Non-small Cell Lung Cancer
Conditions
Brief summary
The purpose of this study is to determine if Pemetrexed plus Carboplatin plus Bevacizumab plus Enzastaurin, followed by maintenance Bevacizumab plus Enzastaurin can extend survival time without disease progression in the first-line treatment of participants with advanced stage non-small cell lung cancer.
Interventions
1125 milligram (mg) loading dose then 500 mg, oral, daily until disease progression
500 milligrams per square meter (mg/m\^2), intravenously ( IV), Day 8 of cycle 1 - 28 days, Day 1 of subsequent cycles every (q) 21 days x 3 cycles
Area under the curve (AUC) 6, IV, Day 8 cycle 1 - 28 days, Day 1 of subsequent cycles q 21 days x 3 cycles
15 milligrams/kilogram (mg/kg), IV, Day 8 of cycle 1 - 28 days, Day 1 of subsequent cycles q 21 days x 3 cycles
oral, daily
Sponsors
Study design
Eligibility
Inclusion criteria
* participants or their legal representative must have signed an informed consent document for clinical research * have laboratory confirmed diagnosis of advanced, nonsquamous cell non-small cell lung cancer (NSCLC) (Stage IIIB or IV disease) which is not curable * have not received any prior systemic chemotherapy, immunotherapy, targeted therapy, or biological therapy for advanced NSCLC, prior radiation therapy is allowed to less than 25% of the bone marrow * have measurable disease * have adequate organ function and estimated life expectancy of 12 weeks
Exclusion criteria
* have known central nervous system (CNS) disease; major surgery within 28 days; minor surgery within 7 days; serious concomitant systemic disorder; serious cardiac condition; have a serious, nonhealing wound, ulcer, or bone fracture * have received treatment within the last 30 days with any drug that has not received regulatory approval for any indication at the time of study entry * have previously received treatment with enzastaurin, pemetrexed, or bevacizumab * are pregnant or breast-feeding * are unable to swallow tablets
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Randomization to measured PD or death from any cause up to 12.2 months | PFS was defined as the time from date of randomization to the first observation of progressive disease (PD) or death due to any cause. For participants not known to have died as of the data cutoff date and who did not have objective PD, PFS was censored at the date of the last objective progression-free assessment. For participants who received subsequent anticancer therapy (after discontinuation from all study treatment) prior to objective disease progression or death, PFS was censored at the date of the last objective progression-free assessment prior to the initiation of post-discontinuation anticancer therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Response Rate) | Randomization to measured progressive disease or death from any cause up to 12.2 months | Tumor response rate was defined as number of participants with overall best response of CR or PR over number of protocol qualified participants using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all tumor lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum of LDs or complete disappearance of target lesions, with persistence (but not worsening) of 1 or more non-target lesions. In either case, no new lesions may have appeared. Percentage of participants was calculated as: (number of participants with CR or PR/ number of participants qualified for tumor response analysis) × 100. |
| Overall Survival (OS) | Randomization to date of death up to 14.3 months | OS was defined as the time from the date of randomization to the date of death from any cause. For participants who were not known to have died as of the data cutoff, OS was censored at the last contact date. |
| Time to Progressive Disease (TTPD) | Randomization to measured PD or death from any cause up to 12.2 months | TTPD was defined as the time from the date of randomization until the first date of objectively determined progressive disease (PD). For participants who died without objective PD (including death from study disease), TTPD was censored at the date of the last objective progression-free disease assessment. For participants not known to have died as of the data cutoff and did not have PD, TTPD was censored at the date of the last objective progression-free disease assessment. |
| Duration of Response (DoR) | Time of response to disease progression or death from any cause up to 12.2 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 from any cause. Response was defined using Response Evaluation Criteria In Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions and PR was defined as having at least a 30% decrease in sum of longest diameter (LD) of target lesions taking as reference the baseline sum of LDs. For participants who died without progressive disease or who were alive, DoR was censored at the last contact of progression free assessment. For participants who received subsequent anticancer therapy (after discontinuation from all study treatment) prior to PD, DoR was censored at the date of last progression-free assessment prior to the initiation of post-discontinuation anticancer therapy. Due to early study closure, DoR was not analyzed. |
| Pharmacology Toxicity and Adverse Events (AEs) | Randomization up to 14.3 months and 30-day follow-up | Clinically significant events were defined as serious AEs (SAEs) and other non-serious AEs. Participants who died due to progressive disease (PD) or an AE while on treatment and or died during the 30 day post-treatment follow-up are included. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module. |
Countries
United States
Participant flow
Pre-assignment details
Participant flow reports those participants who discontinued from study drug.
