Non Small Cell Lung Cancer
Conditions
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
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.
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) During the Induction and Maintenance Therapy Periods | Enrollment 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
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy Periods | Enrollment 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 Periods | Enrollment 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 Period | 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) | 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 Periods | Enrollment 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 Period | 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) | 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 Period | Enrollment 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 Period | Enrollment 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 Period | 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) | 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
| Arm | Count |
|---|---|
| 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 |
| Total | 109 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Induction Period | Adverse Event | 10 |
| Induction Period | Entry Criteria Not Met | 2 |
| Induction Period | Investigator Decision | 3 |
| Induction Period | Progressive Disease | 31 |
| Induction Period | Withdrawal by Subject | 3 |
| Maintenance Period | Adverse Event | 8 |
| Maintenance Period | Progressive Disease | 43 |
| Maintenance Period | Sponsor Decision | 1 |
| Maintenance Period | Withdrawal by Subject | 8 |
Baseline characteristics
| Characteristic | Pemetrexed + Carboplatin |
|---|---|
| Age Continuous | 63.35 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 type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 109 / 109 |
| serious Total, serious adverse events | 17 / 109 |
Outcome results
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pemetrexed + Carboplatin | Progression Free Survival (PFS) During the Induction and Maintenance Therapy Periods | 5.6 months |
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.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Overall Survival (OS) During the Induction and Maintenance Therapy Periods | Overall Survival (OS) at primary endpoint | NA months |
| Pemetrexed + Carboplatin | Overall Survival (OS) During the Induction and Maintenance Therapy Periods | Overall Survival (OS) at final endpoint | 20.2 months |
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.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Overall Survival (OS) During the Maintenance Therapy Period | Overall Survival (OS) at primary endpoint | NA months |
| Pemetrexed + Carboplatin | Overall Survival (OS) During the Maintenance Therapy Period | Overall Survival (OS) at final endpoint | NA months |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieve a Complete Response (CR) or a Partial Response (PR) During the Induction Therapy Period | 38.5 percentage of participants |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy Periods | CR+PR | 34.9 percentage of participants |
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieve a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction and Maintenance Therapy Periods | CR+PR+SD | 72.5 percentage of participants |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy Periods | CR | 0.0 percentage of participants |
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieved a Complete Response (CR) or Partial Response (PR) During the Induction and Maintenance Therapy Periods | PR | 34.9 percentage of participants |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy Period | CR+PR | 3.3 percentage of participants |
| Pemetrexed + Carboplatin | Percentage of Participants Who Achieved a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Maintenance Therapy Period | CR+PR+SD | 48.3 percentage of participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pemetrexed + Carboplatin | Percentage of Participants Who Observe a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) During the Induction Therapy Period | 81.7 percentage of participants |
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.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Pemetrexed + Carboplatin | Progression Free Survival (PFS) During the Maintenance Therapy Period | PFS at primary endpoint | 3.9 months |
| Pemetrexed + Carboplatin | Progression Free Survival (PFS) During the Maintenance Therapy Period | PFS at final endpoint | 3.9 months |