Adenocarcinoma, Carcinoma, Large Cell, Carcinoma, Non-Small-Cell Lung, Carcinoma, Squamous Cell
Conditions
Brief summary
The main objective of this study is to investigate whether administration of maintenance temozolomide following standard treatment could possibly prevent or delay the onset of brain metastases in patients with controlled non-small cell lung cancer (NSCLC).
Detailed description
This is a Phase 2, open-label, randomized, multicenter study of maintenance temozolomide versus observation in subjects with stable or responding stage III/IV NSCLC to be conducted in conformance with Good Clinical Practices. Subjects will be randomly assigned to a study drug (temozolomide) or observation arm. The study drug will be administered at a dose of 75 mg/m\^2 PO daily for 21 consecutive days, followed by a 7-day rest period, until progression or up to a maximum of 6 cycles, whichever occurs first. Subjects completing 6 cycles of treatment will be followed up for incidence of brain metastasis for up to 2 years, or until progression.
Interventions
DRUGTemozolomide
5-mg, 20-mg, and 100-mg gel capsules, 75 mg/m\^2 PO daily for 21 consecutive days, followed by a 7-day rest period, until progression or up to a maximum of 6 cycles, whichever occurs first.
Sponsors
Merck Sharp & Dohme LLC
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult subjects (age \>=18 years), of either sex, and of any race. * Subjects must have stage IV or III with pleural and/or pericardial effusion histologically confirmed NSCLC. * Subjects must have completed 2-6 cycles of a standard systemic therapy, with or without radiation therapy, consisting of at least 2 anti-tumor agents as first-line treatment for Stage III/IV disease, and have documented complete response (CR), partial response (PR), or stable disease (SD) per Response Evaluation Criteria in Solid Tumors (RECIST). * Response must be confirmed within 4-8 weeks of completing first-line chemotherapy. Study treatment must begin within 12 weeks of completing first-line chemotherapy. * Female subjects of childbearing potential or male subjects with female partner of childbearing potential must agree to use a medically accepted method of contraception or be surgically sterilized prior to Screening, while receiving study drug, and for 30 days after stopping study drug. Female subjects of childbearing potential must have a negative pregnancy test confirmed prior to dosing with study drug. * Subjects must be free of any clinically relevant disease (other than stage III/IV NSCLC) that would, in the principal investigator and/or Sponsor's opinion, interfere with the conduct of the study or study evaluations. * Subjects must be able to adhere to the dosing and visit schedules, and agree to report medication taken, concomitant medications, and adverse events (AEs). * Eastern Cooperative Oncology Group (ECOG) performance status \<=2. * Clinical laboratory tests (complete blood count \[CBC\], serum chemistries) must be obtained within 14 days prior to randomization and meet specified criteria.
Exclusion criteria
* Brain metastases documented on post-chemotherapy magnetic resonance imaging (MRI). * Documented history of brain metastases. * Subject has received more than one prior anti-tumor regimen for Stage III/IV disease. Regimen refers to single drug or planned combination of two or more anti-tumor therapies. Bevacizumab (Avastin®) as part of a planned sequence of therapy after first-line platinum-containing double regimen is not considered a second regimen. Neo-adjuvant treatment for resectable subjects is not considered a second regimen. * Subject has used any investigational product within 4 weeks prior to enrollment. * Subject is currently receiving immunotherapy or chemotherapy, cytotoxic or targeted therapy as treatment for active systemic disease. Bevacizumab (Avastin®) as part of the prescribed standard first-line regimen is allowed. * Female who is pregnant, or intends to become pregnant, during the study. * Subject is in a situation or condition that, in the opinion of the investigator, may interfere with optimal participation in the study. * Subject is currently participating in any other clinical study, with the exception of observational long-term follow-up. * Subject is allergic to, or has sensitivity to, the study drug or its excipients. * Documented symptomatic, progressive or new bone metastases following the first-line chemotherapy with or without radiation therapy (biphosphonate use for prophylaxis or as a maintenance therapy is allowed). * No prior malignancy except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the subject has been disease-free for 5 years.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Had Brain Metastases | Up to 12 months (as measured from day 1 of cycle 1 of standard first-line systemic chemotherapy) | Brain Metastases were defined as radiological evidence of brain metastases on magnetic resonance imaging (MRI). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Progression | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to progression or up to 6 cycles (168 days) of study treatment | The time to progression (per response evaluation criteria in solid tumors \[RECIST\]) was analyzed using the Kaplan-Meier method. Definitions of response per RECIST: Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): A decrease of at least 30% in the sum of the longest diameter of target lesions. Progressive Disease (PD): An increase of at least 20% in the sum of the longest diameter of target lesions. Stable Disease (SD): Neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease. |
| Overall Survival | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up | The overall survival was analyzed using the Kaplan-Meier method. |
| Time to Radiological Central Nervous System (CNS) Progression | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to radiological progression or the last known CNS progression-free date | Defined as CNS progression as measured by MRI. Time to CNS progression was analyzed using the Kaplan-Meier method. |
