Non-Small-Cell Lung Cancer
Conditions
Keywords
Non-Small-Cell Lung Cancer, Bisphosphonates, Zoledronic acid, Bone metastases, Prevention of bone metastases
Brief summary
30-40% of patients with lung cancer will develop bone metastases during the course of their disease, which can lead to pain, decreased mobility and skeletal complications. This study will investigate the effect of zoledronic acid on preventing or delaying the development of bone metastases and the impact on disease progression/survival in patients with stage IIIA and IIIB Non-small Cell Lung Cancer (NSCLC).
Interventions
Zoledronic acid 4 mg in 5 mL concentrated solution prepared with 100 mL calcium free infusion solution (0.9 % sodium chloride or 5% glucose solution).
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically or cytologically confirmed Non-small Cell Lung Cancer (NSCLC) * Newly Diagnosed, Stage IIIA and Stage IIIB excluding patients with pleural effusion * Patients must have received primary treatment for their disease and had no progression
Exclusion criteria
* Diagnosed with NSCLC longer than 6 months ago * Treatment with other bisphosphonates in past 12 months * Presence of metastases Other protocol-defined inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival | Up to 24 months | Progression-free survival is defined as the time from randomization to the date of the first documented progression or recurrence of disease or death from any cause. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months. |
| Kaplan-Meier Estimates for Progression-free Survival | Months 6, 12, 18, and 24 | Progression-free survival is defined as the time from randomization to the date of the first documented progression or recurrence of disease or death from any cause. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months. |
| Percentage of Participants With Progression-Free Survival Events | Up to 24 months | Percentage of Participants with the Progression-free survival events: disease progression and death. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | Months 6,12, 18, and 24 | Time to the first skeletal related event defined as the time from randomization to the date of occurrence of the first SRE. Skeletal Related Events were defined as radiation therapy or surgery to bone, spinal cord compression event or a pathologic bone fracture event |
| Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | Months 6, 12, 18 and 24 | Percentage of participants developing at least 1 bone metastasis, whether or not symptomatic. Bone scans were scheduled at screening and at 6-monthly intervals after study entry, or when symptoms suggested the presence of bone metastases. Positive bone scans required confirmation by x-ray, magnetic resonance imaging (MRI), or computed tomography (CT). |
| Kaplan-Meier Estimates for Overall Survival | Months 6, 12, 18, and 24 | — |
| Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | Months 6, 12, 18, and 24 | Time to occurrence of bone metastases was defined as the time from randomization to the date of the first documented bone metastases which could be asymptomatic or symptomatic at the time of detection. Bone scans were scheduled at screening and at 6-monthly intervals after study entry, or when symptoms suggested the presence of bone metastases. Positive bone scans required confirmation by x-ray, magnetic resonance imaging (MRI), or computed tomography (CT). |
| Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry | Months 12 and 24 | Skeletal Related Events were defined as radiation therapy or surgery to bone, spinal cord compression event or a pathologic bone fracture event. |
Countries
Belgium, China, France, Germany, Greece, Hungary, Italy, Netherlands, Poland, Portugal, South Korea, Spain, Taiwan, Thailand, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Zoledronic Acid Zoledronic acid 4 mg intravenous infusion over at least 15 minutes every 3 to 4 weeks for 24 months. Dosage was adjusted for participants with mild or moderate renal impairment. | 226 |
| Control No investigational treatment. If a participant developed bone metastases, treatment was started with Zoledronic acid 4 mg intravenous infusion over at least 15 minutes every 3 to 4 weeks until 24 months from the date of study entry had elapsed. | 211 |
| Total | 437 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Abnormal laboratory value(s) | 5 | 1 |
| Overall Study | Abnormal test procedure(s) | 0 | 3 |
| Overall Study | Administrative problems | 13 | 10 |
| Overall Study | Adverse Event | 27 | 13 |
| Overall Study | Death | 42 | 42 |
| Overall Study | Lost to Follow-up | 3 | 5 |
| Overall Study | Patient no longer requires study drug | 10 | 8 |
| Overall Study | Protocol Violation | 8 | 7 |
| Overall Study | Unsatisfactory therapeutic effect | 13 | 11 |
| Overall Study | Withdrawal by Subject | 37 | 25 |
Baseline characteristics
| Characteristic | Zoledronic Acid | Control | Total |
|---|---|---|---|
| Age, Continuous | 59.2 years STANDARD_DEVIATION 9.19 | 60.0 years STANDARD_DEVIATION 9.27 | 59.6 years STANDARD_DEVIATION 9.23 |
| Sex: Female, Male Female | 65 Participants | 65 Participants | 130 Participants |
| Sex: Female, Male Male | 161 Participants | 146 Participants | 307 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 166 / 224 | 139 / 213 |
| serious Total, serious adverse events | 71 / 224 | 84 / 213 |
Outcome results
Kaplan-Meier Estimates for Progression-free Survival
Progression-free survival is defined as the time from randomization to the date of the first documented progression or recurrence of disease or death from any cause. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months.
Time frame: Months 6, 12, 18, and 24
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Kaplan-Meier Estimates for Progression-free Survival | 6 months | 63.0 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Progression-free Survival | 12 months | 44.4 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Progression-free Survival | 18 months | 30.7 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Progression-free Survival | 24 months | 25.7 Percentage of participants |
| Control | Kaplan-Meier Estimates for Progression-free Survival | 24 months | 36.0 Percentage of participants |
| Control | Kaplan-Meier Estimates for Progression-free Survival | 6 months | 67.9 Percentage of participants |
| Control | Kaplan-Meier Estimates for Progression-free Survival | 18 months | 40.6 Percentage of participants |
| Control | Kaplan-Meier Estimates for Progression-free Survival | 12 months | 48.8 Percentage of participants |
Percentage of Participants With Progression-Free Survival Events
Percentage of Participants with the Progression-free survival events: disease progression and death. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months.
