Non Small Cell Lung Cancer
Conditions
Brief summary
The purpose of this study is to compare the efficacy and safety of two different chemotherapy types in the first line treatment of advanced Non-Small Cell Lung Cancer (NSCLC).
Interventions
75 mg/m² administered intravenously on day 1 of each 21 day cycle, for 6 cycles
500 milligrams/square meter (mg/m²) administered intravenously on Day 1 of each 21-day cycle, for 6 cycles
1250 mg/m² administered intravenously on Day 1 and Day 8 of each 21-day cycle, for 6 cycles
Sponsors
Study design
Eligibility
Inclusion criteria
* Present with histologically proven or cytological diagnosis of non-squamous non-small cell lung cancer (NSCLC) Stage IIIB or IV. * Participants must agree to use a reliable method of birth control during the study and for 3 months following the last dose of study drug. * Female participants must not be pregnant. * No prior systemic chemotherapy for lung cancer. * At least one unidimensionally measurable lesion meeting Response Evaluation Criteria in Solid Tumors. * Eastern Cooperative Oncology Group (ECOG) Performance status of 0 or 1. * Adequate organ function. * Prior radiation therapy allowed to \<25% of the bone marrow. * Signed informed consent document on file. * Estimated life expectancy of greater than or equal to 12 weeks. * Participant compliance and geographic proximity that allow adequate follow up.
Exclusion criteria
* Peripheral neuropathy of great than or equal to Common Terminology Criteria for Adverse Events (CTCAE) Grade 1. * Inability to comply with protocol or study procedures. * A serious concomitant systemic disorder that, in the opinion of the investigator, would compromise the participant's ability to complete the study. * 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. * Second primary malignancy that is clinically detectable at the time of consideration for study enrollment. * Documented brain metastases unless the participant has completed successful local therapy for central nervous system metastases and has not taken corticosteroids for at least 4 weeks before enrollment. * Presence of clinically significant third-space fluid collections, for example, ascites or pleural effusions that cannot be controlled by drainage or other procedures prior to study entry. * Significant weight loss (that is, greater than or equal to 10%) over the previous 6 weeks before study entry. * Concurrent administration of any other anti-tumor therapy. * Inability to interrupt aspirin or other non-steroidal anti-inflammatory agents for a 5-day period (8-day period for long-acting agents, such as piroxicam). * Inability or unwillingness to take folic acid or vitamin B12 supplementation. * Inability to take corticosteroids. * Pregnant or breast-feeding. * Are currently enrolled in, or discontinued within the last 30 days from, a clinical trial involving an off-label use of an investigational drug or device (other than the study drug), or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Randomization to date of death from any cause up to 35.8 months post-randomization | OS was defined as the duration from date of randomization to date of death from any cause. Participants who were alive were censored at the date of last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Randomization to first date of Progressive Disease (PD) or death from any cause up to 33.0 months post-randomization | PFS was defined as the date of randomization to date of first observation of clinical or objective progressive disease (PD) or death due to any cause. PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of one or more new lesions. Participants who were not known to have died or had PD were censored at the date of last contact. |
| Time to Progressive Disease (TtPD) | Randomization to first date of PD up to 23.7 months post-randomization | TtPD defined as the time from study randomization to the first date of progressive disease (PD). PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions. Participants who were not known to have PD or who died without PD were censored at the date of last of last tumor assessment. |
| Duration of Response (DoR) | Date of first response to the date of (PD) or death from any cause up to 22.9 months post-randomization | DoR was defined as the time from first objective status assessment of complete response (CR) or partial response (PR) to the first time progressive disease (PD) or death as a result of any cause. Response using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions. PR was defined as having at least a 30% decrease in sum of longest diameter of target lesions. Participants who are not known to have died or to have PD were censored at the date of last contact. PD assessed using RECIST v1.0 and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions |
| Tumor Response Rate | Randomization until date of objective PD or death from any cause up to 35.8 months post-randomization | Tumor response rate was the percentage of participants with confirmed best tumor response of complete response (CR) or partial response (PR) using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria. Complete Response (CR) was defined as the disappearance of all target lesions; Partial Response (PR) was defined as at least a 30% decrease in sum of longest diameter of target lesions. Progressive disease (PD) assessed using RECIST v1.0 criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions. |
| Risk/Benefit Ratio | Randomization to date of death from any cause up to 35.8 months post-randomization | Risk/benefit ratio was calculated as the percentage of participants who experienced a study-drug related toxicity of Common Terminology Criteria for Adverse Events (CTCAE v3.0) Cancer Therapy Evaluation Program (CTEP) Grade 3 or higher, divided by the Kaplan-Meier estimated percentage of participants surviving one year. |
