Lung Cancer
Conditions
Brief summary
This study is intended for participants with advanced, not amenable to surgery, or metastatic lung cancer who have not received any prior chemotherapy. The study will be conducted in 2 parts: * Part 1 is intended to evaluate safety of pemetrexed + cisplatin + enzastaurin combination chemotherapy * Part 2 whose main objective is to compare the efficacy of pemetrexed + cisplatin + enzastaurin versus pemetrexed + cisplatin + placebo. Participants to be included in Part 2 are those with Nonsquamous Non-Small Cell Lung Cancer (NSCLC).
Interventions
1125 milligrams (mg) loading dose then 500 mg, oral (po), daily (QD), until disease progression
500 milligrams/square meter (mg/m²), intravenously (IV), every 21 days, for each 21-day cycle
75 mg/m², IV, every 21 days, for each 21-day cycle
po, QD
Sponsors
Study design
Eligibility
Inclusion criteria
* diagnosis of advanced NSCLC not amenable to curative treatment. Participants enrolling in Part 2 of the study must have the above stated diagnosis of NSCLC that is also of nonsquamous histology. * no prior systemic therapies \[chemotherapy, et cetera (etc.)\] or pleurodesis with chemotherapy for this disease * prior radiotherapy is allowed but must be completed at least 2 weeks before study enrollment and participant must be recovered from the acute toxic effects * have a good performance status * participant must sign an informed consent document
Exclusion criteria
* participant had myocardial infarction occurring less than 6 months before inclusion, uncontrolled arrhythmia, symptomatic angina pectoris, or cardiac failure not controlled by medications * participant is unable to swallow tablets * participant is taking a certain medicine to control seizure activity, called enzyme inducing antiepileptic drugs and is not able to stop taking the medicine prior to enrolling in the study * participant is unable to interrupt aspirin and/or other anti-inflammatory agents * participant is unwilling or unable to take vitamin supplementation (folic acid and vitamin B12) or medications to prevent side effects
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and 30-day follow up | Presented are data that evaluates safety based on toxicity using Common Terminology Criteria for Adverse Events (CTCAE v3.0), SAEs, and discontinuations due to SAEs or other non-serious adverse events (AE's) of study participants. A summary of SAEs and other non-serious AEs regardless of causality is located in the Reported Adverse Event module. |
| Part 2: Compare Progression-Free Survival (PFS) Between the 2 Treatment Arms Through the Assessment of Tumor Response | Baseline to measured PD up to 5 months | PFS was defined as the time from date of first dose to the first observation of disease progression or death due to any cause. For participants not known to have died as of the data cut-off date and who did not have objective progressive disease (PD), PFS was censored at the date of the last objective progression-free assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to objective disease progression or death, PFS was censored at the date of last objective progression-free assessment prior to the initiation of post discontinuation anticancer therapy. PFS was calculated and analyzed based on an alternative definition of censoring; for each participant who is not known to have died or who have had objective disease progression as of the data cut-off date, PFS was censored at the date of last prior contact. Zero participants were analyzed in this outcome as study was terminated early. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Part 2: Overall Survival (OS) | Baseline to date of death from any cause up to 5 months | OS time was defined as the time from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS was censored at the last contact date (last contact for participants in post discontinuation was equal to the last known alive date in mortality status). Zero participants were analyzed in this outcome as study was terminated early. |
| Part 2: Duration of Disease Control (DDC) and Response | Baseline to measured PD up to 5 months | DDC and response defined as time from complete response (CR), partial response (PR) or stable disease (SD) to first date of objectively determined progressive disease (PD) or death from any cause using RECIST (v1.0) criteria. CR defined as disappearance of all target lesions. PR defined as having ≥30% decrease in sum of longest diameter (LD) of target lesions. PD defined as having ≥20% increase in the sum of the LD of target lesions. SD defined as small changes not meeting above criteria. Participants not known to have died as of data cut-off date, had no objective PD or were lost to follow-up, DCC was censored at date of last objective progression-free assessment (OPFA). Participants who received subsequent anticancer therapy (after discontinuation from study treatment) prior to objective PD or death were censored at date of last OPFA prior to initiation of post discontinuation anticancer therapy. Zero participants were analyzed in this outcome as study was terminated early. |
| Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments | Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and 30-day follow-up | The safety and toxicity profile for Part 2 was defined as serious adverse events (SAEs) and other non-serious adverse events (AEs). A summary of SAEs and other non-serious AEs regardless of causality is located in the Reported Adverse Event module. |
| Part 2: To Assess Biomarkers of the Disease State and Their Correlation to Clinical Outcome | Baseline, Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and end of study up to 5 months | Presented are data that evaluates of biomarkers relevant to the study drug and the disease state of the participant's clinical outcome. Zero participants were analyzed in this outcome as study was terminated early. |
| Part 2: Time to Worsening of Symptoms (TWS) | Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and 30-day follow-up | TWS was measured from the date of study enrollment to the first date of a worsening in any of the 6 Lung Cancer Symptom Scale (LCSS) symptoms (appetite, cough, fatigue, shortness of breath, hemoptysis and pain). Participants marked each symptom on a visual analog scale (VAS) that ranged from 0 millimeter (mm) (as good as it can be/none) to 100 mm (as bad/much as it could be). TWS was also measured individually for each of the 6 symptoms independently and were also measured from the date of enrollment to the first date of worsening in pain. For both measurements, worsening was defined as a 15-mm increase from baseline in the participant-reported score for any symptom. Participants who are not known to have had a worsening TWS were censored at the date of the participant's last LCSS assessment. Zero participants were analyzed in this outcome as study was terminated early. |
| Part 2: Number of Participants With a Complete Response (CR) or Partial Response (PR) (Response Rate) | Baseline to measured progressive disease (PD) up to 5 months | Response rate was defined using Response Evaluation Criteria in Solid Tumors (RECIST v1.0) criteria. Complete Response (CR) was defined as the disappearance of all target lesions. Partial Response (PR) was defined as having at least a 30% decrease in sum of longest diameter (LD) of target lesions. Best response was confirmed by a second assessment in ≥28 days. Response rate was defined as the number of participants with best response of CR or PR divided by the total number of treated participants. Zero participants were analyzed in this outcome as study was terminated early. |
Countries
Belgium, Germany, Italy, Poland, Romania
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Part 1- Cohort 1 Cycle 1: 500 mg enzastaurin orally (po) as loading dose on Day 1 and 125 mg orally twice daily (BID) on Days 2 to 28 of 28-day cycle then 500 milligrams per square meter (mg/m²) pemetrexed intravenous (IV) followed by 75 mg/m2 cisplatin IV on Day 8 of a 28-day cycle.
Cycles 2 to 6: 125 mg enzastaurin po BID Days 1 to 21 of each 21-day cycle, then 500 mg/m² pemetrexed IV followed by 75 mg/m² cisplatin IV on Day 1 of each 21-day cycle. | 9 |
| Part 1- Cohort 2 Cycle 1: 1125 mg enzastaurin po as loading dose on Day 1 of a 28-day cycle and 250 mg po BID on Days 2 to 28 of 28-day cycle, then 500 mg/m2 pemetrexed IV followed by 75 mg/m² cisplatin IV on Day 8 of a 28-day cycle.
Cycles 2 to 6: 250 mg enzastaurin po BID Days 1 to 21 of each 21-day cycle, then 500 mg/m² pemetrexed IV followed by 75 mg/m² cisplatin IV on Day 1 of each 21-day cycle. | 4 |
| Part 2- Enzastaurin Cycle 1: 375 mg enzastaurin po 3 times on Day 1 as a loading dose and 250 mg po BID on Day 2 to 28 of a 28-day cycle, then 500 mg/m² IV followed by 75 mg/m² cisplatin IV on Day 8 of a 28-day cycle.
Cycle 2 to 6: 250 mg enzastaurin po BID on Days 1 to 21 of each 21-day cycle, then 500 mg/m² pemetrexed IV followed by 75 mg/m² cisplatin IV on Day 1 of each 21-day cycle. | 11 |
| Part 2- Placebo Cycle 1: Placebo was administered po 3 times on Day 1 and BID on Days 2 to 28 of a 28-day cycle then 500 mg/m² pemetrexed followed by 75 mg/m² cisplatin administered IV on Day 8 of 28-day cycle.