Time frame: Up to 24 months
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Percentage of Participants With Progression-Free Survival Events | Disease Progression | 60.2 Percentage of participants |
| Zoledronic Acid | Percentage of Participants With Progression-Free Survival Events | Death | 8.4 Percentage of participants |
| Control | Percentage of Participants With Progression-Free Survival Events | Disease Progression | 55.5 Percentage of participants |
| Control | Percentage of Participants With Progression-Free Survival Events | Death | 5.7 Percentage of participants |
Progression-Free Survival
Progression-free survival is defined as the time from randomization to the date of the first documented progression or recurrence of disease or death from any cause. Time to disease progression (TTP) was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines with evaluations every 3 months.
Time frame: Up to 24 months
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Zoledronic Acid | Progression-Free Survival | 9.0 Months |
| Control | Progression-Free Survival | 11.3 Months |
Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases
Time to occurrence of bone metastases was defined as the time from randomization to the date of the first documented bone metastases which could be asymptomatic or symptomatic at the time of detection. Bone scans were scheduled at screening and at 6-monthly intervals after study entry, or when symptoms suggested the presence of bone metastases. Positive bone scans required confirmation by x-ray, magnetic resonance imaging (MRI), or computed tomography (CT).
Time frame: Months 6, 12, 18, and 24
Population: Intent-to-Treat Population consisting of all randomized participants. Any participant without documented bone metastases at the date of analysis was to be censored at the date of the last bone scan.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 6 months | 2.7 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 12 months | 4.2 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 18 months | 11.1 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 24 months | 12.4 Percentage of participants |
| Control | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 24 months | 13.7 Percentage of participants |
| Control | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 6 months | 1.9 Percentage of participants |
| Control | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 18 months | 12.6 Percentage of participants |
| Control | Kaplan-Meier Estimate of the Time to Occurrence of Bone Metastases | 12 months | 9.0 Percentage of participants |
Kaplan-Meier Estimates for Overall Survival
Time frame: Months 6, 12, 18, and 24
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Kaplan-Meier Estimates for Overall Survival | 12 months | 81.8 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Overall Survival | 24 months | 59.5 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Overall Survival | 18 months | 72.4 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates for Overall Survival | 6 months | 92.8 Percentage of participants |
| Control | Kaplan-Meier Estimates for Overall Survival | 18 months | 71.0 Percentage of participants |
| Control | Kaplan-Meier Estimates for Overall Survival | 12 months | 81.8 Percentage of participants |
| Control | Kaplan-Meier Estimates for Overall Survival | 6 months | 93.6 Percentage of participants |
| Control | Kaplan-Meier Estimates for Overall Survival | 24 months | 63.6 Percentage of participants |
Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE)
Time to the first skeletal related event defined as the time from randomization to the date of occurrence of the first SRE. Skeletal Related Events were defined as radiation therapy or surgery to bone, spinal cord compression event or a pathologic bone fracture event
Time frame: Months 6,12, 18, and 24
Population: Intent-to-Treat Population consisting of all randomized participants. Any participant in whom no SRE had been observed during the study was to be censored at the date of the last visit or the date of death whichever was the earlier.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 6 month | 1.0 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 12 month | 2.7 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 18 month | 2.7 Percentage of participants |
| Zoledronic Acid | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 24 month | 2.7 Percentage of participants |
| Control | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 24 month | 1.8 Percentage of participants |
| Control | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 6 month | 0.0 Percentage of participants |
| Control | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 18 month | 1.8 Percentage of participants |
| Control | Kaplan-Meier Estimates of the Time to the First Skeletal Related Event (SRE) | 12 month | 1.8 Percentage of participants |
Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months
Percentage of participants developing at least 1 bone metastasis, whether or not symptomatic. Bone scans were scheduled at screening and at 6-monthly intervals after study entry, or when symptoms suggested the presence of bone metastases. Positive bone scans required confirmation by x-ray, magnetic resonance imaging (MRI), or computed tomography (CT).
Time frame: Months 6, 12, 18 and 24
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 6 months | 2.2 Percentage of participants |
| Zoledronic Acid | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 12 months | 4.0 Percentage of participants |
| Zoledronic Acid | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 18 months | 6.2 Percentage of participants |
| Zoledronic Acid | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 24 months | 6.6 Percentage of participants |
| Control | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 24 months | 9.0 Percentage of participants |
| Control | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 6 months | 4.3 Percentage of participants |
| Control | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 18 months | 8.1 Percentage of participants |
| Control | Percentage of Participants With Bone Metastases at 6, 12, 18, and 24 Months | 12 months | 7.1 Percentage of participants |
Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry
Skeletal Related Events were defined as radiation therapy or surgery to bone, spinal cord compression event or a pathologic bone fracture event.
Time frame: Months 12 and 24
Population: Intent-to-Treat Population consisting of all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Zoledronic Acid | Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry | 24 months | 2.2 Percentage of participants |
| Zoledronic Acid | Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry | 12 months | 2.2 Percentage of participants |
| Control | Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry | 12 months | 1.4 Percentage of participants |
| Control | Percentage of Participants With Skeletal Related Events (SREs) at 12 and 24 Months From Study Entry | 24 months | 1.4 Percentage of participants |