Non-Squamous Non-Small Cell Lung Cancer
Conditions
Brief summary
This 2 arm study will compare the efficacy and safety of sequential treatment with Tarceva or placebo, plus platinum-based therapy, as first line treatment in patients with advanced or recurrent non-small cell lung cancer. Patients will be randomized to receive gemcitabine (1250mg/m2 iv) on days 1 and 8, and cisplatin (75mg/m2) or carboplatin (5xAUC)on day 1, followed by Tarceva 150mg/day or placebo from day 15 to day 28 of each 4 week cycle for a total of 6 cycles,then followed by Tarceva or placebo monotherapy.The anticipated time on study treatment is until disease progression, and the target sample size is 100-500 individuals.
Interventions
po on days 15-28 of each 4 week cycle until disease progression
cisplatin --75mg/m2 oon day 1 of each 4 week cycle for 6 cycles or carboplatin--5xAUC on day 1 of each 4 week cycle for 6 cycles
150mg po on days 15-28 of each 4 week cycle until disease progression
1250mg/m2 iv on days 1 and 8 of each 4 week cycle for 6 cycles
Sponsors
Study design
Eligibility
Inclusion criteria
* adult patients, \>=18 years of age; * advanced (stage IIIB/IV)non-small cell lung cancer; * measurable disease; * Eastern Cooperative Oncology Group (ECOG) Performance Status 0 or 1.
Exclusion criteria
* prior exposure to agents directed at the HER axis; * prior chemotherapy or systemic anti-tumor therapy after advanced disease; * unstable systemic disease; * any other malignancy within last 5 years, except cured basal cell cancer of skin or cured cancer in situ of cervix; * brain metastasis or spinal cord compression.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Median Progression Free Survival (PFS) Time | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Tumor response was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.0). PD was defined as at least a 20 percent (%) increase in the sum of longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. PFS is the time (in months) between the date of randomization and the date of first documented disease progression or death from any cause, whichever comes first. Participants who had neither progressed nor died at the time of data cut-off or who were lost to follow-up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow up for progression of disease, whichever was last. Participants without post baseline tumor assessments who were known to be alive were censored at the time of randomization. Analysis was performed using Kaplan-Meier method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median PFS Time Based on Different Subgroups | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Tumor response was evaluated according to RECIST (version 1.0). PD was defined in outcome measure 1. PFS is the time (in months) between the date of randomization and the date of first documented disease progression or death from any cause, whichever comes first. Participants who had neither progressed nor died at the time of data cut-off or who were lost to follow-up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow up for progression of disease, whichever was last. Participants without post baseline tumor assessments who were known to be alive were censored at the time of randomization. PFS among different subgroups of type of carcinoma, smoking habit, epidermal growth factor receptor (EGFR) mutation type, KRAS mutation type, EGFR immunohistochemistry (IHC) test result type, and EGFR fluorescent in situ hybridization (FISH) result type. |
| Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Randomization until death (assessed at baseline and every 8 weeks thereafter until death or end of study [up to approximately 5.5 years]) | OS was defined as the time between the date of randomization and the date of death from any cause. Participants for whom no death was captured on the clinical database were censored at the most recent date they were known to be alive. Participants with no post baseline information were censored at the time of randomization. OS among different subgroups of type of carcinoma, smoking habit, EGFR mutation type, KRAS mutation type, EGFR IHC test result type, and EGFR FISH result type. Analysis was performed using Kaplan-Meier method. |
| Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Randomization until death (assessed at baseline and every 8 weeks thereafter until death or end of study [up to approximately 5.5 years]) | — |
| Non-Progression Rate: Percentage of Participants With a Confirmed Best Overall Response of Either Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) for At Least 16 Weeks | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Tumor response was evaluated according to RECIST (version 1.0). CR is defined as the disappearance of all target and non-target lesions and normalization of tumor marker level; PR is defined as at least a 30% decrease in the sum of the LD of target lesions, taking as reference the screening sum LD; SD for target lesions is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started and SD for non-target lesions defined as persistence of 1 or more non-target lesion(s) or/and maintenance of tumor marker level above the normal limits. Responses were confirmed with repeated assessment 4 weeks after initial response was observed. |
