Non-Small Cell Lung Cancer
Conditions
Brief summary
Participants with advanced non-small cell lung cancer (NSCLC) will receive a first-line treatment of Pemetrexed, Cisplatin and Bevacizumab as induction therapy followed by a maintenance treatment of Pemetrexed and Bevacizumab. Treatment will continue until disease progression or unacceptable toxicity occurs. The primary objective of this study is to measure how long this treatment could prevent the disease progression.
Detailed description
The study will have 3 periods: a baseline period; a study treatment period, including both induction and maintenance treatment; and a follow-up period. Approximately 110 participants will be enrolled into the study, with the aim of having 100 evaluable participants. Eligible participants will first receive 4 cycles of induction chemotherapy with pemetrexed-cisplatin-bevacizumab. Participants who achieve a response or do not progress after completion of induction chemotherapy and have an adequate performance status will receive maintenance therapy with pemetrexed-bevacizumab. Treatment will continue until disease progression or unacceptable toxicity occurs. When treatment is discontinued, the participants health status will be monitored till death, loss to follow-up or data cut-off date. Participants who continue to receive benefit from treatment at the time of data cut-off may receive continued access to pemetrexed and bevacizumab until disease progression, unacceptable toxicity, or any other reason at investigator or participants decision.
Interventions
DRUGPemetrexed
500 milligram per square meter (mg/m²) given intravenously on Day 1 of each 21-day cycle for four cycles of Induction Therapy, and continued in Maintenance Therapy until progression or unacceptable toxicity.
DRUGCisplatin
75 mg/m² given intravenously on Day 1 of 21-day cycle for a maximum of 4 cycles
DRUGBevacizumab
7.5 milligram per kilogram (mg/kg) given intravenously on Day 1 of 21-day cycle for four cycles of Induction Therapy, and continued in Maintenance Therapy until progression or unacceptable toxicity
Sponsors
Eli Lilly and Company
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histological or cytological diagnosis of nonsquamous Stage IIIB or Stage IV NSCLC that is not amenable to curative therapy * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 * At least 1 unidimensionally measurable lesion meeting the Response Evaluation Criteria In Solid Tumors (RECIST) criteria * Adequate organ function, including the following: * Adequate bone marrow reserve: absolute neutrophil (segmented and bands) count (ANC) ≥1.5 x 10\^9 per Liter (10\^9/L), platelets ≥100 x 10\^9/L, and hemoglobin ≥10 gram per deciliter (g/dL) * Hepatic: bilirubin ≤1.5 times the upper limit of normal (ULN); alkaline phosphatase (AP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) ≤3.0 x ULN (AP, AST, and ALT ≤5 x ULN is acceptable if liver has tumor involvement) * Renal: calculated creatinine clearance (CrCl) ≥45 milliliter per minute (mL/min) based on the original weight-based Cockcroft and Gault formula, and serum creatinine ≤1.5 x ULN * At the time of enrollment, if the urinalysis dipstick result is ≥2+ for protein, a 24-hour urine collection should be taken. In these cases, participants must have ≤1g protein/24 hours to be eligible for study participation * Participants must sign an Informed Consent Document (ICD)
Exclusion criteria
* Have received prior systemic anticancer therapy for lung cancer (including adjuvant early-stage treatment for NSCLC) * Have a serious cardiac condition, such as myocardial infarction within 6 months, angina, or heart disease, as defined by the New York Heart Association Class III or IV * Have a second primary malignancy that is clinically detectable at the time of consideration for study enrollment * Have known central nervous system (CNS) disease, other than stable, treated brain metastasis. Stable, treated brain metastasis is defined as metastasis having no evidence of progression or hemorrhage after treatment and no ongoing requirement for dexamethasone, as ascertained by clinical examination and post-treatment brain imaging (Computed Tomography \[CT\] scan or magnetic resonance imaging \[MRI\]) * Are receiving concurrent administration of any other antitumor therapy * Have a history of gastrointestinal fistula, perforation, or abscess, inflammatory bowel disease, or diverticulitis * Have had significant weight loss (that is, ≥10%) over the previous 6 weeks before study entry * Have a history of gross hemoptysis (bright red blood of ≥½ teaspoon per episode of coughing) \<3 months prior to enrollment or history or evidence of inherited bleeding diathesis or coagulopathy with the risk of bleeding * Are taking or have recently taken (within 10 days of enrollment) full-dose oral or parenteral anticoagulants or thrombolytic agents for therapeutic purposes. Prophylactic use of anticoagulants is allowed; international normalized ratio (INR) should be \<1.5 at study enrollment * Have a history of hypertension, unless hypertension is well controlled upon study entry (≤150/90 millimeter of mercury \[mm Hg\]) and the participant is on a stable regimen of antihypertensive therapy. Participants should not have any prior history of hypertensive crisis or hypertensive encephalopathy * Have had major surgery, open biopsy, or significant traumatic injury within 28 days prior to study enrollment, or anticipate the need for major surgical procedure during the course of the study * History of thrombotic disorders within the last 6 months prior to entry