| Time to Treatment Failure (TtTF) | Randomization until date of discontinuation of study treatment due to adverse events, PD, or death from any cause up to 6.3 months post-randomization | TtTF was defined as date of randomization until the date of discontinuation of study treatment due to adverse event, progressive disease (PD), or death from any cause. PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions. Participants who discontinued study treatment for any other reason were censored at the date of discontinuation of study treatment. Participants still on study drug at data-inclusion cut-off date were censored at the cut-off date. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Disease Control Rate (DCR) | Randomization to date of objective PD or death from any cause up to 35.8 months post-randomization | DCR was the percentage of participants with Complete Response (CR), Partial Response (PR), and Stable Disease (SD). Response determined using Response Evaluation Criteria In Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions; PR was defined as at least a 30% decrease in sum of longest diameter of target lesions; progressive disease (PD) was defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions; SD was defined as small changes that did not meet the above criteria. |
| Survival Without Toxicity (SWT) | Randomization to date of toxicity or date of death up to 34.6 months post-randomization | SWT was defined as the time from randomization to a study-drug related toxicity. Toxicity was defined as Common Terminology Criteria for Adverse Events (CTCAE v3.0) Grade 3 or 4 or death. Participants who do not have a CTCAE Grade 3 or higher toxicity and are alive will be censored at the date of last contact. |
Countries
China
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed Plus Cisplatin (PC) Pemetrexed: 500 milligrams/square meter (mg/m²) administered intravenously on Day 1 of each 21-day cycle, for 6 cycles
Cisplatin: 75 mg/m² administered intravenously on day 1 of each 21-day cycle, for 6 cycles | 126 |
| Gemcitabine Plus Cisplatin (GC) Gemcitabine: 1250 mg/m² administered intravenously on Day 1 and day 8 of each 21-day cycle, for 6 cycles
Cisplatin: 75 mg/m² administered intravenously on day 1 of each 21 day cycle, for 6 cycles | 130 |
| Total | 256 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 4 | 6 |
| Overall Study | Physician Decision | 1 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 4 |
Baseline characteristics
| Characteristic | Pemetrexed Plus Cisplatin (PC) | Total | Gemcitabine Plus Cisplatin (GC) |
|---|---|---|---|
| Age Continuous | 56.6 years STANDARD_DEVIATION 10.65 | 56.1 years STANDARD_DEVIATION 10.29 | 55.7 years STANDARD_DEVIATION 9.95 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 126 Participants | 256 Participants | 130 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 126 Participants | 256 Participants | 130 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment China | 126 participants | 256 participants | 130 participants |
| Sex: Female, Male Female | 55 Participants | 114 Participants | 59 Participants |
| Sex: Female, Male Male | 71 Participants | 142 Participants | 71 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 120 / 125 | 123 / 127 |
| serious Total, serious adverse events | 8 / 125 | 9 / 127 |
Outcome results
Overall Survival (OS)
OS was defined as the duration from date of randomization to date of death from any cause. Participants who were alive were censored at the date of last contact.
Time frame: Randomization to date of death from any cause up to 35.8 months post-randomization
Population: Intent-to-Treat: all participants and are analyzed according to the treatment group they were randomly assigned. Censored participants: PC=37, GC=39.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Overall Survival (OS) | 17.54 months |
| Gemcitabine Plus Cisplatin (GC) | Overall Survival (OS) | 15.51 months |
Duration of Response (DoR)
DoR was defined as the time from first objective status assessment of complete response (CR) or partial response (PR) to the first time progressive disease (PD) or death as a result of any cause. Response using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions. PR was defined as having at least a 30% decrease in sum of longest diameter of target lesions. Participants who are not known to have died or to have PD were censored at the date of last contact. PD assessed using RECIST v1.0 and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions
Time frame: Date of first response to the date of (PD) or death from any cause up to 22.9 months post-randomization
Population: Intent-to-Treat: all randomized participants who were analyzed according to the treatment group they were randomly assigned and who achieved CR or PR. Censored participants: PC=1, GC=0.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Duration of Response (DoR) | 4.53 months |
| Gemcitabine Plus Cisplatin (GC) | Duration of Response (DoR) | 4.98 months |
Progression Free Survival (PFS)
PFS was defined as the date of randomization to date of first observation of clinical or objective progressive disease (PD) or death due to any cause. PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of one or more new lesions. Participants who were not known to have died or had PD were censored at the date of last contact.
Time frame: Randomization to first date of Progressive Disease (PD) or death from any cause up to 33.0 months post-randomization
Population: Intent-to-Treat: all randomized participants who are analyzed according to the treatment group they were randomly assigned. Censored participants: PC=8, GC=10.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Progression Free Survival (PFS) | 5.88 months |
| Gemcitabine Plus Cisplatin (GC) | Progression Free Survival (PFS) | 5.85 months |
Risk/Benefit Ratio
Risk/benefit ratio was calculated as the percentage of participants who experienced a study-drug related toxicity of Common Terminology Criteria for Adverse Events (CTCAE v3.0) Cancer Therapy Evaluation Program (CTEP) Grade 3 or higher, divided by the Kaplan-Meier estimated percentage of participants surviving one year.