| Objective Response Rate: Percentage of Participants With a Confirmed Best Overall Response of CR or PR | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Tumor response was evaluated according to RECIST (version 1.0). CR is defined as the disappearance of all target and non-target lesions and normalization of tumor marker level; PR is defined as at least a 30% decrease in the sum of the LD of target lesions, taking as reference the screening sum LD. Responses were confirmed with repeated assessment 4 weeks after initial response was observed. |
| Duration of Response | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Duration of response is defined as the time between the date of first documented response (CR or PR, as determined by the RECIST criteria) and the date of first documented PD or death. Participants who did not progress or die after they had a confirmed response (CR or PR) were censored at the date of their last tumor assessment where non-progression was documented or last date of follow-up for progression of disease, whichever was last. CR and PR are defined in Outcome Measure 7. |
| Time to Progression | Randomization until PD (assessed at baseline and every 8 weeks thereafter until PD or end of study [up to approximately 1.5 years]) | Time to progression is defined as the time between the date of randomization and the date of the first documented disease progression. Participants who have not progressed at the time of study completion (or data cut off) or who were lost to follow up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow-up for progression of disease, whichever was latest. PD was defined as at least a 20% increase in the sum of LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. Participants with no post baseline tumor assessments were censored at the time of randomization. Analysis was performed using Kaplan-Meier method. |
| Percentage of Participants Alive and Free From Disease Progression | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years]) | Tumor response was evaluated according to RECIST (version 1.0). PD was defined as at least a 20% increase in the sum of LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. |
| Time to Symptomatic Progression | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | Time to symptomatic progression was the time from randomization until the earlier of a clinically meaningful decline from baseline in LCS score, or death on study. LCS scores were obtained from a 7-item questionnaire from the FACT-L (version 4.0). Participants responded to questions such as shortness of breath, cough, tightness in chest, breathing difficulty, appetite loss, weight loss and unclear thinking; on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 (most symptomatic) to 28 (asymptomatic); higher score indicates fewer symptoms. A clinically meaningful decline used to determine symptomatic progression in this study was at least a three point decline in LCS score from baseline. Participants without symptomatic progression at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method. |
| Percentage of Participants With Deterioration in Trial Outcome Index (TOI) Using FACT-L Version 4.0 | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | TOI was defined as the sum of the scores of the Physical Well-Being (PWB), Functional Well-Being (FWB), and LCS. PWB, FWB, and LCS scores were obtained from 7-item questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 84; higher score indicates better physical aspects of quality of life (QoL). A clinically meaningful decline used to determine deterioration in TOI was greater than or equal to (≥) 6-point decline from baseline. Participants without deterioration in TOI at the time of analysis were censored at the time of the last FACT-L assessment. |
| Time to Deterioration in TOI Using FACT-L Version 4.0 | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | Time to deterioration in TOI is defined as time from randomization until the earlier of a clinically meaningful decline from baseline in TOI or death on study. TOI is defined as the sum of the scores of the PWB, FWB, and LCS. PWB, FWB, and LCS scores were obtained from 7-item questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 84; higher score indicates better physical aspects of QoL. A clinically meaningful decline used to determine deterioration in TOI was ≥6-point decline from baseline. Participants without deterioration in TOI at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method. |
| Percentage of Participants With Deterioration in Quality of Life (QOL) Using FACT-L Version 4.0 | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | Total FACT-L score was defined as the sum of the TOI, Social Well Being (SWB) and EWB of the FACT-L questionnaires. TOI (PWB + FWB + LCS), SWB and EWB scores were obtained from 7-item (6-item in the case of EWB) questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 136; higher score indicates better QoL. A clinically meaningful decline used to determine deterioration in QoL was ≥6-point decline from baseline. Participants without deterioration in QoL at the time of analysis were censored at the time of the last FACT-L assessment. |
