Carcinoma, Non Small Cell Lung
Conditions
Keywords
lung cancer, angiogenesis inhibitor, chemotherapy
Brief summary
The primary objective of the study was to demonstrate overall survival improvement for aflibercept + docetaxel compared to docetaxel + placebo as second line treatment for participants with locally advanced or metastatic non-small cell lung cancer (NSCLC). The secondary objectives were to compare other efficacy parameters, to assess the overall safety of the two treatment arms, to assess the pharmacokinetics of intravenous (IV) aflibercept in this participant population and to determine immunogenicity of IV aflibercept in all participants.
Detailed description
The study included: * A screening visit of up to 21 days prior to randomization * Randomization at baseline (Treatment was initiated with 3 days of randomization) * A treatment period with 3-week treatment cycles until the participant met the following discontinuation criteria: had progressive disease, had unacceptable toxicity, or refused further study treatment * A post study treatment follow-up period (a visit was scheduled every 8 weeks until death or end of study)
Interventions
6 mg/kg Aflibercept administered intravenously (IV) over 1 hour once on Day 1, every 3 weeks.
Matching placebo to Aflibercept administered intravenously (IV) over 1 hour once on Day 1, every 3 weeks.
75 mg/m² docetaxel in 250 mL dextrose 5% or NaCl 0.9% administered intravenously (IV) over 1 hour, on Day 1 every 3 weeks.
As a pre- and post-medication for docetaxel, 8 mg dexamethasone was administered orally, the evening before Day 1, on Day 1 (early morning, 1 hour before docetaxel treatment, and evening) and on Day 2 (morning and evening).
Sponsors
Study design
Eligibility
Inclusion criteria
* Histological/cytological proven locally advanced or metastatic non-small cell lung cancer * Disease progression during or after one, and only one, prior anticancer therapy which is platinum-based for advanced or metastatic disease * Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2 * Adequate renal, liver and bone marrow functions
Exclusion criteria
* Squamous histology/cytology * Less than 28 days elapsed from prior treatment with radiotherapy, surgery, or chemotherapy to the time of randomization * Prior isotope therapy, whole pelvic radiotherapy, or radiotherapy to \> 25% of bone marrow * Prior docetaxel treatment * Uncontrolled hypertension The above information was not intended to contain all considerations relevant to participation in a clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline to the date when 687 deaths occurred (26 January 2011) | OS was time interval from the date of randomization to the date of death due to any cause. If death was not observed during the study, overall survival time was censored at the last date the participant was known to be alive, or the study cutoff date, whichever was earlier. The cut-off date for the OS was date when 687 deaths were observed. OS was estimated from Kaplan-Meier Curves. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Baseline to data cut-off (26 January 2011) | PFS was defined as the time interval between the date of randomization and the time of occurrence of the first radiological tumor progression detected by a computer tomography (CT) scan and /or by Magnetic Resonance Imaging (MRI); or death due to any cause; whichever was earlier. Participants without disease progression were censored at the earliest date between their last valid tumour assessment and the data cutoff date. PFS was estimated from Kaplan-Meier Curves. |
| Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Baseline to data cut-off (26 January 2011) | Participants with OR were those who had a confirmed complete response \[CR\] or a confirmed partial response \[PR\], based on RECIST criteria, in which * CR refected the disappearance of all tumor lesions (with no new tumors) * PR reflected a pre-defined decrease in tumor burden - a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD * OR was CR + PR The response rate was the percent of participants with a response. To determine a response, tumors were assessed by the investigators using Computerized Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans; and an observed response was confirmed by repeated imaging after 4 - 6 weeks. |
| Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Baseline (prior to first dose), at cycles 2 and 4 and at the end of study therapy. | HRQL assessments were performed by participants using a self-administered LCSS questionnaire. LCSS is a 9-item questionnaire, six measuring major symptoms for lung malignancies (appetite, fatigue, cough, dyspnea, hemoptysis and pain), and 3 summation items related to total symptomatic distress, activity status and overall quality of life. Participant responses were measured using visual analogue scales (VAS) with 100-mm lines. The LCSS total score was defined as the mean of the 9 items of the scale, each scored between 0 (for best outcome) to 100 (for worst outcome). |
| Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Baseline (prior to first dose), at cycles 2 and 4 and at the end of study therapy. | HRQL assessments were performed by participants using a self-administered LCSS questionnaire. LCSS is a 9-item questionnaire, six measuring major symptoms for lung malignancies, and 3 summation items related to total symptomatic distress, activity status and overall quality of life. Participant responses were measured using visual analogue scales (VAS) with 100-mm lines. ABSI was the mean score for the six major lung cancer symptoms (appetite, fatigue, cough, dyspnea, hemoptysis and pain), each scored between 0 (for best outcome) to 100 (for worst outcome). |
Countries
Argentina, Australia, Austria, Brazil, Bulgaria, Canada, Chile, China, Czechia, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, India, Italy, Malaysia, Netherlands, Poland, Portugal, Romania, Russia, Singapore, South Korea, Spain, Sweden, Taiwan, Turkey (Türkiye), United Kingdom, United States
Participant flow
Pre-assignment details
A total of 1130 participants signed an informed consent to enter the study. Amongst these, 913 were randomized to the two arms in this study. 217 participants were screen failures.