Time frame: Randomization to date of death from any cause up to 35.8 months post-randomization
Population: Safety population: all randomized participants who received at least 1 dose of study drug and were analyzed according to actual treatment received in Cycle 1 of 21-day cycle.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Risk/Benefit Ratio | 0.70 ratio |
| Gemcitabine Plus Cisplatin (GC) | Risk/Benefit Ratio | 0.83 ratio |
Time to Progressive Disease (TtPD)
TtPD defined as the time from study randomization to the first date of progressive disease (PD). PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions. Participants who were not known to have PD or who died without PD were censored at the date of last of last tumor assessment.
Time frame: Randomization to first date of PD up to 23.7 months post-randomization
Population: Intent-to-Treat: all randomized participants who were analyzed according to the treatment group they were randomly assigned. Censored participants: PC=12, GC=19.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Time to Progressive Disease (TtPD) | 5.82 months |
| Gemcitabine Plus Cisplatin (GC) | Time to Progressive Disease (TtPD) | 5.82 months |
Time to Treatment Failure (TtTF)
TtTF was defined as date of randomization until the date of discontinuation of study treatment due to adverse event, progressive disease (PD), or death from any cause. PD assessed using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions. Participants who discontinued study treatment for any other reason were censored at the date of discontinuation of study treatment. Participants still on study drug at data-inclusion cut-off date were censored at the cut-off date.
Time frame: Randomization until date of discontinuation of study treatment due to adverse events, PD, or death from any cause up to 6.3 months post-randomization
Population: Intent-to-Treat: all randomized participants who were analyzed according to the treatment group they were randomly assigned. Censored participants: PC=85, GC=91.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Time to Treatment Failure (TtTF) | NA months |
| Gemcitabine Plus Cisplatin (GC) | Time to Treatment Failure (TtTF) | NA months |
Tumor Response Rate
Tumor response rate was the percentage of participants with confirmed best tumor response of complete response (CR) or partial response (PR) using Response Evaluation Criteria in Solid Tumor (RECIST v1.0) criteria. Complete Response (CR) was defined as the disappearance of all target lesions; Partial Response (PR) was defined as at least a 30% decrease in sum of longest diameter of target lesions. Progressive disease (PD) assessed using RECIST v1.0 criteria and defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions.
Time frame: Randomization until date of objective PD or death from any cause up to 35.8 months post-randomization
Population: Tumor Response-Qualified Population: all randomized participants who received at least l dose of study drug, who were diagnosed with locally advanced/metastatic non-small cell lung cancer, who had at least 1 baseline and 1 post-baseline tumor measurement, and who were not on concurrent systemic chemotherapy.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Tumor Response Rate | 24.8 percentage of participants |
| Gemcitabine Plus Cisplatin (GC) | Tumor Response Rate | 20.7 percentage of participants |
Disease Control Rate (DCR)
DCR was the percentage of participants with Complete Response (CR), Partial Response (PR), and Stable Disease (SD). Response determined using Response Evaluation Criteria In Solid Tumors (RECIST v1.0) criteria. CR was defined as the disappearance of all target lesions; PR was defined as at least a 30% decrease in sum of longest diameter of target lesions; progressive disease (PD) was defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum longest diameter ever recorded since study treatment started, or the appearance of 1 or more new lesions; SD was defined as small changes that did not meet the above criteria.
Time frame: Randomization to date of objective PD or death from any cause up to 35.8 months post-randomization
Population: Tumor Response Qualified Population: all randomized participants who received at least l dose of study drug, who were diagnosed with locally advanced/metastatic non-small cell lung cancer, who had at least 1 baseline and 1 post-baseline tumor measurement, and who are not on concurrent systemic chemotherapy.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Disease Control Rate (DCR) | 78.5 percentage of participants |
| Gemcitabine Plus Cisplatin (GC) | Disease Control Rate (DCR) | 75.9 percentage of participants |
Survival Without Toxicity (SWT)
SWT was defined as the time from randomization to a study-drug related toxicity. Toxicity was defined as Common Terminology Criteria for Adverse Events (CTCAE v3.0) Grade 3 or 4 or death. Participants who do not have a CTCAE Grade 3 or higher toxicity and are alive will be censored at the date of last contact.
Time frame: Randomization to date of toxicity or date of death up to 34.6 months post-randomization
Population: Safety population: all randomized participants who received at least 1 dose of study drug and were analyzed according to actual treatment received in Cycle 1 of 21-day cycles. Censored participants: PC=22, GC=10.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed Plus Cisplatin (PC) | Survival Without Toxicity (SWT) | 5.85 months |
| Gemcitabine Plus Cisplatin (GC) | Survival Without Toxicity (SWT) | 2.56 months |