| Time to Deterioration in QOL Using FACT-L Version 4.0 | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | Time to deterioration in QoL is defined as time from randomization until the earlier of a clinically meaningful decline from baseline in Total FACT-L or death on study. Total FACT-L score was defined as the sum of the TOI, SWB and EWB of the FACT-L questionnaires. TOI (PWB + FWB + LCS), SWB and EWB scores were obtained from 7-item (6-item in the case of EWB) questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 136; higher score indicates better QoL. A clinically meaningful decline used to determine deterioration in QoL was ≥6-point decline from baseline. Participants without deterioration in QoL at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method. |
| Median Follow-up Time During the Study | Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 5.5 years]) | Median follow-up was calculated using 'Reverse Kaplan-Meier' analysis for Overall survival. |
| Percentage of Participants With Symptomatic Progression Assessed Using the Lung Cancer Subscale (LCS) | Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years) | LCS scores were obtained from a 7-item questionnaire from the Functional Assessment of Cancer Therapy - Lung (FACT-L) (version 4.0). Participants responded to questions such as shortness of breath, cough, tightness in chest, breathing difficulty, appetite loss, weight loss and unclear thinking; on a 5-point scale from 0-4, where 0 equaled (=) not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 (most symptomatic) to 28 (asymptomatic); higher score indicates fewer symptoms. A clinically meaningful decline used to determine symptomatic progression in this study was at least a three point decline in LCS score from baseline. Participants without symptomatic progression at the time of analysis were censored at the time of the last FACT-L assessment. |
Countries
China, Hong Kong, Indonesia, Philippines, South Korea, Taiwan, Thailand
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants received 1250 mg/m\^2 of gemcitabine IV infusion on Day 1 and 8, carboplatin 5x AUC or cisplatin 75 mg/m\^2 IV infusion on Day 1 and oral placebo daily from Day 15 to 28 every 4 weeks, continued for 6 cycles (28-day cycle) until PD, unacceptable toxicity or death in the primary study treatment phase. Participants who completed 6 cycles of treatment without PD or unacceptable toxicity, or if they withdrew early because of toxicity from the platinum-doublet chemotherapy, entered the post-study treatment phase and continued same treatment until PD, unacceptable toxicity or death. Participants who withdrew due to PD or toxicity from placebo could not enter the post-study treatment phase. Upon PD (during either the primary or post-study treatment phase), participants had the option to be crossed over to open-label erlotinib 150 mg/day outside the study (Off-study phase). | 225 |
| Erlotinib Participants received 1250 mg/m\^2 of gemcitabine IV infusion on Day 1 and 8, carboplatin 5x AUC or cisplatin 75 mg/m\^2 IV infusion on Day 1 and oral erlotinib 150 mg/day from Day 15 to 28 every 4 weeks, continued for 6 cycles (28-day cycle) until PD, unacceptable toxicity or death in the primary study treatment phase. Participants who completed 6 cycles of treatment without PD or unacceptable toxicity, or if they withdrew early because of toxicity from the platinum-doublet chemotherapy, entered the post-study treatment phase and continued same treatment until PD, unacceptable toxicity or death. Participants who withdrew due to PD or toxicity from erlotinib could not enter the post-study treatment phase. Upon PD (during either the primary or post-study treatment phase), participants were treated at the discretion of the investigators' discretion (Off-study phase). | 226 |
| Total | 451 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Off-study Phase | Death | 185 | 174 |
| Off-study Phase | Failure to return | 5 | 6 |
| Off-study Phase | Other | 18 | 21 |
| Off-study Phase | Refused treatment | 1 | 1 |
| Post-Study Treatment Phase | Adverse Event | 2 | 3 |
| Post-Study Treatment Phase | Death | 1 | 3 |
| Post-Study Treatment Phase | Disease progression | 103 | 122 |
| Post-Study Treatment Phase | Ongoing in the study | 0 | 6 |
| Post-Study Treatment Phase | Other | 3 | 0 |
| Post-Study Treatment Phase | Protocol Violation | 0 | 1 |
| Post-Study Treatment Phase | Refused Treatment | 3 | 0 |
| Primary Study Treatment Phase | Adverse Event | 16 | 16 |
| Primary Study Treatment Phase | Death | 2 | 3 |
| Primary Study Treatment Phase | Did not receive allocated intervention | 4 | 4 |
| Primary Study Treatment Phase | Disease progression | 75 | 59 |
| Primary Study Treatment Phase | Other | 3 | 0 |
| Primary Study Treatment Phase | Refused Treatment | 5 | 4 |
Baseline characteristics
| Characteristic | Placebo | Erlotinib | Total |
|---|---|---|---|
| Age, Continuous | 56.4 years STANDARD_DEVIATION 11.08 | 57.2 years STANDARD_DEVIATION 9.71 | 56.8 years STANDARD_DEVIATION 10.41 |
| Sex: Female, Male Female | 85 Participants | 94 Participants | 179 Participants |
| Sex: Female, Male Male | 140 Participants | 132 Participants | 272 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 217 / 222 | 223 / 226 |
| serious Total, serious adverse events | 76 / 222 | 70 / 226 |
Outcome results
Median Progression Free Survival (PFS) Time
