Lung Cancer, Non-small Cell Lung Cancer
Conditions
Keywords
Non-small cell lung cancer, NSCLC
Brief summary
This large phase III clinical study is studying the effect of vandetanib (ZACTIMA) in treating non-small cell lung cancer (NSCLC). Vandetanib is a new type of agent that targets the blood supply to a cancer tumour (through it's anti-vascular endothelial growth factor receptor (VEGFR) properties) and the tumour cells themselves (through it's anti-endothelial growth factor receptor (EGFR) actions). This study will look at the effects of vandetanib in lung cancer patients who have had their cancer re-appear after treatment with standard chemotherapy. This clinical study will test if the vandetanib anti-VEGF and anti-EGFR characteristics can deliver longer improved progression free survival and improved overall survival than docetaxel (Taxotere) alone. All patients participating this clinical study will receive treatment with docetaxel, a commonly used treatment for recurrent non-small cell lung cancer. In addition, some patients will also receive vandetanib (ZACTIMA), an anti-EGFR / anti-VEGF agent. Recent clinical research shows that vascular endothelial growth factor receptor (VEGFR) inhibition, when used with standard chemotherapy, can lead to increased survival in advanced non-small cell lung cancer (NSCLC) patients. Other research shows that epidermal growth factor receptor (EGFR) inhibitors, like erlotinib (Tarceva) can also increase overall non-small cell lung cancer survival by killing tumour cells and stopping them from dividing.
Interventions
infusion
oral
Sponsors
Study design
Eligibility
Inclusion criteria
Lung cancer patients who answer true to the following statements are eligible to join this clinical study. * I have a confirmed diagnosis of locally advanced or metastatic non small cell lung cancer (Stage IIIb - IV) * I have had 1st line anti-cancer therapy. Previous treatment with Avastin (bevacizumab) in first line NSCLC is allowed.
Exclusion criteria
Lung cancer patients who answer true to the following are NOT eligible to join this clinical study. * I do not have non small cell lung cancer (NSCLC) * I have received treatment with docetaxel (Taxotere). Prior treatment with paclitaxel is acceptable. * I have received 2nd line anti-cancer therapy (For example, patients with previous 2nd line non small cell lung cancer (NSCLC) treatment with Tarceva (erlotinib, OSI-744), Alimta (pemetrexed) are not eligible) * I have been treated with VEGFR-tyrosine kinase inhibitors (TKIs) (sunitinib, sorafenib, other VEGF TKIs). Previous treatment with Avastin (bevacizumab) in 1st line non small cell lung cancer is permitted. * I have a history of uncontrolled irregular heartbeat * I have a history of high blood pressure which has not been controlled with medication If you are unsure of the meaning of the inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) in the Overall Population | RECIST tumour assessments carried out every 6 weeks from randomisation until the date of first documented objective disease progression or date of death from any cause, whichever came first assessed up to 24 months | Median time (in weeks) from randomisation until objective disease progression or death (by any cause in the absence of objective progression) provided death is within 3 months from the last evaluable RECIST assessment. Progression was derived according to RECIST 1.0 and is defined as an increase of at least 20% in the total tumour size of measurable lesions over the nadir measurement, unequivocal progression in the non-target lesions or the appearance of one or more new lesions. |
| Progression-Free Survival (PFS) in the Female Population | RECIST tumour assessments carried out every 6 weeks from randomisation until the date of first documented objective disease progression or date of death from any cause, whichever came first assessed up to 24 months | Median time (in weeks) from randomisation until objective disease progression or death (by any cause in the absence of objective progression) provided death is within 3 months from the last evaluable RECIST assessment. Progression was derived according to RECIST 1.0 and is defined as an increase of at least 20% in the total tumour size of measurable lesions over the nadir measurement, unequivocal progression in the non-target lesions or the appearance of one or more new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) in the Female Population | Time to death in months | Overall survival is defined as the time from date of randomization until death. Any patient not known to have died at the time of analysis will be censored based on the last recorded date on which the patient was known to be alive (ie their status must be known at the censored date and should not be lost to follow up or unknown). |
| Objective Response Rate (ORR) | Each patient was assessed for objective response from the sequence of RECIST scan data up to data cut off. RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression | The ORR is the number of patients that are responders ie those patients with a confirmed best objective response of complete response (CR) or partial response (PR) as determined according to RECIST 1.0. CR is defined as the disappearance of all target lesions with no evidence of tumour elsewhere and PR is defined as at least a 30% reduction in the total tumour size of measurable lesions with no new lesions and no progression in the non-target lesions. |