Participants by arm
| Arm | Count |
|---|---|
| Placebo/Docetaxel Participants with Non-Small-Cell Lung Cancer (NSCLC) were administered Placebo immediately followed by Docetaxel every three weeks until disease progression, unacceptable toxicity, or participant's refusal. | 457 |
| Aflibercept/Docetaxel Participants with Non-Small-Cell Lung Cancer (NSCLC) were administered Aflibercept immediately followed by Docetaxel every three weeks until disease progression, unacceptable toxicity, or participant's refusal. | 456 |
| Total | 913 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 66 | 123 |
| Overall Study | Consent withdrawn | 5 | 7 |
| Overall Study | Did not receive study medication | 2 | 6 |
| Overall Study | Had brain metastasis, was mis-randomized | 1 | 0 |
| Overall Study | Lack of Efficacy | 332 | 255 |
| Overall Study | Lost to Follow-up | 2 | 0 |
| Overall Study | Moved | 1 | 0 |
| Overall Study | Occurence of a secondary cancer | 0 | 1 |
| Overall Study | Occurence of a second cancer | 0 | 1 |
| Overall Study | Physician Decision | 16 | 15 |
| Overall Study | Pre-existing brain metastasis (by MRI) | 1 | 0 |
| Overall Study | Progressive disease (by incorrect scan) | 0 | 1 |
| Overall Study | Promotor ended study | 1 | 0 |
| Overall Study | Protocol Violation | 1 | 3 |
| Overall Study | Study stopped | 1 | 0 |
| Overall Study | Study terminated by sponsor | 1 | 0 |
| Overall Study | Study termination stop further treatment | 4 | 0 |
| Overall Study | Withdrawal by Subject | 23 | 44 |
Baseline characteristics
| Characteristic | Placebo/Docetaxel | Aflibercept/Docetaxel | Total |
|---|---|---|---|
| Age, Continuous | 59.6 Years STANDARD_DEVIATION 9.4 | 59.6 Years STANDARD_DEVIATION 9.5 | 59.6 Years STANDARD_DEVIATION 9.4 |
| Age, Customized <65 years | 316 participants | 315 participants | 631 participants |
| Age, Customized >=75 years | 19 participants | 20 participants | 39 participants |
| Age, Customized >= and <75 years | 122 participants | 121 participants | 243 participants |
| Body Surface Area (BSA) | 1.8 m² STANDARD_DEVIATION 0.2 | 1.8 m² STANDARD_DEVIATION 0.2 | 1.8 m² STANDARD_DEVIATION 0.2 |
| Eastern Cooperative Oncology Group (ECOG) performance status score (as per IVRS) Participants with ECOG Score = 0 | 151 participants | 149 participants | 300 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status score (as per IVRS) Participants with ECOG Score = 1 | 283 participants | 286 participants | 569 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status score (as per IVRS) Participants with ECOG Score = 2 | 23 participants | 21 participants | 44 participants |
| Prior Bevacizumab (as per IVRS) No | 404 participants | 405 participants | 809 participants |
| Prior Bevacizumab (as per IVRS) Yes | 53 participants | 51 participants | 104 participants |
| Race/Ethnicity, Customized Asian/Oriental | 40 participants | 34 participants | 74 participants |
| Race/Ethnicity, Customized Black | 10 participants | 7 participants | 17 participants |
| Race/Ethnicity, Customized Caucasian/White | 405 participants | 411 participants | 816 participants |
| Race/Ethnicity, Customized Other | 2 participants | 4 participants | 6 participants |
| Sex/Gender, Customized Female | 157 participants | 151 participants | 308 participants |
| Sex/Gender, Customized Male | 300 participants | 305 participants | 605 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 388 / 453 | 402 / 452 |
| serious Total, serious adverse events | 159 / 453 | 218 / 452 |
Outcome results
Overall Survival (OS)
OS was time interval from the date of randomization to the date of death due to any cause. If death was not observed during the study, overall survival time was censored at the last date the participant was known to be alive, or the study cutoff date, whichever was earlier. The cut-off date for the OS was date when 687 deaths were observed. OS was estimated from Kaplan-Meier Curves.
Time frame: Baseline to the date when 687 deaths occurred (26 January 2011)
Population: All randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo/Docetaxel | Overall Survival (OS) | 10.41 months |
| Aflibercept/Docetaxel | Overall Survival (OS) | 10.05 months |
Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI)
HRQL assessments were performed by participants using a self-administered LCSS questionnaire. LCSS is a 9-item questionnaire, six measuring major symptoms for lung malignancies, and 3 summation items related to total symptomatic distress, activity status and overall quality of life. Participant responses were measured using visual analogue scales (VAS) with 100-mm lines. ABSI was the mean score for the six major lung cancer symptoms (appetite, fatigue, cough, dyspnea, hemoptysis and pain), each scored between 0 (for best outcome) to 100 (for worst outcome).