Tumor response was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.0). PD was defined as at least a 20 percent (%) increase in the sum of longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. PFS is the time (in months) between the date of randomization and the date of first documented disease progression or death from any cause, whichever comes first. Participants who had neither progressed nor died at the time of data cut-off or who were lost to follow-up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow up for progression of disease, whichever was last. Participants without post baseline tumor assessments who were known to be alive were censored at the time of randomization. Analysis was performed using Kaplan-Meier method.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Median Progression Free Survival (PFS) Time | 6.0 months |
| Erlotinib | Median Progression Free Survival (PFS) Time | 7.6 months |
Duration of Response
Duration of response is defined as the time between the date of first documented response (CR or PR, as determined by the RECIST criteria) and the date of first documented PD or death. Participants who did not progress or die after they had a confirmed response (CR or PR) were censored at the date of their last tumor assessment where non-progression was documented or last date of follow-up for progression of disease, whichever was last. CR and PR are defined in Outcome Measure 7.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population participants who were responders (CR or PR).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Duration of Response | 5.6 months |
| Erlotinib | Duration of Response | 10.3 months |
Median Follow-up Time During the Study
Median follow-up was calculated using 'Reverse Kaplan-Meier' analysis for Overall survival.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 5.5 years])
Population: FAS population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Median Follow-up Time During the Study | 50.3 months |
| Erlotinib | Median Follow-up Time During the Study | 50.2 months |
Median Overall Survival (OS) Time-Overall and Among Different Subgroups
OS was defined as the time between the date of randomization and the date of death from any cause. Participants for whom no death was captured on the clinical database were censored at the most recent date they were known to be alive. Participants with no post baseline information were censored at the time of randomization. OS among different subgroups of type of carcinoma, smoking habit, EGFR mutation type, KRAS mutation type, EGFR IHC test result type, and EGFR FISH result type. Analysis was performed using Kaplan-Meier method.
Time frame: Randomization until death (assessed at baseline and every 8 weeks thereafter until death or end of study [up to approximately 5.5 years])
Population: FAS population. n is the number of participants evaluable under the specified category.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Non-adenocarcinoma (n=57,52) | 12.4 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | KRAS mutation (n=11,10) | 11.2 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Current/former smoker (n=118,114) | 13.0 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | KRAS wild-type (n=101,101) | 14.1 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Adenocarcinoma (n=168,174) | 15.8 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR IHC positive (n=36,40) | 15.2 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR mutation (n=48,49) | 20.6 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR IHC negative (n=25,12) | 12.5 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Never smoked (n=107,112) | 17.5 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR FISH positive (n=20,14) | 17.7 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR wild-type (n=67,69) | 12.2 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR FISH negative (n=23,25) | 12.5 months |
| Placebo | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Overall participants (n=225,226) | 15.2 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR FISH negative (n=23,25) | 16.7 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Overall participants (n=225,226) | 18.2 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Adenocarcinoma (n=168,174) | 20.9 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Non-adenocarcinoma (n=57,52) | 10.3 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Never smoked (n=107,112) | 25.9 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | Current/former smoker (n=118,114) | 13.0 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR mutation (n=48,49) | 30.3 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR wild-type (n=67,69) | 14.9 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | KRAS mutation (n=11,10) | 17.5 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | KRAS wild-type (n=101,101) | 18.1 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR IHC positive (n=36,40) | 18.6 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR IHC negative (n=25,12) | 21.9 months |
| Erlotinib | Median Overall Survival (OS) Time-Overall and Among Different Subgroups | EGFR FISH positive (n=20,14) | 43.1 months |
Median PFS Time Based on Different Subgroups