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival | From enrollment to the first date of objectively determined Progressive Disease (PD) or death from any cause (every other cycle during study treatment and then every 6 weeks during follow-up period)(Baseline up to 36.1 Months) | Progression-Free Survival (PFS) is defined as the time from the date of study enrollment to the first date of objectively determined PD or death from any cause. PD is defined using Response Evaluation Criteria in Solid Tumours (RECIST) Guidelines (Version 1.0), as at least a 20% increase in the sum of longest diameter (LD) of target lesions, taking as references the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. For participants not known to have died as of the data cut-off date and who do not have objective PD, PFS will be censored at the date of the last objective progression-free disease assessment. For participants who receive subsequent systemic anticancer therapy, PFS will be censored at the date of the last objective progression-free disease assessment prior to post-discontinuation systemic therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From enrollment to the date of death from any cause (every cycle during study treatment, every 6 weeks during follow-up period until PD, and then at least every 3 Months) (Baseline up to 36.3 Months) | Overall Survival (OS) is defined as the time from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS will be censored at the last contact date. |
| Percentage of Participants With Confirmed Complete Response or Partial Response During Study Treatment (Induction and Maintenance) | From enrollment to objectively determined PD (assessment during study treatment completed at every other cycle till PD and at 30 day follow-up)(Baseline up to 104.1 Weeks) | Overall Response Rate (ORR) is defined as the percentage of participants whose best response is complete response (CR) or partial response (PR) per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared. |
| Percentage of Participants With Confirmed Response Complete or Partial Response During the Induction Treatment Only | From the time of study enrollment to the first date of objectively determined PD during the induction therapy (assessment during study treatment completed at every other cycle up to four cycles) (Baseline up to 4 cycles) | CR and PR defined per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared. |
| Percentage of Participants With Confirmed Complete Response or Partial Response During the Maintenance Therapy Only | From the start of the maintenance to the first date of objectively determined PD during the maintenance therapy (assessment during maintenance treatment completed at every other cycle till PD and at 30 day follow-up)(Cycle 5 up to 104.1 Weeks) | CR and PR defined per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared. |
Countries
Denmark, Germany, Italy, Spain, Sweden
Participant flow
Pre-assignment details
The study had 3 periods: a baseline period; a study treatment period, including both induction (Ind) and maintenance (Maint) treatment; and a follow-up period.
Participants by arm
| Arm | Count |
|---|---|
| Study Treatment Induction Therapy:
Bevacizumab: 7.5 mg/kg given intravenously on Day 1 for four cycles (cycle=21 days) of Induction Therapy.
Pemetrexed: 500 mg/m² given intravenously on Day 1 for four cycles of Induction Therapy.
Cisplatin: 75 mg/m² given intravenously on Day 1 for a maximum of 4 cycles.
Maintenance Therapy:
Bevacizumab: 7.5 mg/kg given intravenously on Day 1 of each cycle and continued until progression or unacceptable toxicity.
Pemetrexed: 500 mg/m² given intravenously on Day 1 of each cycle and continued until progression or unacceptable toxicity. | 109 |
| Total | 109 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Follow-Up (FU) Period | Lost to Follow-up | 1 |
| Induction Therapy Period | Adverse Event | 10 |
| Induction Therapy Period | Entry Criteria Not Met | 1 |
| Induction Therapy Period | Physician Decision | 2 |
| Induction Therapy Period | Withdrawal by Subject | 2 |
| Maintenance Therapy Period | Adverse Event | 15 |
| Maintenance Therapy Period | Lost to Follow-up | 1 |
| Maintenance Therapy Period | Physician Decision | 4 |
| Maintenance Therapy Period | Protocol Violation | 1 |
| Maintenance Therapy Period | Withdrawal by Subject | 5 |
Baseline characteristics
| Characteristic | Study Treatment |
|---|---|
| Age, Continuous | 59.1 years STANDARD_DEVIATION 8.8 |
| ECOG Performance Status ECOG 0 | 59 Participants |
| ECOG Performance Status ECOG 1 | 50 Participants |
| Initial Pathological Diagnosis Adenocarcinoma | 99 Participants |
| Initial Pathological Diagnosis Large Cell Lung Carcinoma | 3 Participants |
| Initial Pathological Diagnosis Other | 4 Participants |
| Initial Pathological Diagnosis Poorly Differentiated NSCLC | 3 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 108 Participants |
| Region of Enrollment Denmark | 19 participants |
| Region of Enrollment Germany | 25 participants |
| Region of Enrollment Italy | 35 participants |
| Region of Enrollment Spain | 12 participants |
| Region of Enrollment Sweden | 18 participants |
| Sex: Female, Male Female | 45 Participants |
| Sex: Female, Male Male | 64 Participants |
| Stage of Disease Stage IIIB | 10 Participants |
| Stage of Disease Stage IV | 99 Participants |
| Tobacco Use Current Smoker | 28 Participant |
| Tobacco Use Ex-Smoker | 66 Participant |
| Tobacco Use Never Smoked | 15 Participant |
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 | 105 / 109 | 68 / 72 | 106 / 109 |
| serious Total, serious adverse events | 32 / 109 | 14 / 72 | 39 / 109 |
Outcome results
Primary
Progression-Free Survival
Progression-Free Survival (PFS) is defined as the time from the date of study enrollment to the first date of objectively determined PD or death from any cause. PD is defined using Response Evaluation Criteria in Solid Tumours (RECIST) Guidelines (Version 1.0), as at least a 20% increase in the sum of longest diameter (LD) of target lesions, taking as references the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. For participants not known to have died as of the data cut-off date and who do not have objective PD, PFS will be censored at the date of the last objective progression-free disease assessment. For participants who receive subsequent systemic anticancer therapy, PFS will be censored at the date of the last objective progression-free disease assessment prior to post-discontinuation systemic therapy.