Cycle 2 to 6: Placebo was administered po BID on Days 1 to 21 of each 21-day cycle then 500 mg/m² pemetrexed followed by 75 mg/m² cisplatin administered IV on Day 1 of each 21-day cycle. | 10 |
| Other 500 mg/m² pemetrexed and 75 mg/m² cisplatin administered intravenously | 1 |
| Total | 35 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 1 | 1 | 1 | 0 |
| Overall Study | Death | 0 | 0 | 1 | 1 |
| Overall Study | Investigator Decision | 0 | 0 | 0 | 1 |
| Overall Study | Progressive Disease | 7 | 0 | 1 | 0 |
| Overall Study | Sponsor Decision | 1 | 3 | 8 | 9 |
Baseline characteristics
| Characteristic | Part 1- Cohort 2 | Part 2- Enzastaurin | Part 1- Cohort 1 | Part 2- Placebo | Other | Total |
|---|---|---|---|---|---|---|
| Age, Continuous | 61.2 years STANDARD_DEVIATION 6.85 | 58.6 years STANDARD_DEVIATION 9.62 | 58.3 years STANDARD_DEVIATION 9.32 | 59.5 years STANDARD_DEVIATION 9.39 | 49.1 years | 58.8 years STANDARD_DEVIATION 8.88 |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 0-Fully Active | 1 Participants | 4 Participants | 1 Participants | 3 Participants | 0 Participants | 9 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 1-Ambulatory, work of a light or sedentary nature | 3 Participants | 7 Participants | 8 Participants | 7 Participants | 1 Participants | 26 Participants |
| Race/Ethnicity, Customized Caucasian | 4 Participants | 11 Participants | 9 Participants | 10 Participants | 1 Participants | 35 Participants |
| Region of Enrollment Belgium | 1 Participants | 1 Participants | 4 Participants | 4 Participants | 0 Participants | 10 Participants |
| Region of Enrollment Germany | 3 Participants | 6 Participants | 5 Participants | 2 Participants | 0 Participants | 16 Participants |
| Region of Enrollment Poland | 0 Participants | 4 Participants | 0 Participants | 4 Participants | 1 Participants | 9 Participants |
| Sex: Female, Male Female | 2 Participants | 6 Participants | 1 Participants | 6 Participants | 1 Participants | 16 Participants |
| Sex: Female, Male Male | 2 Participants | 5 Participants | 8 Participants | 4 Participants | 0 Participants | 19 Participants |
| Type of Carcinoma Adenocarcinoma, Bronchioalveolar | 0 Participants | 5 Participants | 0 Participants | 3 Participants | 1 Participants | 9 Participants |
| Type of Carcinoma Adenocarcinoma: Lung | 3 Participants | 1 Participants | 7 Participants | 4 Participants | 0 Participants | 15 Participants |
| Type of Carcinoma Carcinoma Large Cell: Lung | 0 Participants | 3 Participants | 1 Participants | 2 Participants | 0 Participants | 6 Participants |
| Type of Carcinoma Carcinoma Non-Small Cell: Lung | 0 Participants | 2 Participants | 0 Participants | 1 Participants | 0 Participants | 3 Participants |
| Type of Carcinoma Squamous Cell Carcinoma: Lung | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 9 / 9 | 4 / 4 | 8 / 11 | 8 / 10 | 1 / 1 |
| serious Total, serious adverse events | 5 / 9 | 0 / 4 | 2 / 11 | 4 / 10 | 0 / 1 |
Outcome results
Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation]
Presented are data that evaluates safety based on toxicity using Common Terminology Criteria for Adverse Events (CTCAE v3.0), SAEs, and discontinuations due to SAEs or other non-serious adverse events (AE's) of study participants. A summary of SAEs and other non-serious AEs regardless of causality is located in the Reported Adverse Event module.
