Carcinoma, Adenosquamous, Carcinoma, Large Cell, Carcinoma, Non-Small-Cell Lung, Carcinoma, Squamous Cell
Conditions
Keywords
IGF-1R inhibitor, Non-small-cell lung carcinoma, CP-751, 871
Brief summary
Determine whether the addition of CP- 751,871 in combination with paclitaxel plus carboplatin prolongs survival in patients with locally advanced (Stage IIIB with pleural effusion) or metastatic (Stage IV or recurrent) NSCLC of non adenocarcinoma histology.
Detailed description
The study was discontinued on December 29, 2009 due to an analysis by an independent Data Safety Monitoring Committee indicating that the addition of CP-751,871 \[figitumumab\] to paclitaxel plus carboplatin would be unlikely to meet the primary endpoint of improving overall survival compared to paclitaxel plus carboplatin alone. The DSMC recommendation to terminate the trial was based on futility, not on specific safety concerns; however, the DSMC recommended to investigate hyperglycemia as a potential contributor to the morbidity of the patients.
Interventions
CP 751,871 is a potent and selective fully human monoclonal antibody against the insulin like growth factor 1 receptor (IGF-1R). Patients in Arm A will receive CP-751, 871 intravenously every 21 days for up to six cycles.
Carboplatin is a standard chemotherapeutic agent used in patients with lung cancer. Patients in Arm A will receive carboplatin intravenously every 21 days for up to six cycles.
Paclitaxel is a standard chemotherapeutic agent used in patients with lung cancer. Patients in Arm A will receive paclitaxel intravenously every 21 days for up to six cycles.
Sponsors
Study design
Eligibility
Inclusion criteria
* Confirmed diagnosis of non small cell lung cancer with a primary histology of predominantly squamous cell, large cell or adenosquamous carcinoma. * Advanced NSCLC with documented Stage IIIB (with pleural effusion) or Stage IV or recurrent disease. * No prior systemic treatment for NSCLC, except for adjuvant chemotherapy. Adjuvant chemotherapy must have completed for greater than or equal to 12 months prior to randomization. * Prior surgery or radiation therapy is permitted if completed at least 3 weeks prior to randomization and all acute toxicities have resolved. * ECOG performance status (PS) 0 or 1.
Exclusion criteria
* Patients with symptomatic central nervous system (CNS) metastases are not permitted. * Patients requiring chronic steroid use or patients with uncontrolled diabetes are not permitted. * Patients with other active cancer types are not permitted.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline until death, assessed monthly after end of treatment, up to 30 months | Overall survival was the duration from randomization to death. For participants who are alive, overall survival was censored at the last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response (OR) | At baseline, every 6 weeks until radiological disease progression has been documented or the participant begins a subsequent anticancer therapy, up to 22.7 months | Percentage of participants with OR based on assessment of confirmed complete response (CR) or confirmed partial response(PR) according to Response Evaluation Criteria in Solid Tumors (RECIST). CR defined as complete disappearance of all target lesions and non-target disease. No new lesons. PR defined as ≥30% decrease under baseline of the sum of diameters of all target lesions. No unequivocal progression of non-target disease. No new lesions. |
| European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30) | Day 1 of every cycle (3-week cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months | EORTC QLQ-C30: included functional scales (physical, role, cognitive, emotional, and social), global health status, symptom scales (fatigue, pain, nausea/vomiting) and single items (dyspnoea, appetite loss, insomnia, constipation/diarrhea and financial difficulties). Most questions used 4 point scale (1 'Not at all' to 4 'Very much'; 2 questions used 7-point scale (1 'very poor' to 7 'Excellent'). Scores averaged, transformed to 0-100 scale; higher score=better level of functioning or greater degree of symptoms. |
| European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Questionnaire-Lung Cancer 13 (QLQ- LC13) Score | Day 1 of every cycle (3-week cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months | QLQ-LC13 consisted of 13 questions relating to disease symptoms specific to lung cancer and treatment side effects typical of treatment with chemotherapy and radiotherapy. The 13 questions comprised 1 multi-item scale for dyspnea and 10 single-item symptoms and side effects (coughing, hemoptysis, sore mouth, dysphagia, peripheral neuropathy, alopecia, chest pain, arm pain, other pain, and medicine for pain). Recall period: past week; response range: not at all to very much. Scale score range: 0 to 100. Higher symptom score = greater degree of symptoms. |
| Euro Quality of Life (EQ-5D)- Health State Profile Utility Score | Day 1 of every cycle (3-weeks cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months | EQ-5D: participant rated questionnaire to assess health-related quality of life in terms of a single utility score. Health State Profile component assesses level of current health for 5 domains: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression; 1 indicates better health state (no problems); 3 indicates worst health state (confined to bed). Scoring formula developed by EuroQol Group assigns a utility value for each domain in the profile. Score is transformed and results in a total score range of -0.594 to 1; higher score indicates a better health state. |