Tumor response was evaluated according to RECIST (version 1.0). PD was defined in outcome measure 1. PFS is the time (in months) between the date of randomization and the date of first documented disease progression or death from any cause, whichever comes first. Participants who had neither progressed nor died at the time of data cut-off or who were lost to follow-up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow up for progression of disease, whichever was last. Participants without post baseline tumor assessments who were known to be alive were censored at the time of randomization. PFS among different subgroups of type of carcinoma, smoking habit, epidermal growth factor receptor (EGFR) mutation type, KRAS mutation type, EGFR immunohistochemistry (IHC) test result type, and EGFR fluorescent in situ hybridization (FISH) result type.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population. n is the number of participants evaluable under the specified category.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Placebo | Median PFS Time Based on Different Subgroups | Adenocarcinoma (n=168,174) | 6.5 months |
| Placebo | Median PFS Time Based on Different Subgroups | Non-adenocarcinoma (n=57,52) | 5.8 months |
| Placebo | Median PFS Time Based on Different Subgroups | Never smoked (n=107,112) | 6.6 months |
| Placebo | Median PFS Time Based on Different Subgroups | Former/current smoker (n=118,114) | 5.9 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR mutation (n=48,49) | 6.9 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR wild-type (n=67,69) | 5.9 months |
| Placebo | Median PFS Time Based on Different Subgroups | KRAS mutation (n=11,10) | 4.5 months |
| Placebo | Median PFS Time Based on Different Subgroups | KRAS wild-type (n=101,101) | 6.8 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR IHC positive (n=36,40) | 6.0 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR IHC negative (n=25,12) | 6.7 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR FISH positive (n=20,14) | 5.9 months |
| Placebo | Median PFS Time Based on Different Subgroups | EGFR FISH negative (n=23,25) | 6.0 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR FISH positive (n=20,14) | 12.9 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | Adenocarcinoma (n=168,174) | 8.2 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | KRAS mutation (n=11,10) | 6.0 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | Non-adenocarcinoma (n=57,52) | 5.7 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR IHC negative (n=25,12) | 10.1 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | Never smoked (n=107,112) | 10.9 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | KRAS wild-type (n=101,101) | 8.0 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | Former/current smoker (n=118,114) | 5.7 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR FISH negative (n=23,25) | 7.5 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR mutation (n=48,49) | 15.6 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR IHC positive (n=36,40) | 8.1 months |
| Erlotinib | Median PFS Time Based on Different Subgroups | EGFR wild-type (n=67,69) | 7.1 months |
Non-Progression Rate: Percentage of Participants With a Confirmed Best Overall Response of Either Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) for At Least 16 Weeks
Tumor response was evaluated according to RECIST (version 1.0). CR is defined as the disappearance of all target and non-target lesions and normalization of tumor marker level; PR is defined as at least a 30% decrease in the sum of the LD of target lesions, taking as reference the screening sum LD; SD for target lesions is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started and SD for non-target lesions defined as persistence of 1 or more non-target lesion(s) or/and maintenance of tumor marker level above the normal limits. Responses were confirmed with repeated assessment 4 weeks after initial response was observed.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Non-Progression Rate: Percentage of Participants With a Confirmed Best Overall Response of Either Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) for At Least 16 Weeks | 64.4 percentage of participants |
| Erlotinib | Non-Progression Rate: Percentage of Participants With a Confirmed Best Overall Response of Either Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) for At Least 16 Weeks | 67.3 percentage of participants |
Objective Response Rate: Percentage of Participants With a Confirmed Best Overall Response of CR or PR
Tumor response was evaluated according to RECIST (version 1.0). CR is defined as the disappearance of all target and non-target lesions and normalization of tumor marker level; PR is defined as at least a 30% decrease in the sum of the LD of target lesions, taking as reference the screening sum LD. Responses were confirmed with repeated assessment 4 weeks after initial response was observed.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Objective Response Rate: Percentage of Participants With a Confirmed Best Overall Response of CR or PR | 17.8 percentage of participants |
| Erlotinib | Objective Response Rate: Percentage of Participants With a Confirmed Best Overall Response of CR or PR | 42.9 percentage of participants |
Percentage of Participants Alive and Free From Disease Progression
Tumor response was evaluated according to RECIST (version 1.0). PD was defined as at least a 20% increase in the sum of LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions.