| Disease Control Rate (DCR) | RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression | Disease control rate is defined as the number of patients who achieved disease control at least 6 weeks following randomisation. Disease control at 6 weeks is defined as a best objective response of complete response (CR), partial response (PR) or stable disease (SD) \>= 6 weeks as determined according to RECIST 1.0. CR is defined as the disappearance of all target lesions with no evidence of tumour elsewhere, PR is defined as at least a 30% reduction in the total tumour size of measurable lesions with no new lesions and no progression in the non-target lesions and SD \>= 6 is assigned to patients who have not responded and have no evidence of progression at least 6 weeks after randomisation. |
| Duration of Response (DoR) | RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression | Response is defined as a confirmed best objective response of CR or PR. Duration of response is defined as time from the date of first documented response until date of documented progression or death in the absence of disease progression (provided death is within 3 months of last RECIST assessment) |
| Time to Deterioration of Disease-related Symptoms (TDS) by FACT-L Pulmonary Symptom Index (PSI) | FACT-L questionnaires are to be administered every 3 weeks after randomisation | The pulmonary symptom index (PSI) consists of 4 items of the LCS relating to pulmonary symptoms (i.e. 3 items relating to breathing/dyspnea, and 1 item relating to cough). The PSI score is the sum of the scores from the 4 items. Time to deterioration is defined as the interval from the date of randomization to the first assessment of worsened without an improvement in the next 21 days. A patient will be defined as having a deterioration in symptoms if they have a single visit assessment of 'worsened' with no visit assessment of 'improved' within the next 21 days. |
| Time to Deterioration of Disease-related Symptoms (TDS) by Functional Assessment of Cancer Therapy - Lung (FACT-L) Lung Cancer Subscale (LCS). | FACT-L questionnaires are to be administered every 3 weeks after randomisation | The lung cancer subscale (LCS) consists of 7 items of the FACT-L (3 items relating to breathing/dyspnea, and 1 item each relating to cough, weight loss, appetite, and cognition). The LCS total score is the sum of the scores from the 7 items. Time to deterioration is defined as the interval from the date of randomization to the first assessment of worsened without an improvement in the next 21 days. A patient will be defined as having a deterioration in symptoms if they have a single visit assessment of 'worsened' with no visit assessment of 'improved' within the next 21 days. |
| Overall Survival (OS) in the Overall Population | Time to death in months | Overall survival is defined as the time from date of randomization until death. Any patient not known to have died at the time of analysis will be censored based on the last recorded date on which the patient was known to be alive (ie their status must be known at the censored date and should not be lost to follow up or unknown). |
Countries
Argentina, Austria, Belgium, Brazil, Canada, China, Denmark, France, Germany, Greece, India, Indonesia, Italy, Japan, Malaysia, Mexico, Netherlands, Portugal, Singapore, South Korea, Spain, Thailand, Turkey (Türkiye), United States, Vietnam
Participant flow
Recruitment details
First patient enrolled 08 May 2006, last patient enrolled 14 March 2008, cut off date 22 August 2008
Participants by arm
| Arm | Count |
|---|---|
| Vandetanib 100 mg Plus Docetaxel Vandetanib 100 mg plus docetaxel | 694 |
| Placebo Plus Docetaxel Placebo plus docetaxel | 697 |
| Total | 1,391 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 403 | 418 |
| Overall Study | Discontinue treatment survival follow up | 202 | 200 |
| Overall Study | Lost to Follow-up | 9 | 12 |
| Overall Study | Non-compliance | 0 | 2 |
| Overall Study | Randomised but never received treatment | 6 | 6 |
| Overall Study | Site ended participation in study | 1 | 0 |
| Overall Study | Withdrawal by Subject | 23 | 30 |
Baseline characteristics
| Characteristic | Vandetanib 100 mg Plus Docetaxel | Placebo Plus Docetaxel | Total |
|---|---|---|---|
| Age, Continuous | 58.5 years | 58.4 years | 58.45 years |
| Sex: Female, Male Female | 497 Participants | 473 Participants | 970 Participants |
| Sex: Female, Male Male | 197 Participants | 224 Participants | 421 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 637 / 694 | 630 / 697 |
| serious Total, serious adverse events | 263 / 694 | 232 / 697 |
Outcome results
Progression-Free Survival (PFS) in the Female Population
Median time (in weeks) from randomisation until objective disease progression or death (by any cause in the absence of objective progression) provided death is within 3 months from the last evaluable RECIST assessment. Progression was derived according to RECIST 1.0 and is defined as an increase of at least 20% in the total tumour size of measurable lesions over the nadir measurement, unequivocal progression in the non-target lesions or the appearance of one or more new lesions.
Time frame: RECIST tumour assessments carried out every 6 weeks from randomisation until the date of first documented objective disease progression or date of death from any cause, whichever came first assessed up to 24 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Progression-Free Survival (PFS) in the Female Population | 20.1 Weeks |
| Placebo Plus Docetaxel | Progression-Free Survival (PFS) in the Female Population | 18.3 Weeks |
Progression-Free Survival (PFS) in the Overall Population
Median time (in weeks) from randomisation until objective disease progression or death (by any cause in the absence of objective progression) provided death is within 3 months from the last evaluable RECIST assessment. Progression was derived according to RECIST 1.0 and is defined as an increase of at least 20% in the total tumour size of measurable lesions over the nadir measurement, unequivocal progression in the non-target lesions or the appearance of one or more new lesions.
