Carcinoma, Non-Small-Cell Lung, Lung Neoplasms
Conditions
Brief summary
This is a prospective open label, controlled, randomized study to test the safety and efficacy of active specific immunotherapy with tecemotide (L-BLP25) for the treatment of subjects with Stage IIIB or Stage IV non-small cell lung cancer (NSCLC). To be eligible, subjects entering the trial will have to demonstrate either stable disease or a clinical response after first-line treatment (chemotherapy alone, or chemotherapy and radiotherapy) and have an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2. Following a 3 week washout period, subjects will be stratified by disease status (either Stage IIIB locoregional disease or Stage IIIB with malignant pleural effusion and Stage IV), and randomized to either best supportive care (BSC) plus tecemotide (L-BLP25) treatment or BSC alone.
Interventions
After receiving single low dose cyclophosphamide, subjects will receive 8 consecutive weekly subcutaneous vaccinations with 1000 microgram (mcg) of tecemotide (L-BLP25) at weeks 0, 1, 2, 3, 4, 5, 6 and 7 followed by maintenance vaccinations (1000 mcg of tecemotide (L-BLP25) at 6-week intervals, commencing at Week 13, until discontinuation from the study due to ECOG status of 4, participation in alternate trial, serious adverse event, or reasons that preclude assessment of clinical status in the opinion of the investigator, and in case of unavailability of study vaccine.
A single intravenous infusion of 300 milligram per square meter (mg/m\^2) (to a maximum 600 mg) of cyclophosphamide will be given 3 days before the first vaccine treatment.
The BSC will be provided at the investigator's discretion, and may include palliative radiation, psychosocial support, analgesics and nutritional support. Second-line chemotherapy is permitted when indicated for treatment of progressive disease.
Sponsors
Study design
Eligibility
Inclusion criteria
* Stage IIIB or Stage IV NSCLC * Stable disease or a clinical response following first-line treatment, consisting of either chemotherapy alone or chemotherapy and radiotherapy. Subjects must have completed the first-line treatment at least 3 weeks prior to study entry * Eastern Cooperative Oncology Group (ECOG) performance status of greater than or equal to (\>=) 2 * Ability to understand and willingness to sign a written informed consent * Other protocol-defined inclusion criteria could apply
Exclusion criteria
* Received immunotherapy within 4 weeks prior to study entry * Received immunosuppressive drugs within 3 weeks prior to study entry * Subjects with known brain metastases * Past or current history of neoplasm other than lung carcinoma, except for curatively treated non-melanoma skin cancer, in situ carcinoma of the cervix or other cancer curatively treated and with no evidence of disease for at least 5 years * Autoimmune disease or immunodeficiency * Clinically significant hepatic, renal or cardiac dysfunction * Subjects with clinically significant active infection * Pregnant or breast feeding women, women of childbearing potential, unless using effective contraception as determined by the investigator * Other protocol-defined
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | From the first dose of study drug administration until 30 days after the last dose of study drug administration or assessed until cut-off date (15 March 2006) | An adverse event (AE) was defined as any new untoward medical occurrences/worsening of pre-existing medical condition, whether or not related to study drug. A serious AE was an AE that results in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect. Treatment-emergent are events between first dose of study drug and up to 30 days after last dose that were absent before treatment or that worsened relative to pretreatment state. Number of participants with TEAEs, serious TEAEs, TEAEs leading to death, and TEAEs with CALGB toxicity Grade 3 or 4 were reported. |
| Overall Survival Time | Time from randomization to death or last day known to be alive, reported between day of first participant randomized that is, 08 August 2000, up to cut-off (15 March 2006) | Time from randomization to death or last day known to be alive. Participants without event were censored at the last date known to be alive or at the clinical cut-off date (15 March 2006), whichever was earlier. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | At baseline, Week 4, Week 8 and then at 12 Week intervals beginning at week 19 until withdrawal/discontinuation from the study. | Functional Assessment of Cancer Therapy - Lung cancer (FACT-L) is a valid instrument used to measure quality of life (QoL) in participants with cancer consisting of the 27-item FACT-General (G) and 9-item lung cancer subscale (LCS). FACT-G is organized into subscales: physical well-being (PWB)-7 items; social/family well-being (SWB)-7 items; emotional well-being (EWB)-6 items; functional well-being (FWB)-7 items. Each item uses a 5 point rating scale (0=not at all and 4=equals very much). FACT-L total score=4 subscales + LCS and ranges from 0 to 144. Higher scores indicate better QOL. |
| Number of Participants With Positive T-cell Proliferation | Time from randomization until cut-off date (15 March 2006) | T-cell proliferation assays were performed and the number of participants with positive mucinous glycoprotein 1 (MUC1) specific T-cell proliferative response were reported. |
| Number of Participants With Elevated CA27-29 Antigen Levels | Study entry, Week 8 | CA 27-29 is a blood test used to monitor certain types of cancer. CA 27-29 is the name of an antigen, which is a substance that stimulates your body's defense system. CA27-29 antigen levels were determined on all participants and assessed the disease burden of participants at study entry, evaluated early recurrence, presence of residual disease, continued remission or poor prognosis. |
Countries
Germany
Participant flow
Recruitment details
First/Last participant (informed consent): 08 August 2000/02 December 2002. Clinical data cut-off: 15 March 2006. Participants randomized at 17 centers in Canada and United Kingdom.