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin Combination biochemotherapy:
Pemetrexed: 500 milligrams per square meter (mg/m\^2) intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Carboplatin: Area under the curve (AUC) 6 intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Bevacizumab: 15 milligrams/kilogram (mg/kg) intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Enzastaurin: 1125 milligram (mg) loading dose on Day 1 of Cycle 1 (28 days), followed by 500 mg oral daily dose for 3 cycles
Maintenance therapy:
Enzastaurin: 500 mg oral daily dose for 21-day cycles until disease progression
Bevacizumab: 15 mg/kg intravenously on Day 1 of every 21-day cycle until disease progression | 20 |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo Combination biochemotherapy:
Pemetrexed: 500 mg/m\^2 intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Carboplatin: AUC 6 intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Bevacizumab: 15 mg/kg intravenously on Day 8 of Cycle 1 (28 days), then on Day 1 of subsequent cycles every 21 days for 3 cycles
Placebo: Oral tablets daily to complete Cycle 1 (28 days), then subsequent 21-day cycles for 3 cycles
Maintenance therapy:
Bevacizumab: 15 mg/kg intravenously on Day 1 of every 21-day cycle until disease progression
Placebo: Oral tablets daily for 21-day cycles until progressive disease | 20 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 1 |
| Overall Study | Death | 1 | 0 |
| Overall Study | Progressive Disease | 12 | 13 |
| Overall Study | Symptomatic deterioration | 1 | 2 |
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Total |
|---|---|---|---|
| Age, Continuous | 61.2 years STANDARD_DEVIATION 9 | 62.1 years STANDARD_DEVIATION 9.3 | 61.6 years STANDARD_DEVIATION 9.1 |
| Disease Stage Stage IIIB | 3 Participants | 3 Participants | 6 Participants |
| Disease Stage Stage IV | 17 Participants | 17 Participants | 34 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 0 - Fully Active | 11 Participants | 10 Participants | 21 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 1 - Ambulatory, Restricted Strenuous Activity | 9 Participants | 10 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 20 Participants | 20 Participants | 40 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Prior therapy No | 17 Participants | 17 Participants | 34 Participants |
| Prior therapy Yes | 3 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 20 Participants | 20 Participants | 40 Participants |
| Region of Enrollment United States | 20 Participants | 20 Participants | 40 Participants |
| Sex: Female, Male Female | 10 Participants | 9 Participants | 19 Participants |
| Sex: Female, Male Male | 10 Participants | 11 Participants | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 19 / 20 | 20 / 20 |
| serious Total, serious adverse events | 6 / 20 | 7 / 20 |
Outcome results
Progression-Free Survival (PFS)
PFS was defined as the time from date of randomization to the first observation of progressive disease (PD) or death due to any cause. For participants not known to have died as of the data cutoff date and who did not have objective PD, PFS was censored at the date of the last objective progression-free assessment. For participants who received subsequent anticancer therapy (after discontinuation from all study treatment) prior to objective disease progression or death, PFS was censored at the date of the last objective progression-free assessment prior to the initiation of post-discontinuation anticancer therapy.
Time frame: Randomization to measured PD or death from any cause up to 12.2 months
Population: All randomized participants identified by assigned treatment group. Number of participants censored: Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin = 5; Pemetrexed + Carboplatin + Bevacizumab + Placebo = 2.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Progression-Free Survival (PFS) | 3.5 months |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Progression-Free Survival (PFS) | 4.3 months |
Duration of Response (DoR)
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 from any cause. Response was defined using Response Evaluation Criteria In Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions and PR was defined as having at least a 30% decrease in sum of longest diameter (LD) of target lesions taking as reference the baseline sum of LDs. For participants who died without progressive disease or who were alive, DoR was censored at the last contact of progression free assessment. For participants who received subsequent anticancer therapy (after discontinuation from all study treatment) prior to PD, DoR was censored at the date of last progression-free assessment prior to the initiation of post-discontinuation anticancer therapy. Due to early study closure, DoR was not analyzed.
Time frame: Time of response to disease progression or death from any cause up to 12.2 months
Population: All randomized participants. Participants censored: Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin = 16; Pemetrexed + Carboplatin + Bevacizumab + Placebo = 14.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Duration of Response (DoR) | 4.7 Months |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Duration of Response (DoR) | 3.5 Months |
Overall Survival (OS)
OS was defined as the time from the date of randomization to the date of death from any cause. For participants who were not known to have died as of the data cutoff, OS was censored at the last contact date.
Time frame: Randomization to date of death up to 14.3 months
Population: All randomized participants identified by assigned treatment group. Participants censored: Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin = 12; Pemetrexed + Carboplatin + Bevacizumab + Placebo = 9.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Overall Survival (OS) | 9.1 months |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Overall Survival (OS) | 7.6 months |
Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Response Rate)
Tumor response rate was defined as number of participants with overall best response of CR or PR over number of protocol qualified participants using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all tumor lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum of LDs or complete disappearance of target lesions, with persistence (but not worsening) of 1 or more non-target lesions. In either case, no new lesions may have appeared. Percentage of participants was calculated as: (number of participants with CR or PR/ number of participants qualified for tumor response analysis) × 100.
Time frame: Randomization to measured progressive disease or death from any cause up to 12.2 months
Population: All randomized participants identified by assigned treatment group.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Response Rate) | 20.0 percentage of participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Response Rate) | 30.0 percentage of participants |
Pharmacology Toxicity and Adverse Events (AEs)
Clinically significant events were defined as serious AEs (SAEs) and other non-serious AEs. Participants who died due to progressive disease (PD) or an AE while on treatment and or died during the 30 day post-treatment follow-up are included. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
Time frame: Randomization up to 14.3 months and 30-day follow-up
Population: All randomized participants who received at least 1 dose of study drug.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to PD | 0 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to AEs | 1 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths within 30-days after treatment | 0 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Non-serious AEs | 19 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Serious AEs | 6 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Serious AEs | 7 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Non-serious AEs | 20 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to AEs | 1 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to PD | 0 Participants |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths within 30-days after treatment | 0 Participants |
Time to Progressive Disease (TTPD)
TTPD was defined as the time from the date of randomization until the first date of objectively determined progressive disease (PD). For participants who died without objective PD (including death from study disease), TTPD was censored at the date of the last objective progression-free disease assessment. For participants not known to have died as of the data cutoff and did not have PD, TTPD was censored at the date of the last objective progression-free disease assessment.
Time frame: Randomization to measured PD or death from any cause up to 12.2 months
Population: All randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed + Carboplatin + Bevacizumab + Enzastaurin | Time to Progressive Disease (TTPD) | 4.3 Months |
| Pemetrexed + Carboplatin + Bevacizumab + Placebo | Time to Progressive Disease (TTPD) | 4.8 Months |