Time frame: RECIST tumour assessments carried out every 6 weeks from randomisation until the date of first documented objective disease progression or date of death from any cause, whichever came first assessed up to 24 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Progression-Free Survival (PFS) in the Overall Population | 17.3 Weeks |
| Placebo Plus Docetaxel | Progression-Free Survival (PFS) in the Overall Population | 14 Weeks |
Disease Control Rate (DCR)
Disease control rate is defined as the number of patients who achieved disease control at least 6 weeks following randomisation. Disease control at 6 weeks is defined as a best objective response of complete response (CR), partial response (PR) or stable disease (SD) \>= 6 weeks as determined according to RECIST 1.0. CR is defined as the disappearance of all target lesions with no evidence of tumour elsewhere, PR is defined as at least a 30% reduction in the total tumour size of measurable lesions with no new lesions and no progression in the non-target lesions and SD \>= 6 is assigned to patients who have not responded and have no evidence of progression at least 6 weeks after randomisation.
Time frame: RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Disease Control Rate (DCR) | 413 Participants |
| Placebo Plus Docetaxel | Disease Control Rate (DCR) | 380 Participants |
Duration of Response (DoR)
Response is defined as a confirmed best objective response of CR or PR. Duration of response is defined as time from the date of first documented response until date of documented progression or death in the absence of disease progression (provided death is within 3 months of last RECIST assessment)
Time frame: RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Duration of Response (DoR) | 29.9 Weeks |
| Placebo Plus Docetaxel | Duration of Response (DoR) | 19.7 Weeks |
Objective Response Rate (ORR)
The ORR is the number of patients that are responders ie those patients with a confirmed best objective response of complete response (CR) or partial response (PR) as determined according to RECIST 1.0. CR is defined as the disappearance of all target lesions with no evidence of tumour elsewhere and PR is defined as at least a 30% reduction in the total tumour size of measurable lesions with no new lesions and no progression in the non-target lesions.
Time frame: Each patient was assessed for objective response from the sequence of RECIST scan data up to data cut off. RECIST tumour assessments carried out every 6 weeks from randomisation until objective progression
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Objective Response Rate (ORR) | 120 Participants |
| Placebo Plus Docetaxel | Objective Response Rate (ORR) | 71 Participants |
Overall Survival (OS) in the Female Population
Overall survival is defined as the time from date of randomization until death. Any patient not known to have died at the time of analysis will be censored based on the last recorded date on which the patient was known to be alive (ie their status must be known at the censored date and should not be lost to follow up or unknown).
Time frame: Time to death in months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Overall Survival (OS) in the Female Population | 12.7 Months |
| Placebo Plus Docetaxel | Overall Survival (OS) in the Female Population | 14.2 Months |
Overall Survival (OS) in the Overall Population
Overall survival is defined as the time from date of randomization until death. Any patient not known to have died at the time of analysis will be censored based on the last recorded date on which the patient was known to be alive (ie their status must be known at the censored date and should not be lost to follow up or unknown).
Time frame: Time to death in months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Overall Survival (OS) in the Overall Population | 10.6 Months |
| Placebo Plus Docetaxel | Overall Survival (OS) in the Overall Population | 10 Months |
Time to Deterioration of Disease-related Symptoms (TDS) by FACT-L Pulmonary Symptom Index (PSI)
The pulmonary symptom index (PSI) consists of 4 items of the LCS relating to pulmonary symptoms (i.e. 3 items relating to breathing/dyspnea, and 1 item relating to cough). The PSI score is the sum of the scores from the 4 items. Time to deterioration is defined as the interval from the date of randomization to the first assessment of worsened without an improvement in the next 21 days. A patient will be defined as having a deterioration in symptoms if they have a single visit assessment of 'worsened' with no visit assessment of 'improved' within the next 21 days.
Time frame: FACT-L questionnaires are to be administered every 3 weeks after randomisation
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Time to Deterioration of Disease-related Symptoms (TDS) by FACT-L Pulmonary Symptom Index (PSI) | 12.3 Weeks |
| Placebo Plus Docetaxel | Time to Deterioration of Disease-related Symptoms (TDS) by FACT-L Pulmonary Symptom Index (PSI) | 11.9 Weeks |
Time to Deterioration of Disease-related Symptoms (TDS) by Functional Assessment of Cancer Therapy - Lung (FACT-L) Lung Cancer Subscale (LCS).
The lung cancer subscale (LCS) consists of 7 items of the FACT-L (3 items relating to breathing/dyspnea, and 1 item each relating to cough, weight loss, appetite, and cognition). The LCS total score is the sum of the scores from the 7 items. Time to deterioration is defined as the interval from the date of randomization to the first assessment of worsened without an improvement in the next 21 days. A patient will be defined as having a deterioration in symptoms if they have a single visit assessment of 'worsened' with no visit assessment of 'improved' within the next 21 days.
Time frame: FACT-L questionnaires are to be administered every 3 weeks after randomisation
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Vandetanib 100 mg Plus Docetaxel | Time to Deterioration of Disease-related Symptoms (TDS) by Functional Assessment of Cancer Therapy - Lung (FACT-L) Lung Cancer Subscale (LCS). | 15 Weeks |
| Placebo Plus Docetaxel | Time to Deterioration of Disease-related Symptoms (TDS) by Functional Assessment of Cancer Therapy - Lung (FACT-L) Lung Cancer Subscale (LCS). | 11.9 Weeks |