Time frame: Baseline (prior to first dose), at cycles 2 and 4 and at the end of study therapy.
Population: ITT population with questionnaires evaluable for ABSI.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Baseline (N=429, N=429) | 26.17 units on a scale | Standard Deviation 16.3 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Cycle 2 (N=327, N=316) | 26.23 units on a scale | Standard Deviation 15.93 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Cycle 4 (N=211, N=241) | 24.52 units on a scale | Standard Deviation 15.22 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | End of treatment (N=253, N=239) | 30.73 units on a scale | Standard Deviation 17.26 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | End of treatment (N=253, N=239) | 31.19 units on a scale | Standard Deviation 18.12 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Baseline (N=429, N=429) | 28.24 units on a scale | Standard Deviation 16.91 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Cycle 4 (N=211, N=241) | 26.19 units on a scale | Standard Deviation 16.38 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Average Symptom Burden Index (ASBI) | Cycle 2 (N=327, N=316) | 27.05 units on a scale | Standard Deviation 15.92 |
Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS)
HRQL assessments were performed by participants using a self-administered LCSS questionnaire. LCSS is a 9-item questionnaire, six measuring major symptoms for lung malignancies (appetite, fatigue, cough, dyspnea, hemoptysis and pain), and 3 summation items related to total symptomatic distress, activity status and overall quality of life. Participant responses were measured using visual analogue scales (VAS) with 100-mm lines. The LCSS total score was defined as the mean of the 9 items of the scale, each scored between 0 (for best outcome) to 100 (for worst outcome).
Time frame: Baseline (prior to first dose), at cycles 2 and 4 and at the end of study therapy.
Population: ITT population with questionnaires evaluable for LCSS.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Baseline (N=431, N=428) | 29.52 units on a scale | Standard Deviation 17.03 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Cycle 2 (N=329, N=315) | 29.50 units on a scale | Standard Deviation 16.72 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Cycle 4 (N=211, N=240) | 27.67 units on a scale | Standard Deviation 16.24 |
| Placebo/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | End of treatment (N=254, N=240) | 34.82 units on a scale | Standard Deviation 18.34 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | End of treatment (N=254, N=240) | 36.07 units on a scale | Standard Deviation 18.81 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Baseline (N=431, N=428) | 31.54 units on a scale | Standard Deviation 18.03 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Cycle 4 (N=211, N=240) | 29.61 units on a scale | Standard Deviation 16.92 |
| Aflibercept/Docetaxel | Health Related Quality of Life (HRQL) Assessed by the Lung Cancer Symptom Scale (LCSS) | Cycle 2 (N=329, N=315) | 30.54 units on a scale | Standard Deviation 16.78 |
Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria
Participants with OR were those who had a confirmed complete response \[CR\] or a confirmed partial response \[PR\], based on RECIST criteria, in which * CR refected the disappearance of all tumor lesions (with no new tumors) * PR reflected a pre-defined decrease in tumor burden - a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD * OR was CR + PR The response rate was the percent of participants with a response. To determine a response, tumors were assessed by the investigators using Computerized Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans; and an observed response was confirmed by repeated imaging after 4 - 6 weeks.
Time frame: Baseline to data cut-off (26 January 2011)
Population: Evaluable population: All ITT participants with measurable disease at study entry, and with at least one valid post baseline tumor evaluation, except if the participant died due to progressive disease or had documented (ie, radiological) progression before having any post-baseline tumor evaluation.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Complete Response (CR) rate | 0.2 percentage of participants |
| Placebo/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Partial Response (PR) rate | 8.6 percentage of participants |
| Placebo/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Overall Response (OR) rate | 8.9 percentage of participants |
| Aflibercept/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Complete Response (CR) rate | 0.2 percentage of participants |
| Aflibercept/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Partial Response (PR) rate | 23.0 percentage of participants |
| Aflibercept/Docetaxel | Overall Response (OR) Rate as Per Response Evaluation Criteria in Solid Tumours (RECIST) Criteria | Overall Response (OR) rate | 38.6 percentage of participants |
Progression Free Survival (PFS)
PFS was defined as the time interval between the date of randomization and the time of occurrence of the first radiological tumor progression detected by a computer tomography (CT) scan and /or by Magnetic Resonance Imaging (MRI); or death due to any cause; whichever was earlier. Participants without disease progression were censored at the earliest date between their last valid tumour assessment and the data cutoff date. PFS was estimated from Kaplan-Meier Curves.
Time frame: Baseline to data cut-off (26 January 2011)
Population: Intent to treat (ITT) population. The results are based on a total of 865 PFS events (434 in the placebo group and 431 in the aflibercept group) at the time of cutoff.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo/Docetaxel | Progression Free Survival (PFS) | 4.11 months |
| Aflibercept/Docetaxel | Progression Free Survival (PFS) | 5.19 months |