Pre-assignment details
A total of 437 participants were screened for eligibility and 171 participants were randomized.
Participants by arm
| Arm | Count |
|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) A single intravenous infusion of 300 milligram per square meter (mg/m\^2) (to a maximum 600 mg) of cyclophosphamide was given 3 days before the first vaccine treatment. After receiving cyclophosphamide, participants received 8 consecutive weekly subcutaneous vaccinations with 1000 microgram (mcg) of tecemotide (L-BLP25) at Weeks 0, 1, 2, 3, 4, 5, 6, and 7 followed by maintenance vaccinations with 1000 mcg of tecemotide (L-BLP25) at 6-week intervals, commencing at Week 13, until discontinuation from study due to ECOG status of 4, participation in alternate trial, serious adverse event, or reasons that preclude assessment of clinical status in the opinion of investigator, and incase of unavailability of study vaccine. The Best Supportive Care (BSC) was provided at the investigator's discretion, and included palliative radiation, psychosocial support, analgesics and nutritional support as required. Second-line chemotherapy was permitted when indicated for treatment of progressive disease. | 88 |
| Best Supportive Care (BSC) Alone The BSC was provided at the investigator's discretion, and included palliative radiation, psychosocial support, analgesics and nutritional support as required. Second-line chemotherapy was permitted when indicated for treatment of progressive disease. | 83 |
| Total | 171 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Ongoing at data cut-off | 10 | 0 |
Baseline characteristics
| Characteristic | Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Best Supportive Care (BSC) Alone | Total |
|---|---|---|---|
| Age, Continuous | 60.4 years STANDARD_DEVIATION 10 | 58.7 years STANDARD_DEVIATION 11.3 | 59.6 years STANDARD_DEVIATION 10.7 |
| Sex: Female, Male Female | 36 Participants | 40 Participants | 76 Participants |
| Sex: Female, Male Male | 52 Participants | 43 Participants | 95 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 88 / 88 | 80 / 83 |
| serious Total, serious adverse events | 29 / 88 | 34 / 83 |
Outcome results
Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4
An adverse event (AE) was defined as any new untoward medical occurrences/worsening of pre-existing medical condition, whether or not related to study drug. A serious AE was an AE that results in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect. Treatment-emergent are events between first dose of study drug and up to 30 days after last dose that were absent before treatment or that worsened relative to pretreatment state. Number of participants with TEAEs, serious TEAEs, TEAEs leading to death, and TEAEs with CALGB toxicity Grade 3 or 4 were reported.
Time frame: From the first dose of study drug administration until 30 days after the last dose of study drug administration or assessed until cut-off date (15 March 2006)
Population: Analysis population included all participants randomized in the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs | 88 participants |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | Serious TEAEs | 29 participants |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs leading to death | 13 participants |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs with CALGB toxicity Grade 3 or 4 | 42 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs with CALGB toxicity Grade 3 or 4 | 42 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs | 80 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | TEAEs leading to death | 20 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, TEAEs Leading to Death, and TEAEs With Cancer and Leukemia Group B (CALGB) Toxicity Grade 3 or 4 | Serious TEAEs | 34 participants |
Overall Survival Time
Time from randomization to death or last day known to be alive. Participants without event were censored at the last date known to be alive or at the clinical cut-off date (15 March 2006), whichever was earlier.
