Non-Small Cell Lung Cancer
Conditions
Brief summary
The purpose of this study is to compare the combination of pemetrexed and carboplatin with the combination of docetaxel and carboplatin in terms of survival without Grade 3 or 4 toxicity in previously untreated patients with locally advanced or metastatic non-small cell lung cancer (NSCLC).
Interventions
500 mg/m\^2, IV, q 21 days x 6 cycles maximum
75 mg/m\^2, IV, q 21 days x 6 cycles maximum
AUC 5 mg\*min/mL, IV, q 21 days x 6 cycles maximum
Sponsors
Study design
Eligibility
Inclusion criteria
* Patient with locally advanced or metastatic (Stage IIIB/IV) NCSLC with no prior chemotherapy for advanced disease or molecular target treatment * Easter Cooperative Oncology Group (ECOG) performance status 0 to 2 * Estimated life expectancy of at least 8 weeks
Exclusion criteria
* Known or suspected brain metastases * Concurrent administration of any other tumor therapy * Serious concomitant disorders * Pregnancy or breast feeding * Inability or unwillingness to take folic acid or vitamin B12 supplementation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survival Without Grade 3 or 4 Toxicity | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | Defined as the time from date of randomization to first date of a Grade 3 or 4 treatment-emergent adverse event (TEAE; as graded by the National Cancer Institute Common Terminology Criteria for Adverse Events \[CTCAE\], version 3.0) or death due to any cause. Grade 3 TEAE: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated. Grade 4 TEAE: Life-threatening consequences; urgent intervention indicated. Participants who were alive without experiencing Grade 3 or 4 toxicity were censored at the date of last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | OS is the duration from enrollment to death. For participants who are alive, OS is censored at the last contact. |
| Progression-free Survival (PFS) | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | Defined as the time from date of first dose to the first observation of disease progression (PD), or death due to any cause. |
| Percentage of Participants With Tumor Response (Response Rate) | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | Response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Complete Response (CR)=disappearance of all target lesions; Partial Response (PR)=at least a 30% decrease in sum of longest diameter of target lesions; Progressive Disease (PD)=at least a 20% increase in sum of longest diameter of target lesions; Stable Disease (SD)=small changes not meeting above criteria. Response rate (%)=Number of participants with CR+PR/Number of participants analyzed \*100. Disease Control rate=Number of participants with SD+PR+CR/Number of participants analyzed \*100. |
| Survival Without Grade 4 Toxicity | Baseline to until 218 events (defined as death or Grade 4 toxicity) have been observed (up to 33.3 months). | Survival without Grade 4 toxicity is the time from the date of randomization to the first date of a Grade 4 TEAE or death due to any cause. Participants who are alive without experiencing Grade 4 toxicity will be censored for this analysis at the date of last contact. |
| Number of Participants With Adverse Events (AEs) | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | Summaries of serious AEs (SAEs) and all other non-serious AEs are located in the Reported Adverse Event Module. |
| Survival Without Clinically Important Grade 3 or 4 Toxicity | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | Survival without Grade 3 or 4 toxicity is the time from date of randomization to the first date of the following clinically important Grade 3 or 4 TEAEs graded by the Common Terminology Criteria for Adverse Events \[CTCAE\], version 3.0: neutropenia (lasting \>5 days), febrile neutropenia, documented infections related to neutropenia, anemia, thrombocytopenia, fatigue, nausea, vomiting, diarrhea, stomatitis, and neurosensory events; or death due to any cause. Participants who were alive without experiencing Grade 3 or 4 toxicity were censored for this analysis at the date of last contact. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response | Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months). | The duration of a complete response (CR) or partial response (PR) was defined as the time from first objective status assessment of CR or PR to the first time of progression or death as a result of any cause. Response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. CR=disappearance of all target lesions; PR=at least a 30% decrease in sum of longest diameter of target lesions. |
Countries
Australia, Brazil, China, Mexico, South Korea, Taiwan
Participant flow
Pre-assignment details
Analyses were conducted on the qualified intent-to-treat population (Q-ITT) unless otherwise specified. This population includes all data from all randomized participants, with nonsquamous histology, receiving at least 1 dose of the study drug according to the treatment the participants were assigned.