Time frame: Randomization until PD or death (assessed at baseline and every 8 weeks thereafter until PD, death or end of study [up to approximately 1.5 years])
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Alive and Free From Disease Progression | 6.2 percentage of participants |
| Erlotinib | Percentage of Participants Alive and Free From Disease Progression | 22.6 percentage of participants |
Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups
Time frame: Randomization until death (assessed at baseline and every 8 weeks thereafter until death or end of study [up to approximately 5.5 years])
Population: FAS population. n is the number of participants evaluable under the specified category.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Non-adenocarcinoma (n=57,52) | 8.8 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | KRAS mutation (n=11,10) | 0.0 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Current/former smoker (n=118,114) | 13.6 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | KRAS wild-type (n=101,101) | 14.9 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Adenocarcinoma (n=168,174) | 14.9 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR IHC positive (n=36,40) | 11.1 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR mutation (n=48,49) | 22.9 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR IHC negative (n=25,12) | 8.0 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Never smoked (n=107,112) | 13.1 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR FISH positive (n=20,14) | 10.0 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR wild-type (n=67,69) | 7.5 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR FISH negative (n=23,25) | 13.0 percentage of participants |
| Placebo | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Overall participants (n=225,226) | 13.3 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR FISH negative (n=23,25) | 16.0 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Overall participants (n=225,226) | 15.9 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Adenocarcinoma (n=168,174) | 19.5 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Non-adenocarcinoma (n=57,52) | 3.8 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Never smoked (n=107,112) | 23.2 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | Current/former smoker (n=118,114) | 8.8 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR mutation (n=48,49) | 30.6 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR wild-type (n=67,69) | 10.1 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | KRAS mutation (n=11,10) | 20.0 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | KRAS wild-type (n=101,101) | 17.8 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR IHC positive (n=36,40) | 25.0 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR IHC negative (n=25,12) | 33.3 percentage of participants |
| Erlotinib | Percentage of Participants Alive at the End of Study-Overall and Among Different Subgroups | EGFR FISH positive (n=20,14) | 42.9 percentage of participants |
Percentage of Participants With Deterioration in Quality of Life (QOL) Using FACT-L Version 4.0
Total FACT-L score was defined as the sum of the TOI, Social Well Being (SWB) and EWB of the FACT-L questionnaires. TOI (PWB + FWB + LCS), SWB and EWB scores were obtained from 7-item (6-item in the case of EWB) questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 136; higher score indicates better QoL. A clinically meaningful decline used to determine deterioration in QoL was ≥6-point decline from baseline. Participants without deterioration in QoL at the time of analysis were censored at the time of the last FACT-L assessment.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With Deterioration in Quality of Life (QOL) Using FACT-L Version 4.0 | 79.6 percentage of participants |
| Erlotinib | Percentage of Participants With Deterioration in Quality of Life (QOL) Using FACT-L Version 4.0 | 70.4 percentage of participants |
Percentage of Participants With Deterioration in Trial Outcome Index (TOI) Using FACT-L Version 4.0
TOI was defined as the sum of the scores of the Physical Well-Being (PWB), Functional Well-Being (FWB), and LCS. PWB, FWB, and LCS scores were obtained from 7-item questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 84; higher score indicates better physical aspects of quality of life (QoL). A clinically meaningful decline used to determine deterioration in TOI was greater than or equal to (≥) 6-point decline from baseline. Participants without deterioration in TOI at the time of analysis were censored at the time of the last FACT-L assessment.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With Deterioration in Trial Outcome Index (TOI) Using FACT-L Version 4.0 | 75.6 percentage of participants |
| Erlotinib | Percentage of Participants With Deterioration in Trial Outcome Index (TOI) Using FACT-L Version 4.0 | 65.9 percentage of participants |
Percentage of Participants With Symptomatic Progression Assessed Using the Lung Cancer Subscale (LCS)