| Progression-Free Survival (PFS) | At baseline, every 6 weeks until radiological disease progression or the participant begins a subsequent anticancer therapy, up to 22.7 months. | PFS was defined as the time from randomization to first progression or death due to any cause, whichever came first. Participants last known to be alive and progression-free, with baseline and \>=1 on-study assessment, were censored at last disease assessment verifying lack of progression. Progression was determined by the investigator per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 (20% increase in the sum of target lesions' longest diameter over nadir, unequivocal progression of non-target disease, or appearance of new lesions). |
| Minimum Observed Plasma Trough Concentration (Cmin)for Figitumumab | Cycle 1, Day 1 (predose and 1 hour after end of infusion); Day 1 of Cycles 2, 4, 6 (predose); Cycle 5 Day 1 (predose, 1 hour after end of infusion); 28 days and 150 days after the last figi dose | — |
| Number of Participants With Total Anti-drug Antibodies (ADA) | Cycles 1, 2, and 4 (predose); 28 days and 150 days after the last figi dose | ADAs are immunogenicity indicators to figitumumab. Participants reporting positive for ADAs are indicated by an endpoint titer of no less than 6.64. |
| Change From Baseline in Serum Insulin Growth Factor 1 (IGF1) Levels | Cycles 1 and 4 (predose) and at end of treatment | — |
| Maximum Observed Plasma Concentration (Cmax) for Figitumumab | Cycle 1, Day 1 (predose and 1 hour after end of infusion); Day 1 of Cycles 2, 4, 6 (predose); Cycle 5 Day 1 (predose, 1 hour after end of infusion); 28 days and 150 days after the last figi dose | — |
Countries
Australia, Austria, Brazil, Bulgaria, Canada, Czechia, Finland, France, Germany, Greece, Hong Kong, Hungary, India, Italy, Japan, Poland, Puerto Rico, Russia, Slovakia, South Korea, Spain, Switzerland, Taiwan, Turkey (Türkiye), Ukraine, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Figitumumab + Paclitaxel and Carboplatin Figitumumab (figi, \[CP-751, 871\]) was given in combination with paclitaxel (200 milligram/square metre \[mg/m\^2\]) and carboplatin (area under the concentration-time curve \[AUC\]=6) administered in 3-week cycles. Figi 20 milligram/kilogram (mg/kg) was administered intravenously (IV) on Day 1 of a 3-week cycle for up to 6 cycles, followed by single agent figi maintenance in every 3-week cycles after completion or discontinuation of chemotherapy for reasons other than disease progression. | 342 |
| Paclitaxel and Carboplatin (Chemo) Standard platinum-based doublet chemotherapy (chemo) consisting of paclitaxel (200 milligram/square metre \[mg/m\^2\]) and carboplatin (area under the concentration-time curve \[AUC\]=6) was administered via IV on Day 1 of a 3-week cycle. Chemo treatment continued for a maximum of 6 cycles. | 339 |
| Total | 681 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 258 | 247 |
| Overall Study | Follow-up was discontinued | 1 | 0 |
| Overall Study | Lost to Follow-up | 7 | 11 |
| Overall Study | Randomized but not treated | 3 | 7 |
| Overall Study | Study terminated by sponsor | 51 | 62 |
| Overall Study | Withdrawal by Subject | 22 | 12 |
Baseline characteristics
| Characteristic | Figitumumab + Paclitaxel and Carboplatin | Paclitaxel and Carboplatin (Chemo) | Total |
|---|---|---|---|
| Age, Continuous | 61.8 years STANDARD_DEVIATION 9 | 61.8 years STANDARD_DEVIATION 9.1 | 61.8 years STANDARD_DEVIATION 9 |
| Sex: Female, Male Female | 81 Participants | 79 Participants | 160 Participants |
| Sex: Female, Male Male | 261 Participants | 260 Participants | 521 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 316 / 338 | 303 / 333 |
| serious Total, serious adverse events | 223 / 338 | 170 / 333 |
Outcome results
Overall Survival (OS)
Overall survival was the duration from randomization to death. For participants who are alive, overall survival was censored at the last contact.
Time frame: Baseline until death, assessed monthly after end of treatment, up to 30 months
Population: All randomized participants where participants were classified according to the randomized treatment regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Figitumumab + Paclitaxel and Carboplatin | Overall Survival (OS) | 8.6 months |
| Paclitaxel and Carboplatin (Chemo) | Overall Survival (OS) | 9.8 months |
Change From Baseline in Serum Insulin Growth Factor 1 (IGF1) Levels
Time frame: Cycles 1 and 4 (predose) and at end of treatment
Population: This study was terminated early due to futility. As such, these data were not analyzed.
European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30)
EORTC QLQ-C30: included functional scales (physical, role, cognitive, emotional, and social), global health status, symptom scales (fatigue, pain, nausea/vomiting) and single items (dyspnoea, appetite loss, insomnia, constipation/diarrhea and financial difficulties). Most questions used 4 point scale (1 'Not at all' to 4 'Very much'; 2 questions used 7-point scale (1 'very poor' to 7 'Excellent'). Scores averaged, transformed to 0-100 scale; higher score=better level of functioning or greater degree of symptoms.