Time frame: Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) 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) |
|---|---|---|---|
| Part 1- Cohort 1 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | SAEs | 5 Participants |
| Part 1- Cohort 1 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | AEs | 9 Participants |
| Part 1- Cohort 1 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | Discontinued due to AE | 1 Participants |
| Part 1- Cohort 2 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | SAEs | 0 Participants |
| Part 1- Cohort 2 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | AEs | 4 Participants |
| Part 1- Cohort 2 | Part 1: Evaluate Safety [Toxicity, Serious Adverse Events (SAEs) and Reasons for Participant's Discontinuation] | Discontinued due to AE | 1 Participants |
Part 2: Compare Progression-Free Survival (PFS) Between the 2 Treatment Arms Through the Assessment of Tumor Response
PFS was defined as the time from date of first dose to the first observation of disease progression or death due to any cause. For participants not known to have died as of the data cut-off date and who did not have objective progressive disease (PD), PFS was censored at the date of the last objective progression-free assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to objective disease progression or death, PFS was censored at the date of last objective progression-free assessment prior to the initiation of post discontinuation anticancer therapy. PFS was calculated and analyzed based on an alternative definition of censoring; for each participant who is not known to have died or who have had objective disease progression as of the data cut-off date, PFS was censored at the date of last prior contact. Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Baseline to measured PD up to 5 months
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: Duration of Disease Control (DDC) and Response
DDC and response defined as time from complete response (CR), partial response (PR) or stable disease (SD) to first date of objectively determined progressive disease (PD) or death from any cause using RECIST (v1.0) criteria. CR defined as disappearance of all target lesions. PR defined as having ≥30% decrease in sum of longest diameter (LD) of target lesions. PD defined as having ≥20% increase in the sum of the LD of target lesions. SD defined as small changes not meeting above criteria. Participants not known to have died as of data cut-off date, had no objective PD or were lost to follow-up, DCC was censored at date of last objective progression-free assessment (OPFA). Participants who received subsequent anticancer therapy (after discontinuation from study treatment) prior to objective PD or death were censored at date of last OPFA prior to initiation of post discontinuation anticancer therapy. Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Baseline to measured PD up to 5 months
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: Number of Participants With a Complete Response (CR) or Partial Response (PR) (Response Rate)
Response rate was defined using Response Evaluation Criteria in Solid Tumors (RECIST v1.0) criteria. Complete Response (CR) was defined as the disappearance of all target lesions. Partial Response (PR) was defined as having at least a 30% decrease in sum of longest diameter (LD) of target lesions. Best response was confirmed by a second assessment in ≥28 days. Response rate was defined as the number of participants with best response of CR or PR divided by the total number of treated participants. Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Baseline to measured progressive disease (PD) up to 5 months
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: Overall Survival (OS)
OS time was defined as the time from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS was censored at the last contact date (last contact for participants in post discontinuation was equal to the last known alive date in mortality status). Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Baseline to date of death from any cause up to 5 months
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: Time to Worsening of Symptoms (TWS)
TWS was measured from the date of study enrollment to the first date of a worsening in any of the 6 Lung Cancer Symptom Scale (LCSS) symptoms (appetite, cough, fatigue, shortness of breath, hemoptysis and pain). Participants marked each symptom on a visual analog scale (VAS) that ranged from 0 millimeter (mm) (as good as it can be/none) to 100 mm (as bad/much as it could be). TWS was also measured individually for each of the 6 symptoms independently and were also measured from the date of enrollment to the first date of worsening in pain. For both measurements, worsening was defined as a 15-mm increase from baseline in the participant-reported score for any symptom. Participants who are not known to have had a worsening TWS were censored at the date of the participant's last LCSS assessment. Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and 30-day follow-up
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: To Assess Biomarkers of the Disease State and Their Correlation to Clinical Outcome
Presented are data that evaluates of biomarkers relevant to the study drug and the disease state of the participant's clinical outcome. Zero participants were analyzed in this outcome as study was terminated early.
Time frame: Baseline, Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and end of study up to 5 months
Population: No participant completed a full cycle of therapy and data were not collected for this Outcome Measure.
Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments
The safety and toxicity profile for Part 2 was defined as serious adverse events (SAEs) and other non-serious adverse events (AEs). A summary of SAEs and other non-serious AEs regardless of causality is located in the Reported Adverse Event module.
Time frame: Cycle 1 (28-day cycle), Cycles 2, 3, 4, 5, and 6 (21-day cycles) and 30-day follow-up
Population: All randomized participants who received at least 1 dose enzastaurin or placebo.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Part 1- Cohort 1 | Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments | SAEs | 2 Participants |
| Part 1- Cohort 1 | Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments | AEs | 8 Participants |
| Part 1- Cohort 2 | Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments | SAEs | 4 Participants |
| Part 1- Cohort 2 | Part 2: To Evaluate the Safety and Toxicity Profile of Study Treatments | AEs | 8 Participants |