Carcinoma, Adenosquamous Cell, Carcinoma, Large Cell, Carcinoma, Non-Small-Cell Lung, Carcinoma, Squamous Cell
Conditions
Keywords
IGR-1R, Non small cell lung cancer, CP-751, 871, Figitumumab
Brief summary
The objective of this study is to test a clinical benefit of the addition of CP 751,871 to erlotinib therapy in patients with advanced NSCLC of non adenocarcinoma histology. The primary endpoint is Overall Survival (OS).
Detailed description
This study was terminated on March 8, 2010 due to an analysis by an independent Data Safety Monitoring Committee (DSMC) indicating that the addition of CP-751,871 \[figitumumab\] to erlotinib \[Tarceva\] would be unlikely to meet the primary endpoint of improving overall survival when compared to erlotinib alone. This Oncology study continues as terminated, however for ethical reasons some patients, noted with resultant benefit, continue receiving treatment.
Interventions
CP 751,871 (20 mg/kg) will be administered as an IV infusion on study Days 1 and 2 in Cycle 1, and every three weeks (from Day 1) (Cycle) thereafter.
Erlotinib (one tablet of 150 mg/day PO).
Sponsors
Study design
Eligibility
Inclusion criteria
* Non small cell lung cancer with a primary histology of squamous cell, large cell or adenosquamous carcinoma. At least 1 measurable lesion, as defined by RECIST.
Exclusion criteria
* Primary NSCLC adenocarcinoma and its subtypes or unknown/unspecified histology. * Prior Erlotinib therapy. * Prior anti IGF IR based investigational therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Baseline, assessed every cycle until disease progression and then every 4 weeks until death, up to 30.65 months | The time from date of randomization to date of death due to any cause. For participants who were alive, overall survival was censored at the last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response | Baseline, 6, 9, 12, 15, 18 weeks after randomization, thereafter assessed every 6 weeks until disease progression during treatment (or every 8 weeks until disease progression during off-treatment), up to 29.7 months | Percentage of participants with objective response (OR) based on assessment of confirmed complete response (CR) or confirmed partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. CR are defined as complete disappearance of all lesions (target and/or non target). PR are those with at least 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions. |
| Maximum Observed Plasma Concentration (Cmax) for Figitumumab | Cycle 1 (Day 1 [predose], Day 2 [1 hour after end of infusion] ), Cycles 2, 4, 6 (predose), Cycle 5 (predose, 1 hour after end of infusion) for figi plus erlo group; Cycles 1, 2,4 (predose) for erlo, then figi group | — |
| Minimum Observed Plasma Trough Concentration (Cmin) for Figitumumab | Cycle 1 (Day 1 [predose], Day 2 [1 hour after end of infusion] ), Cycles 2, 4, 6 (predose), Cycle 5 (predose, 1 hour after end of infusion) for figi plus erlo group; Cycles 1, 2,4 (predose) for erlo, then figi group | — |
| Percentage of Participants Reporting Positive for Total Anti-drug Antibodies (ADA) | Cycles 1, 2, 4 (predose), End of Treatment ([EOT] 21-28 days after last dose), about 150 days after last figi dose for figi plus erlo group; Cycles 1, 2, 4 (predose), EOT, about 150 days after last figi dose for erlo, then figi group | ADAs are immunogenicity indicators to figitumumab. Participants reporting positive for ADAs are indicated by an endpoint titer of no less than 6.64. |
| Progression Free Survival (PFS) | Baseline, 6, 9, 12, 15, 18 weeks after randomization, thereafter assessed every 6 weeks until disease progression during treatment (or every 8 weeks until disease progression during off-treatment), up to 29.7 months | Time from randomization to date of first documentation of progression or death due to any cause, whichever came first. Participants last known to be alive and progression-free, who had a baseline and at least 1 on-study disease 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, as a 20% increase in the sum of the longest diameter of target lesions, or target lesions over nadir, unequivocal progression of non-target disease, or the appearance of new lesions. |
| Change From Baseline in Euro Quality of Life (EQ-5D)- Health State Profile Utility at Cycles 2, 3, Then Every Other Cycle and EOT (21-28 Days After Last Dose) | Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every other cycle and EOT (21-28 days after last dose) | EQ-5D is a 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. 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 -0.594 to 1.000; higher score indicates a better health state. |
| Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30) at Cycles 2, 3, and Then Every Odd Cycle Starting With Cycle 5 and EOT (21-28 Days After Last Dose) | Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every odd cycle starting with Cycle 5 and EOT (21-28 days after last dose) | EORTC QLQ-C30 includes 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 use 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. |
| Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Score at Cycles 2, 3, and Then Every Odd Cycle Starting With Cycle 5, and EOT (21-28 Days After Last Dose) | Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every odd cycle starting with Cycle 5 and EOT (21-28 days after last dose) | QLQ-LC13 consists 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 comprise 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. |
| Counts of Circulating Tumor Cell (CTC) Expressing Positive Insulin-Like Growth Factor 1 Receptor (IGF-1R) | Baseline, Cycle 2 Day 1 (predose) and EOT (21-28 days after last dose) | — |
Countries
Belgium, Brazil, Bulgaria, Canada, Chile, Czechia, France, Greece, Hungary, Indonesia, Ireland, Italy, Latvia, Poland, Puerto Rico, Romania, Russia, Serbia, Slovenia, South Africa, South Korea, Spain, Switzerland, Taiwan, Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Figitumumab + Erlotinib (as Randomized) Figitumumab (20 mg/kg) in combination with erlotinib (150 mg/day) was given in 3-week cycles. Figitumumab was administered as an IV infusion on study Days 1 and 2 in Cycle 1, and on Day 1 every 3 weeks (from Day 1) thereafter. Erlotinib was taken as 150 mg at least 1 hour before or 2 hours after the ingestion of food. Intent-to-treat population according to randomization was analyzed. | 293 |
| Erlotinib (as Randomized) Erlotinib was taken as 150 mg daily at least 1 hour before or 2 hours after the ingestion of food. Intent-to-treat population according to randomization was analyzed. | 290 |
| Total | 583 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| After Progression on Erlotinib | Death | 0 | 0 | 0 | 71 |
| After Progression on Erlotinib | Lost to Follow-up | 0 | 0 | 0 | 3 |
| After Progression on Erlotinib | study terminated by sponsor | 0 | 0 | 0 | 4 |
| After Progression on Erlotinib | Withdrawal by Subject | 0 | 0 | 0 | 5 |
| Before Progression on Erlotinib | Death | 235 | 167 | 1 | 0 |
| Before Progression on Erlotinib | Lost to Follow-up | 9 | 5 | 0 | 0 |
| Before Progression on Erlotinib | Other | 1 | 2 | 0 | 0 |
| Before Progression on Erlotinib | Randomized but not treated | 3 | 1 | 0 | 0 |
| Before Progression on Erlotinib | study terminated by sponsor | 18 | 14 | 0 | 0 |
| Before Progression on Erlotinib | Switched to figitumumab | 0 | 83 | 0 | 0 |
| Before Progression on Erlotinib | Withdrawal by Subject | 26 | 18 | 0 | 0 |
Baseline characteristics
| Characteristic | Figitumumab + Erlotinib (as Randomized) | Erlotinib (as Randomized) | Total |
|---|---|---|---|
| Age, Customized <70 years | 226 participants | 222 participants | 448 participants |
| Age, Customized >=70 years | 67 participants | 68 participants | 135 participants |
| Sex: Female, Male Female | 65 Participants | 65 Participants | 130 Participants |
| Sex: Female, Male Male | 228 Participants | 225 Participants | 453 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 265 / 289 | 265 / 290 | 79 / 83 |
| serious Total, serious adverse events | 204 / 289 | 153 / 290 | 63 / 83 |
Outcome results
Overall Survival
The time from date of randomization to date of death due to any cause. For participants who were alive, overall survival was censored at the last contact.
Time frame: Baseline, assessed every cycle until disease progression and then every 4 weeks until death, up to 30.65 months
Population: Full (intent-to-treat) analysis set, which included all participants randomized regardless of treatment received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Figitumumab + Erlotinib | Overall Survival | 5.7 months |
| Erlotinib | Overall Survival | 6.2 months |
Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30) at Cycles 2, 3, and Then Every Odd Cycle Starting With Cycle 5 and EOT (21-28 Days After Last Dose)
EORTC QLQ-C30 includes 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 use 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: Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every odd cycle starting with Cycle 5 and EOT (21-28 days after last dose)
Population: This outcome measure was added in Protocol Amendment 3 (28 January 2010). However, data were not collected as the majority of the subjects had already been enrolled prior to this amendment and the study was terminated shortly thereafter (02 March 2010).
Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Score at Cycles 2, 3, and Then Every Odd Cycle Starting With Cycle 5, and EOT (21-28 Days After Last Dose)
QLQ-LC13 consists 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 comprise 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: Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every odd cycle starting with Cycle 5 and EOT (21-28 days after last dose)
Population: This outcome measure was added in Protocol Amendment 3 (28 January 2010). However, data were not collected as the majority of the subjects had already been enrolled prior to this amendment and the study was terminated shortly thereafter (02 March 2010).
Change From Baseline in Euro Quality of Life (EQ-5D)- Health State Profile Utility at Cycles 2, 3, Then Every Other Cycle and EOT (21-28 Days After Last Dose)
EQ-5D is a 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. 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 -0.594 to 1.000; higher score indicates a better health state.
Time frame: Baseline (Cycle 1 Day 1 predose), Cycles 2, 3 (Day 1), every other cycle and EOT (21-28 days after last dose)
Population: Due to futility, the study was terminated early; therefore EQ-5D data were not analyzed.
Counts of Circulating Tumor Cell (CTC) Expressing Positive Insulin-Like Growth Factor 1 Receptor (IGF-1R)
Time frame: Baseline, Cycle 2 Day 1 (predose) and EOT (21-28 days after last dose)
Population: Due to futility, the study was terminated early; therefore biomarker results were not analyzed.
Maximum Observed Plasma Concentration (Cmax) for Figitumumab
Time frame: Cycle 1 (Day 1 [predose], Day 2 [1 hour after end of infusion] ), Cycles 2, 4, 6 (predose), Cycle 5 (predose, 1 hour after end of infusion) for figi plus erlo group; Cycles 1, 2,4 (predose) for erlo, then figi group
Population: Due to futility, the study was terminated early; therefore pharmacokinetic data were not analyzed.
Minimum Observed Plasma Trough Concentration (Cmin) for Figitumumab
Time frame: Cycle 1 (Day 1 [predose], Day 2 [1 hour after end of infusion] ), Cycles 2, 4, 6 (predose), Cycle 5 (predose, 1 hour after end of infusion) for figi plus erlo group; Cycles 1, 2,4 (predose) for erlo, then figi group
Population: Due to futility, the study was terminated early; therefore pharmacokinetic data were not analyzed.
Percentage of Participants Reporting Positive for 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, 4 (predose), End of Treatment ([EOT] 21-28 days after last dose), about 150 days after last figi dose for figi plus erlo group; Cycles 1, 2, 4 (predose), EOT, about 150 days after last figi dose for erlo, then figi group
Population: Analysis population included all participants treated with figi. Data are combined for figi+erlo and erlo then figi because the objective was to report any participants with positive ADA after exposure to figi regardless of figi administration order, rather comparison of these 2 treatment groups. N=number of participants evaluable.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Figitumumab + Erlotinib | Percentage of Participants Reporting Positive for Total Anti-drug Antibodies (ADA) | 0.28 percentage of participants |
Percentage of Participants With Objective Response
Percentage of participants with objective response (OR) based on assessment of confirmed complete response (CR) or confirmed partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. CR are defined as complete disappearance of all lesions (target and/or non target). PR are those with at least 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.
Time frame: Baseline, 6, 9, 12, 15, 18 weeks after randomization, thereafter assessed every 6 weeks until disease progression during treatment (or every 8 weeks until disease progression during off-treatment), up to 29.7 months
Population: Full (intent-to-treat) analysis set, which included all participants randomized regardless of treatment received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Figitumumab + Erlotinib | Percentage of Participants With Objective Response | 5.5 percentage of participants |
| Erlotinib | Percentage of Participants With Objective Response | 3.8 percentage of participants |
Progression Free Survival (PFS)
Time from randomization to date of first documentation of progression or death due to any cause, whichever came first. Participants last known to be alive and progression-free, who had a baseline and at least 1 on-study disease 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, as a 20% increase in the sum of the longest diameter of target lesions, or target lesions over nadir, unequivocal progression of non-target disease, or the appearance of new lesions.
Time frame: Baseline, 6, 9, 12, 15, 18 weeks after randomization, thereafter assessed every 6 weeks until disease progression during treatment (or every 8 weeks until disease progression during off-treatment), up to 29.7 months
Population: Full (intent-to-treat) analysis set, which included all participants randomized regardless of treatment received.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Figitumumab + Erlotinib | Progression Free Survival (PFS) | 2.1 months |
| Erlotinib | Progression Free Survival (PFS) | 2.6 months |