatic distress4.21 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Pain6.11 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Interference with activity level6.51 months
Pemetrexed and BSCTime to Worsening of Symptoms (TWS)Global quality of life5.75 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Global quality of life3.71 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Loss of appetite4.40 months
Placebo and BSCTime to Worsening of Symptoms (TWS)HemoptysisNA months
Placebo and BSCTime to Worsening of Symptoms (TWS)Fatigue3.09 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Interference with activity level3.98 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Cough4.67 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Pain4.63 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Dyspnea4.40 months
Placebo and BSCTime to Worsening of Symptoms (TWS)Symptomatic distress3.78 months

Source: ClinicalTrials.gov · Data processed: Apr 2, 2026