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A Study in Non-squamous Non Small Cell Lung Cancer in Asian Patients

Post-marketing Clinical Trial of Induction Chemotherapy of Pemetrexed Plus Carboplatin Followed by Pemetrexed Maintenance Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01020786
Enrollment
109
Registered
2009-11-26
Start date
2009-11-30
Completion date
2012-06-30
Last updated
2013-08-27

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

Keywords

Non-squamous

Brief summary

To investigate efficacy and safety of the combination with pemetrexed plus carboplatin, followed by pemetrexed in patients with advanced nonsquamous Non Small Cell Lung Cancer (NSCLC) who receive at least one dose of the induction therapy.

Interventions

DRUGPemetrexed

Induction Therapy: 500 milligrams per square meter (mg/m\^2) given intravenously (IV) on Day 1 of every 21-day cycle for 4 cycles. Maintenance Therapy: 500 mg/m\^2 given IV on Day 1 of every 21-day cycle until disease progression or unacceptable toxicity.

DRUGCarboplatin

Dosage equal to area under the curve (AUC)6 milligrams per milliliter per minute (mg/mL/min) for participant, given IV on Day 1 of every 21-day cycle for 4 cycles.

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Non-squamous cell Non Small Cell Lung Cancer (NSCLC) disease * Clinical stage IIIB/IV or recurrent disease after surgery * No prior systemic chemotherapy, immunotherapy, targeted therapy or biological therapy, including adjuvant therapy * Prior radiation therapy is allowed to less than 25% of the bone marrow * Measurable disease as defined by response evaluation criteria in solid tumors (RECIST) * The Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 * Adequate organ function * Estimated life expectancy of at least 12 weeks

Exclusion criteria

* Clinically significant third-space fluid collections * Central nervous system disease other than stable and treated brain metastasis * More than 3 weeks interval between the surgery and enrollment request date * Unable to interrupt aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), for a 5 days period * Unable or unwilling to take folic acid or vitamin B12 supplementation * Unable to take corticosteroids. * Serious concomitant disorder that, in the opinion of the investigator, would compromise the patient's ability to adhere to the protocol * Currently have and historically had interstitial pneumonitis (interstitial pneumonia) or pulmonary fibrosis manifested as opacity on Chest x-ray or Computed tomography (CT)

Design outcomes

Primary

MeasureTime frameDescription
Progression Free Survival (PFS) During the Induction and Maintenance Therapy PeriodsEnrollment to the date of progressive disease (PD) or the date of death from any cause (up to 18 months)PFS defined as time from enrollment date to first date of objective progression of disease or of death from any cause. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy.

Secondary

MeasureTime frameDescription
Percentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy PeriodsEnrollment to date of progressive disease (up to 18 months)Calculated as the percentage of participants who achieved a confirmed CR, PR, or SD. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. SD = small changes that do not meet above criteria.
Percentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy PeriodsEnrollment to date of progressive disease (up to 18 months)Calculated as the percentage of participants who achieved a confirmed CR or PR. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. Stable Disease (SD) = small changes that do not meet above criteria.
Progression Free Survival (PFS) During the Maintenance Therapy PeriodFrom the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 24.4 months)Measured from the date of the first dose of the maintenance therapy. Calculated by subtracting induction therapy period from PFS. Tumor response assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0; define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy.
Overall Survival (OS) During the Induction and Maintenance Therapy PeriodsEnrollment to the date of death from any cause (up to 30.8 months)OS was defined as the time from the enrollment date to the date of death from any cause. For participants who were alive, OS was censored at the last contact.
Percentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy PeriodFrom the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 18 months)Percentage of participants who achieved confirmed CR (disappearance of all target lesions), PR (30% decrease in sum of longest diameter of target lesions), or SD (small changes that do not meet above criteria). Response derived from target lesion assessments performed before maintenance therapy (as baseline), during maintenance therapy (as post-baseline), and non-target lesion assessments performed during maintenance therapy according to RECIST guideline version 1.0, defines when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments.
Percentage of Participants Who Observe a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction Therapy PeriodEnrollment to the date of PD, or end of induction period up to Cycle 4 (21-day cycle)Calculated as the percentage of participants who achieved a CR, PR, or SD (confirmed or not). Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. SD = small changes that do not meet above criteria.
Percentage of Participants Who Achieve a Complete Response (CR) or a Partial Response (PR) During the Induction Therapy PeriodEnrollment to date of PD, or end of induction period up to Cycle 4 (21-day cycle)Calculated as percentage of participants who achieved a CR or PR (confirmed or not). Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of longest diameter of target lesions. Stable Disease (SD) = small changes that do not meet above criteria.
Overall Survival (OS) During the Maintenance Therapy PeriodFrom the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 26.3 months)OS was defined as the duration from the date of the first dose of the maintenance therapy to the date of death from any cause and was calculated by subtracting the induction therapy period from OS. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy. For participants who were alive, OS was censored at the last contact.

