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A Study Comparing Two Different Chemotherapy Types in Chinese Patients With Advanced Non Small Cell Lung Cancer

A Randomized Phase 3 Study Comparing Pemetrexed Plus Cisplatin With Gemcitabine Plus Cisplatin as First-Line Treatment in Patients With Advanced Non-squamous Non-Small Cell Lung Cancer.

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01005680
Enrollment
256
Registered
2009-11-02
Start date
2009-11-30
Completion date
2012-11-30
Last updated
2013-12-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Non Small Cell Lung Cancer

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

DRUGCisplatin

75 mg/m² administered intravenously on day 1 of each 21 day cycle, for 6 cycles

DRUGPemetrexed

500 milligrams/square meter (mg/m²) administered intravenously on Day 1 of each 21-day cycle, for 6 cycles

DRUGGemcitabine

1250 mg/m² administered intravenously on Day 1 and Day 8 of each 21-day cycle, for 6 cycles

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* 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

MeasureTime frameDescription
Overall Survival (OS)Randomization to date of death from any cause up to 35.8 months post-randomizationOS 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

MeasureTime frameDescription
Progression Free Survival (PFS)Randomization to first date of Progressive Disease (PD) or death from any cause up to 33.0 months post-randomizationPFS 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-randomizationTtPD 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-randomizationDoR 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 RateRandomization until date of objective PD or death from any cause up to 35.8 months post-randomizationTumor 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 RatioRandomization to date of death from any cause up to 35.8 months post-randomizationRisk/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-randomizationTtTF 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

MeasureTime frameDescription
Disease Control Rate (DCR)Randomization to date of objective PD or death from any cause up to 35.8 months post-randomizationDCR 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-randomizationSWT 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

ArmCount
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
Total256

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up46
Overall StudyPhysician Decision11
Overall StudyWithdrawal by Subject14

Baseline characteristics

CharacteristicPemetrexed Plus Cisplatin (PC)TotalGemcitabine Plus Cisplatin (GC)
Age Continuous56.6 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 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
126 Participants256 Participants130 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
126 Participants256 Participants130 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
0 Participants0 Participants0 Participants
Region of Enrollment
China
126 participants256 participants130 participants
Sex: Female, Male
Female
55 Participants114 Participants59 Participants
Sex: Female, Male
Male
71 Participants142 Participants71 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
120 / 125123 / 127
serious
Total, serious adverse events
8 / 1259 / 127

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed Plus Cisplatin (PC)Overall Survival (OS)17.54 months
Gemcitabine Plus Cisplatin (GC)Overall Survival (OS)15.51 months
p-value: 0.82295% CI: [0.77, 1.39]Cox Proportional Hazard
Secondary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed Plus Cisplatin (PC)Duration of Response (DoR)4.53 months
Gemcitabine Plus Cisplatin (GC)Duration of Response (DoR)4.98 months
p-value: 0.88795% CI: [0.51, 1.79]Cox Proportional Hazard
Secondary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed Plus Cisplatin (PC)Progression Free Survival (PFS)5.88 months
Gemcitabine Plus Cisplatin (GC)Progression Free Survival (PFS)5.85 months
p-value: 0.6495% CI: [0.82, 1.37]Cox Proportional Hazard
Secondary

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.

ArmMeasureValue (NUMBER)
Pemetrexed Plus Cisplatin (PC)Risk/Benefit Ratio0.70 ratio
Gemcitabine Plus Cisplatin (GC)Risk/Benefit Ratio0.83 ratio
Secondary

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.

ArmMeasureValue (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
p-value: 0.92895% CI: [0.78, 1.32]Cox Proportional Hazard
Secondary

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.

ArmMeasureValue (MEDIAN)
Pemetrexed Plus Cisplatin (PC)Time to Treatment Failure (TtTF)NA months
Gemcitabine Plus Cisplatin (GC)Time to Treatment Failure (TtTF)NA months
p-value: 0.86195% CI: [0.67, 1.61]Cox Proportional Hazard
Secondary

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.

ArmMeasureValue (NUMBER)
Pemetrexed Plus Cisplatin (PC)Tumor Response Rate24.8 percentage of participants
Gemcitabine Plus Cisplatin (GC)Tumor Response Rate20.7 percentage of participants
p-value: 0.451two-sided Z test
Other Pre-specified

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.

ArmMeasureValue (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
p-value: 0.627two-sided Z test
Other Pre-specified

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.

ArmMeasureValue (MEDIAN)
Pemetrexed Plus Cisplatin (PC)Survival Without Toxicity (SWT)5.85 months
Gemcitabine Plus Cisplatin (GC)Survival Without Toxicity (SWT)2.56 months

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026