Time frame: Time from randomization to death or last day known to be alive, reported between day of first participant randomized that is, 08 August 2000, up to cut-off (15 March 2006)
Population: Analysis population included all randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Overall Survival Time | 17.2 months |
| Best Supportive Care (BSC) Alone | Overall Survival Time | 13.0 months |
Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score
Functional Assessment of Cancer Therapy - Lung cancer (FACT-L) is a valid instrument used to measure quality of life (QoL) in participants with cancer consisting of the 27-item FACT-General (G) and 9-item lung cancer subscale (LCS). FACT-G is organized into subscales: physical well-being (PWB)-7 items; social/family well-being (SWB)-7 items; emotional well-being (EWB)-6 items; functional well-being (FWB)-7 items. Each item uses a 5 point rating scale (0=not at all and 4=equals very much). FACT-L total score=4 subscales + LCS and ranges from 0 to 144. Higher scores indicate better QOL.
Time frame: At baseline, Week 4, Week 8 and then at 12 Week intervals beginning at week 19 until withdrawal/discontinuation from the study.
Population: Analysis population included all the participants with a baseline and at least one post-baseline complete FACT-L questionnaire. n signifies number of participants evaluable at each timepoint for this outcome measure, for each reporting group, respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Baseline (n=88, 78) | 109.3 Units on a scale | Standard Deviation 14.8 |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 4 (n=86, 75) | 109.4 Units on a scale | Standard Deviation 15.9 |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 8 (n=84, 73) | 108.1 Units on a scale | Standard Deviation 16.1 |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 19 (n=54, 55) | 108.2 Units on a scale | Standard Deviation 14.9 |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 31(n=34, 36) | 110.1 Units on a scale | Standard Deviation 14.7 |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 43 (n=31, 20) | 110.3 Units on a scale | Standard Deviation 17.4 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 31(n=34, 36) | 103.5 Units on a scale | Standard Deviation 19.6 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Baseline (n=88, 78) | 106.4 Units on a scale | Standard Deviation 15.6 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 19 (n=54, 55) | 100.1 Units on a scale | Standard Deviation 20.6 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 4 (n=86, 75) | 104.1 Units on a scale | Standard Deviation 17 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 43 (n=31, 20) | 111.6 Units on a scale | Standard Deviation 12.8 |
| Best Supportive Care (BSC) Alone | Functional Assessment of Cancer Therapy (FACT-L) Questionnaire Score | Week 8 (n=84, 73) | 101.6 Units on a scale | Standard Deviation 17.5 |
Number of Participants With Elevated CA27-29 Antigen Levels
CA 27-29 is a blood test used to monitor certain types of cancer. CA 27-29 is the name of an antigen, which is a substance that stimulates your body's defense system. CA27-29 antigen levels were determined on all participants and assessed the disease burden of participants at study entry, evaluated early recurrence, presence of residual disease, continued remission or poor prognosis.
Time frame: Study entry, Week 8
Population: Analysis population included all randomized participants. n signifies number of participants evaluable at each timepoint for this outcome measure, for each reporting group, respectively.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Elevated CA27-29 Antigen Levels | Study entry (n=84, 82) | 21 participants |
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Elevated CA27-29 Antigen Levels | Week 8 (n=82, 71) | 20 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Elevated CA27-29 Antigen Levels | Study entry (n=84, 82) | 21 participants |
| Best Supportive Care (BSC) Alone | Number of Participants With Elevated CA27-29 Antigen Levels | Week 8 (n=82, 71) | 18 participants |
Number of Participants With Positive T-cell Proliferation
T-cell proliferation assays were performed and the number of participants with positive mucinous glycoprotein 1 (MUC1) specific T-cell proliferative response were reported.
Time frame: Time from randomization until cut-off date (15 March 2006)
Population: Analysis population included all randomized participants. N signifies total number of participants who were evaluable for this measure. T-cell measure was done only on arm A where subjects received tecemotide for induction of t-cell response. Therefore arm B BSC did not have any samples taken for this assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tecemotide (L-BLP25) Plus Best Supportive Care (BSC) | Number of Participants With Positive T-cell Proliferation | 16 participants |