Countries

Japan

Participant flow

Pre-assignment details

Induction period: pemetrexed and carboplatin were administered for 4 cycles (1 cycle=21 days). Participants with documented complete response (CR), partial response (PR), or stable disease (SD) entered the maintenance therapy period (fifth cycle and after). Maintenance period: pemetrexed monotherapy until a discontinuation criterion was met.

Participants by arm

ArmCount
Pemetrexed + Carboplatin
Induction therapy period (Pemetrexed + carboplatin): 500 milligrams per square meter (mg/m\^2) of pemetrexed given intravenously (IV) on Day 1 of every 21-day cycle for 4 cycles. Carboplatin: dosage equal to the area under the curve (AUC) 6 milligrams per milliliter per minute (mg/mL/min) for participant, given IV on Day 1 of every 21-day cycle for 4 cycles. Maintenance therapy period (pemetrexed monotherapy): 500 mg/m\^2 of pemetrexed given IV on Day 1 of every 21-day cycle until disease progression or unacceptable toxicity.
109
Total109

Withdrawals & dropouts

PeriodReasonFG000
Induction PeriodAdverse Event10
Induction PeriodEntry Criteria Not Met2
Induction PeriodInvestigator Decision3
Induction PeriodProgressive Disease31
Induction PeriodWithdrawal by Subject3
Maintenance PeriodAdverse Event8
Maintenance PeriodProgressive Disease43
Maintenance PeriodSponsor Decision1
Maintenance PeriodWithdrawal by Subject8

Baseline characteristics

CharacteristicPemetrexed + Carboplatin
Age Continuous63.35 years
STANDARD_DEVIATION 8.692
Percentage of Participants in Each Disease Stage
Other
3.7 percentage of participants
Percentage of Participants in Each Disease Stage
Stage IIIb
30.3 percentage of participants
Percentage of Participants in Each Disease Stage
Stage IV
66.1 percentage of participants
Percentage of Participants in Each Eastern Cooperative Oncology Group (ECOG) Status
0 - Fully Active
33.9 percentage of participants
Percentage of Participants in Each Eastern Cooperative Oncology Group (ECOG) Status
1 - Ambulatory, Restricted Strenuous Activity
66.1 percentage of participants
Percentage of Participants in Each Epidermal Growth Factor Receptor (EGFR) Mutation Status Category
Negative
57.8 percentage of participants
Percentage of Participants in Each Epidermal Growth Factor Receptor (EGFR) Mutation Status Category
Not Done
17.4 percentage of participants
Percentage of Participants in Each Epidermal Growth Factor Receptor (EGFR) Mutation Status Category
Positive
22.0 percentage of participants
Percentage of Participants in Each Epidermal Growth Factor Receptor (EGFR) Mutation Status Category
Unknown
2.8 percentage of participants
Percentage of Participants in Each Histology Category
Adenocarcinoma Lung
97.2 percentage of participants
Percentage of Participants in Each Histology Category
Carcinoma, Non-small Cell, Lung Not Otherwise S
0 percentage of participants
Percentage of Participants in Each Histology Category
Large Cell Lung Carcinoma
2.8 percentage of participants
Percentage of Participants in Each Smoking Status Category at Study Entry
Current Smoker
8.3 percentage of participants
Percentage of Participants in Each Smoking Status Category at Study Entry
Former Smoker
61.5 percentage of participants
Percentage of Participants in Each Smoking Status Category at Study Entry
Never Smoker
30.3 percentage of participants
Percentage of Participants in Each Smoking Status Category at Study Entry
Unknown
0.0 percentage of participants
Race/Ethnicity, Customized
Japanese
109 participants
Region of Enrollment
Japan
109 participants
Sex: Female, Male
Female
40 Participants
Sex: Female, Male
Male
69 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
109 / 109
serious
Total, serious adverse events
17 / 109