Time frame: Day 1 of every cycle (3-week cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months
Population: Due to futility, the study was terminated early; therefore these data were not analyzed.
European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Questionnaire-Lung Cancer 13 (QLQ- LC13) Score
QLQ-LC13 consisted of 13 questions relating to disease symptoms specific to lung cancer and treatment side effects typical of treatment with chemotherapy and radiotherapy. The 13 questions comprised 1 multi-item scale for dyspnea and 10 single-item symptoms and side effects (coughing, hemoptysis, sore mouth, dysphagia, peripheral neuropathy, alopecia, chest pain, arm pain, other pain, and medicine for pain). Recall period: past week; response range: not at all to very much. Scale score range: 0 to 100. Higher symptom score = greater degree of symptoms.
Time frame: Day 1 of every cycle (3-week cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months
Population: Due to futility, the study was terminated early; therefore these data were not analyzed.
Euro Quality of Life (EQ-5D)- Health State Profile Utility Score
EQ-5D: participant rated questionnaire to assess health-related quality of life in terms of a single utility score. Health State Profile component assesses level of current health for 5 domains: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression; 1 indicates better health state (no problems); 3 indicates worst health state (confined to bed). Scoring formula developed by EuroQol Group assigns a utility value for each domain in the profile. Score is transformed and results in a total score range of -0.594 to 1; higher score indicates a better health state.
Time frame: Day 1 of every cycle (3-weeks cycle), every 3 weeks during maintenance phase and at the End of Treatment Visit, assessed up to 37.4 months
Population: Due to futility, the study was terminated early; therefore EQ-5D data were not analyzed.
Maximum Observed Plasma Concentration (Cmax) for Figitumumab
Time frame: Cycle 1, Day 1 (predose and 1 hour after end of infusion); Day 1 of Cycles 2, 4, 6 (predose); Cycle 5 Day 1 (predose, 1 hour after end of infusion); 28 days and 150 days after the last figi dose
Population: This study was terminated early due to futility. As such, Cmax was not summarized.
Minimum Observed Plasma Trough Concentration (Cmin)for Figitumumab
Time frame: Cycle 1, Day 1 (predose and 1 hour after end of infusion); Day 1 of Cycles 2, 4, 6 (predose); Cycle 5 Day 1 (predose, 1 hour after end of infusion); 28 days and 150 days after the last figi dose
Population: This study was terminated early due to futility. As such, Cmin was not summarized.
Number of Participants With Total Anti-drug Antibodies (ADA)
ADAs are immunogenicity indicators to figitumumab. Participants reporting positive for ADAs are indicated by an endpoint titer of no less than 6.64.
Time frame: Cycles 1, 2, and 4 (predose); 28 days and 150 days after the last figi dose
Population: All participants who received figitumumab (CP-751,871).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Figitumumab + Paclitaxel and Carboplatin | Number of Participants With Total Anti-drug Antibodies (ADA) | 2 participants |
| Paclitaxel and Carboplatin (Chemo) | Number of Participants With Total Anti-drug Antibodies (ADA) | 0 participants |
Percentage of Participants With Objective Response (OR)
Percentage of participants with OR based on assessment of confirmed complete response (CR) or confirmed partial response(PR) according to Response Evaluation Criteria in Solid Tumors (RECIST). CR defined as complete disappearance of all target lesions and non-target disease. No new lesons. PR defined as ≥30% decrease under baseline of the sum of diameters of all target lesions. No unequivocal progression of non-target disease. No new lesions.
Time frame: At baseline, every 6 weeks until radiological disease progression has been documented or the participant begins a subsequent anticancer therapy, up to 22.7 months
Population: All randomized participants where participants were classified according to the randomized treatment regardless of what treatment, if any, was received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Figitumumab + Paclitaxel and Carboplatin | Percentage of Participants With Objective Response (OR) | 33.0 percentage of participants |
| Paclitaxel and Carboplatin (Chemo) | Percentage of Participants With Objective Response (OR) | 34.5 percentage of participants |
Progression-Free Survival (PFS)
PFS was defined as the time from randomization to first progression or death due to any cause, whichever came first. Participants last known to be alive and progression-free, with baseline and \>=1 on-study assessment, were censored at last disease assessment verifying lack of progression. Progression was determined by the investigator per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 (20% increase in the sum of target lesions' longest diameter over nadir, unequivocal progression of non-target disease, or appearance of new lesions).
Time frame: At baseline, every 6 weeks until radiological disease progression or the participant begins a subsequent anticancer therapy, up to 22.7 months.
Population: All randomized participants where participants were classified according to the randomized treatment regardless of what treatment, if any, was received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Figitumumab + Paclitaxel and Carboplatin | Progression-Free Survival (PFS) | 4.7 months |
| Paclitaxel and Carboplatin (Chemo) | Progression-Free Survival (PFS) | 4.6 months |