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed Plus Carboplatin pemetrexed 500 mg/m\^2 plus carboplatin AUC 5 mg\*min/mL on Day 1 every 21 days | 106 |
| Docetaxel Plus Carboplatin docetaxel 75 mg/m\^2 plus carboplatin AUC 5 mg\*min/mL on Day 1 every 21 days | 105 |
| Total | 211 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 84 | 81 |
| Overall Study | Lost to Follow-up | 6 | 10 |
| Overall Study | Physician Decision | 4 | 1 |
| Overall Study | Withdrawal by Subject | 7 | 11 |
Baseline characteristics
| Characteristic | Pemetrexed Plus Carboplatin | Total | Docetaxel Plus Carboplatin |
|---|---|---|---|
| Age Continuous | 59.6 years STANDARD_DEVIATION 10 | 59.4 years STANDARD_DEVIATION 10.3 | 59.2 years STANDARD_DEVIATION 10.7 |
| Histology Adenocarcinoma, lung | 10 participants | 21 participants | 11 participants |
| Histology Adenocarcinoma, not otherwise specified | 80 participants | 160 participants | 80 participants |
| Histology Carcinoma, lung | 6 participants | 11 participants | 5 participants |
| Histology Large cell carcinoma, lung | 10 participants | 19 participants | 9 participants |
| Region of Enrollment Australia | 10 participants | 24 participants | 14 participants |
| Region of Enrollment Brazil | 35 participants | 60 participants | 25 participants |
| Region of Enrollment China | 20 participants | 37 participants | 17 participants |
| Region of Enrollment Korea, Republic of | 21 participants | 39 participants | 18 participants |
| Region of Enrollment Mexico | 17 participants | 39 participants | 22 participants |
| Region of Enrollment Taiwan | 3 participants | 12 participants | 9 participants |
| Sex: Female, Male Female | 42 Participants | 97 Participants | 55 Participants |
| Sex: Female, Male Male | 64 Participants | 114 Participants | 50 Participants |
| Smoking Status Currently Smoking | 11 participants | 22 participants | 11 participants |
| Smoking Status Ever Smoking but Quit | 61 participants | 114 participants | 53 participants |
| Smoking Status Never Smoking | 34 participants | 75 participants | 41 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 94 / 106 | 100 / 105 |
| serious Total, serious adverse events | 28 / 106 | 35 / 105 |
Outcome results
Survival Without Grade 3 or 4 Toxicity
Defined as the time from date of randomization to first date of a Grade 3 or 4 treatment-emergent adverse event (TEAE; as graded by the National Cancer Institute Common Terminology Criteria for Adverse Events \[CTCAE\], version 3.0) or death due to any cause. Grade 3 TEAE: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated. Grade 4 TEAE: Life-threatening consequences; urgent intervention indicated. Participants who were alive without experiencing Grade 3 or 4 toxicity were censored at the date of last contact.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on protocol-qualified, intent-to-treat (Q-ITT) population. This population includes all data from all randomized participants, with nonsquamous histology, receiving at least 1 dose of the study drug according to the treatment the participants were assigned.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Survival Without Grade 3 or 4 Toxicity | 3.2 months |
| Docetaxel Plus Carboplatin | Survival Without Grade 3 or 4 Toxicity | 0.7 months |
Number of Participants With Adverse Events (AEs)
Summaries of serious AEs (SAEs) and all other non-serious AEs are located in the Reported Adverse Event Module.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on safety population. This population includes all participants with non-squamous histology who received at least one dose of study drug. Participants were analysed according to treatments they actually received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed Plus Carboplatin | Number of Participants With Adverse Events (AEs) | Non-Serious Adverse Events (AEs) | 94 participants |
| Pemetrexed Plus Carboplatin | Number of Participants With Adverse Events (AEs) | Serious Adverse Events (SAEs) | 28 participants |
| Docetaxel Plus Carboplatin | Number of Participants With Adverse Events (AEs) | Non-Serious Adverse Events (AEs) | 100 participants |
| Docetaxel Plus Carboplatin | Number of Participants With Adverse Events (AEs) | Serious Adverse Events (SAEs) | 35 participants |
Overall Survival (OS)
OS is the duration from enrollment to death. For participants who are alive, OS is censored at the last contact.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on protocol-qualified, intent-to-treat (Q-ITT) population. This population includes all data from all randomized participants, with nonsquamous histology, receiving at least 1 dose of the study drug according to the treatment the participants were assigned.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Overall Survival (OS) | 14.9 months |
| Docetaxel Plus Carboplatin | Overall Survival (OS) | 14.7 months |
Percentage of Participants With Tumor Response (Response Rate)