Outcome results

Primary

Progression Free Survival (PFS) During the Induction and Maintenance Therapy Periods

PFS defined as time from enrollment date to first date of objective progression of disease or of death from any cause. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy.

Time frame: Enrollment to the date of progressive disease (PD) or the date of death from any cause (up to 18 months)

Population: Full Analysis Set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin; 31 participants were censored as they received subsequent systemic anticancer therapy before confirming objective PD or there was not a confirmed objective PD.

ArmMeasureValue (MEDIAN)
Pemetrexed + CarboplatinProgression Free Survival (PFS) During the Induction and Maintenance Therapy Periods5.6 months
Secondary

Overall Survival (OS) During the Induction and Maintenance Therapy Periods

OS was defined as the time from the enrollment date to the date of death from any cause. For participants who were alive, OS was censored at the last contact.

Time frame: Enrollment to the date of death from any cause (up to 30.8 months)

Population: Full analysis set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin; 79 participants were censored as the observation period was not enough at the time of data cut-off for the primary endpoint (EP) of PFS. There were 48 participants censored at the final endpoint data cut-off.

ArmMeasureGroupValue (MEDIAN)
Pemetrexed + CarboplatinOverall Survival (OS) During the Induction and Maintenance Therapy PeriodsOverall Survival (OS) at primary endpointNA months
Pemetrexed + CarboplatinOverall Survival (OS) During the Induction and Maintenance Therapy PeriodsOverall Survival (OS) at final endpoint20.2 months
Secondary

Overall Survival (OS) During the Maintenance Therapy Period

OS was defined as the duration from the date of the first dose of the maintenance therapy to the date of death from any cause and was calculated by subtracting the induction therapy period from OS. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy. For participants who were alive, OS was censored at the last contact.

Time frame: From the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 26.3 months)

Population: Analysis set: Maintenance-treated participants, which consist of the participants who received the maintenance therapy with pemetrexed; 56 participants and 38 participants were censored as the observation period was not enough at the time of data cut-off for the primary endpoint, PFS, and final endpoint, respectively.

ArmMeasureGroupValue (MEDIAN)
Pemetrexed + CarboplatinOverall Survival (OS) During the Maintenance Therapy PeriodOverall Survival (OS) at primary endpointNA months
Pemetrexed + CarboplatinOverall Survival (OS) During the Maintenance Therapy PeriodOverall Survival (OS) at final endpointNA months
Secondary

Percentage of Participants Who Achieve a Complete Response (CR) or a Partial Response (PR) During the Induction Therapy Period

Calculated as percentage of participants who achieved a CR or PR (confirmed or not). Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of longest diameter of target lesions. Stable Disease (SD) = small changes that do not meet above criteria.

Time frame: Enrollment to date of PD, or end of induction period up to Cycle 4 (21-day cycle)

Population: Full Analysis Set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin.

ArmMeasureValue (NUMBER)
Pemetrexed + CarboplatinPercentage of Participants Who Achieve a Complete Response (CR) or a Partial Response (PR) During the Induction Therapy Period38.5 percentage of participants
Secondary

Percentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy Periods

Calculated as the percentage of participants who achieved a confirmed CR, PR, or SD. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. SD = small changes that do not meet above criteria.