Time frame: From enrollment to the first date of objectively determined Progressive Disease (PD) or death from any cause (every other cycle during study treatment and then every 6 weeks during follow-up period)(Baseline up to 36.1 Months)
Population: 30 participants were censored. Participants qualified by the following criteria:~* Confirmed histological or cytological diagnosis of nonsquamous Stage IIIB or Stage IV lung cancer~* At least 1 unidimensionally measurable lesion~* No concomitant curative anticancer therapy~* Treated with at least one dose of study drug
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Study Treatment | Progression-Free Survival | 6.9 Months |
Secondary
Overall Survival
Overall Survival (OS) is defined as the time from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS will be censored at the last contact date.
Time frame: From enrollment to the date of death from any cause (every cycle during study treatment, every 6 weeks during follow-up period until PD, and then at least every 3 Months) (Baseline up to 36.3 Months)
Population: 32 participants were censored. All enrolled participants receiving at least one dose of study drug.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Study Treatment | Overall Survival | 14.7 Months |
Secondary
Percentage of Participants With Confirmed Complete Response or Partial Response During Study Treatment (Induction and Maintenance)
Overall Response Rate (ORR) is defined as the percentage of participants whose best response is complete response (CR) or partial response (PR) per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared.
Time frame: From enrollment to objectively determined PD (assessment during study treatment completed at every other cycle till PD and at 30 day follow-up)(Baseline up to 104.1 Weeks)
Population: Participants qualified by the following criteria:~* Confirmed histological or cytological diagnosis of nonsquamous Stage IIIB or Stage IV lung cancer~* At least 1 unidimensionally measurable lesion~* No concomitant curative anticancer therapy~* Treated with at least one dose of study drug
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Study Treatment | Percentage of Participants With Confirmed Complete Response or Partial Response During Study Treatment (Induction and Maintenance) | 42.2 Percentage of Participants |
Secondary
Percentage of Participants With Confirmed Complete Response or Partial Response During the Maintenance Therapy Only
CR and PR defined per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared.
Time frame: From the start of the maintenance to the first date of objectively determined PD during the maintenance therapy (assessment during maintenance treatment completed at every other cycle till PD and at 30 day follow-up)(Cycle 5 up to 104.1 Weeks)
Population: Participants qualified by the following criteria:~* Confirmed histological or cytological diagnosis of nonsquamous Stage IIIB or Stage IV lung cancer~* At least 1 unidimensionally measurable lesion~* No concomitant curative anticancer therapy~* Treated with at least one dose of study drug
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Study Treatment | Percentage of Participants With Confirmed Complete Response or Partial Response During the Maintenance Therapy Only | 11.1 Percentage of Participants |
Secondary
Percentage of Participants With Confirmed Response Complete or Partial Response During the Induction Treatment Only
CR and PR defined per RECIST Guidelines, Version 1.0. CR is disappearance of all tumor lesions. PR is either a) at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LDs, or b) complete disappearance of target lesions, with persistence (but not worsening) of 1 or more nontarget lesions. In either case, no new lesions may have appeared.
Time frame: From the time of study enrollment to the first date of objectively determined PD during the induction therapy (assessment during study treatment completed at every other cycle up to four cycles) (Baseline up to 4 cycles)
Population: Participants qualified by the following criteria:~* Confirmed histological or cytological diagnosis of nonsquamous Stage IIIB or Stage IV lung cancer~* At least 1 unidimensionally measurable lesion~* No concomitant curative anticancer therapy~* Treated with at least one dose of study drug
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Study Treatment | Percentage of Participants With Confirmed Response Complete or Partial Response During the Induction Treatment Only | 34.9 Percentage of Participants |