| Cancer-related Quality of Life (QoL) as Assessed by The European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire C30 Version 3.0 (QLQ-C30), and the EORTC Lung Cancer Module (QLQ-LC13) | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment) | The EORTC QLQ-C30 is a 30-item questionnaire developed to assess the QoL of cancer patients. Scores range from 0 -100. For functional and global QoL scales, higher scores mean a better level of function. For symptom-oriented scales, a higher score means more severe symptoms and a decrease in QoL. The EORTC QLQ-LC13 is a 13-item questionnaire developed to supplement the EORTC QLQ-C30 in lung cancer patients. It has a score range 0-100 with higher scores representing an increase in symptoms. |
| Tolerability of Maintenance Temozolomide | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment) | Tolerability was defined as number of participants with any adverse event leading to study discontinuation and/or study drug discontinuation. |
| Number of Participants With Brain Metastases at First Progression | from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment) | Brain Metastases were defined as radiological evidence of brain metastases on MRI. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Temozolomide Treatment Participants received temozolomide at a dose of 75 mg/m\^2 orally (PO) daily for 21 consecutive days, followed by a 7-day rest period per 28-day cycle, until progression or up to a maximum of 6 cycles, whichever occurred first. | 26 |
| Observation Observation | 27 |
| Total | 53 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Did not start study treatment | 1 | 0 |
Baseline characteristics
| Characteristic | Temozolomide Treatment | Observation | Total |
|---|---|---|---|
| Age, Continuous | 64.8 years STANDARD_DEVIATION 9.4 | 65.1 years STANDARD_DEVIATION 10.8 | 65.0 years STANDARD_DEVIATION 10 |
| Sex: Female, Male Female | 12 Participants | 11 Participants | 23 Participants |
| Sex: Female, Male Male | 14 Participants | 16 Participants | 30 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 25 / 26 | 24 / 27 |
| serious Total, serious adverse events | 8 / 26 | 4 / 27 |
Outcome results
Primary
Number of Participants Who Had Brain Metastases
Brain Metastases were defined as radiological evidence of brain metastases on magnetic resonance imaging (MRI).
Time frame: Up to 12 months (as measured from day 1 of cycle 1 of standard first-line systemic chemotherapy)
Population: Evaluable population, defined as a participant who had at least one post-randomization MRI scan
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide Treatment | Number of Participants Who Had Brain Metastases | 4 participants |
| Observation | Number of Participants Who Had Brain Metastases | 3 participants |
p-value: 0.69952-sided Exact Pearson Chi-square Test
Secondary
Cancer-related Quality of Life (QoL) as Assessed by The European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire C30 Version 3.0 (QLQ-C30), and the EORTC Lung Cancer Module (QLQ-LC13)
The EORTC QLQ-C30 is a 30-item questionnaire developed to assess the QoL of cancer patients. Scores range from 0 -100. For functional and global QoL scales, higher scores mean a better level of function. For symptom-oriented scales, a higher score means more severe symptoms and a decrease in QoL. The EORTC QLQ-LC13 is a 13-item questionnaire developed to supplement the EORTC QLQ-C30 in lung cancer patients. It has a score range 0-100 with higher scores representing an increase in symptoms.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment)
Population: No analysis was performed due to study termination.
Secondary
Number of Participants With Brain Metastases at First Progression
Brain Metastases were defined as radiological evidence of brain metastases on MRI.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment)
Population: No analysis was performed due to study termination.
Secondary
Overall Survival
The overall survival was analyzed using the Kaplan-Meier method.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide Treatment | Overall Survival | 27.14 months |
| Observation | Overall Survival | 22.54 months |
Secondary
Time to Progression
The time to progression (per response evaluation criteria in solid tumors \[RECIST\]) was analyzed using the Kaplan-Meier method. Definitions of response per RECIST: Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): A decrease of at least 30% in the sum of the longest diameter of target lesions. Progressive Disease (PD): An increase of at least 20% in the sum of the longest diameter of target lesions. Stable Disease (SD): Neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to progression or up to 6 cycles (168 days) of study treatment
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide Treatment | Time to Progression | 11.70 months |
| Observation | Time to Progression | 10.68 months |
Secondary
Time to Radiological Central Nervous System (CNS) Progression
Defined as CNS progression as measured by MRI. Time to CNS progression was analyzed using the Kaplan-Meier method.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to radiological progression or the last known CNS progression-free date
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide Treatment | Time to Radiological Central Nervous System (CNS) Progression | NA months |
| Observation | Time to Radiological Central Nervous System (CNS) Progression | NA months |
Secondary
Tolerability of Maintenance Temozolomide
Tolerability was defined as number of participants with any adverse event leading to study discontinuation and/or study drug discontinuation.
Time frame: from Cycle 1 Day 1 of Standard First Line Systemic Therapy to the last time of follow-up (up to 6 cycles (168 days) of study treatment)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide Treatment | Tolerability of Maintenance Temozolomide | 5 participants |
| Observation | Tolerability of Maintenance Temozolomide | NA participants |