Time frame: Enrollment to date of progressive disease (up to 18 months)

Population: Full Analysis Set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin.

ArmMeasureGroupValue (NUMBER)
Pemetrexed + CarboplatinPercentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy PeriodsCR+PR34.9 percentage of participants
Pemetrexed + CarboplatinPercentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy PeriodsCR+PR+SD72.5 percentage of participants
Secondary

Percentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy Periods

Calculated as the percentage of participants who achieved a confirmed CR or PR. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. Stable Disease (SD) = small changes that do not meet above criteria.

Time frame: Enrollment to date of progressive disease (up to 18 months)

Population: Full Analysis Set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin.

ArmMeasureGroupValue (NUMBER)
Pemetrexed + CarboplatinPercentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy PeriodsCR0.0 percentage of participants
Pemetrexed + CarboplatinPercentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy PeriodsPR34.9 percentage of participants
Secondary

Percentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy Period

Percentage of participants who achieved confirmed CR (disappearance of all target lesions), PR (30% decrease in sum of longest diameter of target lesions), or SD (small changes that do not meet above criteria). Response derived from target lesion assessments performed before maintenance therapy (as baseline), during maintenance therapy (as post-baseline), and non-target lesion assessments performed during maintenance therapy according to RECIST guideline version 1.0, defines when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments.

Time frame: From the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 18 months)

Population: Analysis set: Maintenance-treated participants, which consist of the participants who received the maintenance therapy with pemetrexed.

ArmMeasureGroupValue (NUMBER)
Pemetrexed + CarboplatinPercentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy PeriodCR+PR3.3 percentage of participants
Pemetrexed + CarboplatinPercentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy PeriodCR+PR+SD48.3 percentage of participants
Secondary

Percentage of Participants Who Observe a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction Therapy Period

Calculated as the percentage of participants who achieved a CR, PR, or SD (confirmed or not). Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0, which define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. CR = disappearance of all target lesions. PR = 30% decrease in the sum of the longest diameter of target lesions. Progressive Disease (PD) = 20% increase in the sum of the longest diameter of target lesions. SD = small changes that do not meet above criteria.

Time frame: Enrollment to the date of PD, or end of induction period up to Cycle 4 (21-day cycle)

Population: Full Analysis Set (FAS): consists of the participants who received the induction combination therapy with pemetrexed and carboplatin.

ArmMeasureValue (NUMBER)
Pemetrexed + CarboplatinPercentage of Participants Who Observe a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction Therapy Period81.7 percentage of participants
Secondary

Progression Free Survival (PFS) During the Maintenance Therapy Period

Measured from the date of the first dose of the maintenance therapy. Calculated by subtracting induction therapy period from PFS. Tumor response assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guideline version 1.0; define when cancer participants improve (respond), stay the same (stabilize), or worsen (progression) during treatments. Participants receiving any subsequent systemic anticancer therapy before objective progression or death were censored at date of last objective progression-free disease assessment before starting subsequent systemic anticancer therapy.

Time frame: From the start of maintenance therapy in Cycle 5 (21-day cycle) until the date of measured progressive disease (PD) or death from any cause (up to 24.4 months)

Population: Analysis set: Maintenance-treated participants who received maintenance therapy with pemetrexed; 20 and 12 participants were censored at time of primary endpoint (18 months) and final endpoint. They received subsequent systemic anticancer therapy before confirming objective PD or there was not a confirmed objective PD at cut-off.

ArmMeasureGroupValue (MEDIAN)
Pemetrexed + CarboplatinProgression Free Survival (PFS) During the Maintenance Therapy PeriodPFS at primary endpoint3.9 months
Pemetrexed + CarboplatinProgression Free Survival (PFS) During the Maintenance Therapy PeriodPFS at final endpoint3.9 months

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