Response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Complete Response (CR)=disappearance of all target lesions; Partial Response (PR)=at least a 30% decrease in sum of longest diameter of target lesions; Progressive Disease (PD)=at least a 20% increase in sum of longest diameter of target lesions; Stable Disease (SD)=small changes not meeting above criteria. Response rate (%)=Number of participants with CR+PR/Number of participants analyzed \*100. Disease Control rate=Number of participants with SD+PR+CR/Number of participants analyzed \*100.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on tumour response-qualified population. This population includes all participants with locally advanced or metastatic non-small cell lung cancer (NSCLC), non-squamous histology with measurable disease as defined by RECIST (Version 1.0), who received at least 1 dose of pemetrexed, docetaxel, or carboplatin.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Complete Response | 0.9 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Tumor Response Rate | 34.0 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Disease Control Rate | 74.5 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Partial Response | 33.0 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Stable Disease | 40.6 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Progressive Disease | 16.0 percentage of participants |
| Pemetrexed Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Unknown | 9.4 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Unknown | 18.3 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Complete Response | 0 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Stable Disease | 41.3 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Partial Response | 23.1 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Tumor Response Rate | 23.1 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Progressive Disease | 17.3 percentage of participants |
| Docetaxel Plus Carboplatin | Percentage of Participants With Tumor Response (Response Rate) | Disease Control Rate | 64.4 percentage of participants |
Progression-free Survival (PFS)
Defined as the time from date of first dose to the first observation of disease progression (PD), or death due to any cause.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on protocol-qualified, intent-to-treat (Q-ITT) population. This set includes all data from all randomized participants, with nonsquamous histology, receiving at least 1 dose of the study drug according to the treatment the participants were assigned.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Progression-free Survival (PFS) | 5.8 months |
| Docetaxel Plus Carboplatin | Progression-free Survival (PFS) | 6.0 months |
Survival Without Clinically Important Grade 3 or 4 Toxicity
Survival without Grade 3 or 4 toxicity is the time from date of randomization to the first date of the following clinically important Grade 3 or 4 TEAEs graded by the Common Terminology Criteria for Adverse Events \[CTCAE\], version 3.0: neutropenia (lasting \>5 days), febrile neutropenia, documented infections related to neutropenia, anemia, thrombocytopenia, fatigue, nausea, vomiting, diarrhea, stomatitis, and neurosensory events; or death due to any cause. Participants who were alive without experiencing Grade 3 or 4 toxicity were censored for this analysis at the date of last contact.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on protocol-qualified, intent-to-treat (Q-ITT) population. This population includes all data from all randomized participants, with nonsquamous histology, receiving at least one dose of the study drug according to the treatment the participants were assigned.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Survival Without Clinically Important Grade 3 or 4 Toxicity | 3.6 months |
| Docetaxel Plus Carboplatin | Survival Without Clinically Important Grade 3 or 4 Toxicity | 1.3 months |
Survival Without Grade 4 Toxicity
Survival without Grade 4 toxicity is the time from the date of randomization to the first date of a Grade 4 TEAE or death due to any cause. Participants who are alive without experiencing Grade 4 toxicity will be censored for this analysis at the date of last contact.
Time frame: Baseline to until 218 events (defined as death or Grade 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on protocol-qualified, intent-to-treat (Q-ITT) population. This population includes all data from all randomized participants, with nonsquamous histology, receiving at least 1 dose of the study drug according to the treatment the participants were assigned.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Survival Without Grade 4 Toxicity | 12.2 participants |
| Docetaxel Plus Carboplatin | Survival Without Grade 4 Toxicity | 2.0 participants |
Duration of Response
The duration of a complete response (CR) or partial response (PR) was defined as the time from first objective status assessment of CR or PR to the first time of progression or death as a result of any cause. Response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. CR=disappearance of all target lesions; PR=at least a 30% decrease in sum of longest diameter of target lesions.
Time frame: Baseline to until 218 events (defined as death or Grade 3 or 4 toxicity) have been observed (up to 33.3 months).
Population: Analysis was performed on tumour response qualified population. This population includes all participants with locally advanced or metastatic non-small cell lung cancer (NSCLC), non-squamous histology with measurable disease as defined by RECIST (Version 1.0), who received at least 1 dose of pemetrexed, docetaxel, or carboplatin.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Carboplatin | Duration of Response | 5.5 months |
| Docetaxel Plus Carboplatin | Duration of Response | 5.4 months |