LCS scores were obtained from a 7-item questionnaire from the Functional Assessment of Cancer Therapy - Lung (FACT-L) (version 4.0). Participants responded to questions such as shortness of breath, cough, tightness in chest, breathing difficulty, appetite loss, weight loss and unclear thinking; on a 5-point scale from 0-4, where 0 equaled (=) not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 (most symptomatic) to 28 (asymptomatic); higher score indicates fewer symptoms. A clinically meaningful decline used to determine symptomatic progression in this study was at least a three point decline in LCS score from baseline. Participants without symptomatic progression at the time of analysis were censored at the time of the last FACT-L assessment.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With Symptomatic Progression Assessed Using the Lung Cancer Subscale (LCS) | 72.4 percentage of participants |
| Erlotinib | Percentage of Participants With Symptomatic Progression Assessed Using the Lung Cancer Subscale (LCS) | 66.4 percentage of participants |
Time to Deterioration in QOL Using FACT-L Version 4.0
Time to deterioration in QoL is defined as time from randomization until the earlier of a clinically meaningful decline from baseline in Total FACT-L or death on study. Total FACT-L score was defined as the sum of the TOI, SWB and EWB of the FACT-L questionnaires. TOI (PWB + FWB + LCS), SWB and EWB scores were obtained from 7-item (6-item in the case of EWB) questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 136; higher score indicates better QoL. A clinically meaningful decline used to determine deterioration in QoL was ≥6-point decline from baseline. Participants without deterioration in QoL at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Deterioration in QOL Using FACT-L Version 4.0 | 4.5 months |
| Erlotinib | Time to Deterioration in QOL Using FACT-L Version 4.0 | 5.6 months |
Time to Deterioration in TOI Using FACT-L Version 4.0
Time to deterioration in TOI is defined as time from randomization until the earlier of a clinically meaningful decline from baseline in TOI or death on study. TOI is defined as the sum of the scores of the PWB, FWB, and LCS. PWB, FWB, and LCS scores were obtained from 7-item questionnaires from the FACT-L (Version 4.0). Participants responded to questions on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 to 84; higher score indicates better physical aspects of QoL. A clinically meaningful decline used to determine deterioration in TOI was ≥6-point decline from baseline. Participants without deterioration in TOI at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Deterioration in TOI Using FACT-L Version 4.0 | 5.6 months |
| Erlotinib | Time to Deterioration in TOI Using FACT-L Version 4.0 | 6.3 months |
Time to Progression
Time to progression is defined as the time between the date of randomization and the date of the first documented disease progression. Participants who have not progressed at the time of study completion (or data cut off) or who were lost to follow up were censored at the date of the last tumor assessment where non-progression was documented or last date of follow-up for progression of disease, whichever was latest. PD was defined as at least a 20% increase in the sum of LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. Participants with no post baseline tumor assessments were censored at the time of randomization. Analysis was performed using Kaplan-Meier method.
Time frame: Randomization until PD (assessed at baseline and every 8 weeks thereafter until PD or end of study [up to approximately 1.5 years])
Population: FAS population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Progression | 6.5 months |
| Erlotinib | Time to Progression | 7.9 months |
Time to Symptomatic Progression
Time to symptomatic progression was the time from randomization until the earlier of a clinically meaningful decline from baseline in LCS score, or death on study. LCS scores were obtained from a 7-item questionnaire from the FACT-L (version 4.0). Participants responded to questions such as shortness of breath, cough, tightness in chest, breathing difficulty, appetite loss, weight loss and unclear thinking; on a 5-point scale from 0-4, where 0 = not at all and 4 = very much. The participants' responses were summed to result in an overall score, scores range on a scale of 0 (most symptomatic) to 28 (asymptomatic); higher score indicates fewer symptoms. A clinically meaningful decline used to determine symptomatic progression in this study was at least a three point decline in LCS score from baseline. Participants without symptomatic progression at the time of analysis were censored at the time of the last FACT-L assessment. Analysis was performed using Kaplan-Meier method.
Time frame: Baseline, Day 1 of Cycles 3 and 5, Day 1 of post-study Visits 1 and 2 until end of study medication administration or PD (up to approximately 1.5 years)
Population: FAS population.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Time to Symptomatic Progression | 6.6 months |
| Erlotinib | Time to Symptomatic Progression | 7.2 months |