Non-Squamous Non-Small Cell Lung Cancer
Conditions
Brief summary
This 2 arm study will evaluate the efficacy and safety of Avastin + gemcitabine, and Avastin + gemcitabine + attenuated doses of cisplatin, as first line treatment in elderly patients with non-squamous non-small cell lung cancer. Patients will be randomised to receive either Avastin 7.5mg/kg iv on day 1 + gemcitabine 1200mg/m2 on days 1-8 of each 3 week cycle, or Avastin 7.5mg/kg iv on day 1 + cisplatin 60mg/m2 on day 1 + gemcitabine 1000mg/m2 on days 1-8 of each 3 week cycle. After 6 cycles of combination therapy, all patients will continue to receive Avastin monotherapy. The anticipated time on study treatment is until disease progression, and the target sample size is \<100 individuals.
Interventions
7.5mg/kg iv on day 1 of each 3 week cycle
60mg/m2 on day 1 of each 3 week cycle
1200mg/m2 on days 1-8 of each 3 week cycle
Sponsors
Study design
Eligibility
Inclusion criteria
* adult patients, \>=70 years of age; * inoperable, locally advanced, metastatic non-squamous non-small cell lung cancer; * \>=1 measurable lesion; * ECOG performance status 0-1.
Exclusion criteria
* neoadjuvant/adjuvant chemotherapy within 6 months prior to enrollment; * radical radiotherapy with curative intent within 28 days prior to enrollment; * history of \>=grade 2 hemoptysis in 3 months prior to enrollment; * evidence of CNS metastases; * current or recent (within 10 days of first dose of Avastin)use of aspirin (\>325 mg/day)or full dose anticoagulants or thrombolytic agents for therapeutic purposes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Alive and Without Progressive Disease at Month 6 | Month 6 | Disease progression was assessed according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (v 1.1). Disease progression was defined at least a 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 millimeter (mm), progression of existing non-target lesions, or presence of new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death, or consent withdrawal (up to 53 months) | PFS was defined as the interval between the date of randomization and the first documentation of progressive disease or death from any cause. Disease progression was assessed according to RECIST criteria v 1.1. Disease progression was defined at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions. PFS was estimated using Kaplan Meier method. |
| Percentage of Participants Alive at 12 Months After Randomization | 1 year | — |
| Percentage of Participants Who Died | From randomization to death or end of the study (up to 53 months) | — |
| Overall Survival (OS) | From randomization to death or end of the study (up to 53 months) | OS was defined as the interval between the date of randomization and death from any cause. OS was estimated using Kaplan Meier method. |
| Percentage of Participants With Disease Progression or Death | Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death, or consent withdrawal (up to 53 months) | Disease progression was assessed according to RECIST criteria v1.1. Disease progression was defined as at least a 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions. |
| Percentage of Participants With an Objective Response | Cycle 3 Day 15, Cycle 6 Day 15 and at Month 6 | Objective response was defined as having a CR or PR according to a RECIST criteria v 1.1. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions. |
| Percentage of Participants With Disease Control | Cycle 3 Day 15, Cycle 6 Day 15 and at Month 6 | Disease control was defined as having CR/PR/SD as per RECIST criteria v 1.1. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. PD was defined as at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions. |
| Duration of Response (DoR) | Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death or consent withdrawal (up to 53 months) | DoR was defined for participants who had achieved an objective response (CR/PR) (whichever status was recorded first) as the time period from first documentation of a response to the date of first occurrence of investigator documented disease progression or death. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions. Disease progression was defined as increase by at least 20% in the sum of the longest diameters of each target lesion, taking as a reference the smallest sum of the longest diameters or appearance of one or more new lesions. DoR was estimated using Kaplan Meier method. |
| Percentage of Participants by Best Overall Response | Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death or consent withdrawal (up to 53 months) | Best overall response was defined as the best response recorded from the start of the treatment until disease progression/recurrence, assessed according to RECIST criteria v 1.1. Complete Response (CR): disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to less than (\<) 10 millimeter (mm) in short axis; Partial Response (PR): at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesion, and no new lesions; Progressive Disease (PD): at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions; Stable Disease (SD): neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. |
Countries
Italy
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Bevacizumab + Gemcitabine Participants received bevacizumab 7.5 mg/kg IV infusion on Day 1 and gemcitabine 1200 mg/m\^2 IV infusion on Days 1 and 8 of each 21-day cycle for a maximum of 6 cycles. After Cycle 6, participants continued treatment with bevacizumab 7.5 mg/kg IV infusion on Day 1 of every 21-day cycle until progressive disease, death, or intolerable toxicity. | 44 |
| Bevacizumab + Gemcitabine + Cisplatin Participants received bevacizumab 7.5 mg/kg IV infusion and cisplatin 60 mg/m\^2 IV infusion on Day 1 and gemcitabine 1000 mg/m\^2 IV infusion on Days 1 and 8 of each 21-day cycle for a maximum of 6 cycles. After Cycle 6, participants continued treatment with bevacizumab 7.5 mg/kg IV infusion on Day 1 of every 21 day cycle until progressive disease, death, or intolerable toxicity. | 42 |
| Total | 86 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 2 | 1 |
| Overall Study | Death | 28 | 29 |
| Overall Study | Lost to Follow-up | 1 | 1 |
| Overall Study | Other | 4 | 2 |
| Overall Study | Progressive Disease (PD) | 0 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 2 |
Baseline characteristics
| Characteristic | Bevacizumab + Gemcitabine | Bevacizumab + Gemcitabine + Cisplatin | Total |
|---|---|---|---|
| Age, Continuous | 74.2 years STANDARD_DEVIATION 3.2 | 73.8 years STANDARD_DEVIATION 3.5 | 74.0 years STANDARD_DEVIATION 3.3 |
| Sex: Female, Male Female | 16 Participants | 12 Participants | 28 Participants |
| Sex: Female, Male Male | 28 Participants | 30 Participants | 58 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 38 / 43 | 37 / 40 |
| serious Total, serious adverse events | 17 / 43 | 10 / 40 |
Outcome results
Percentage of Participants Alive and Without Progressive Disease at Month 6
Disease progression was assessed according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (v 1.1). Disease progression was defined at least a 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 millimeter (mm), progression of existing non-target lesions, or presence of new lesions.
Time frame: Month 6
Population: Intent-to-treat (ITT) set included all participants in the RND set who received at least one dose of any study medication; participants were classified according to treatment received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants Alive and Without Progressive Disease at Month 6 | 25.6 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants Alive and Without Progressive Disease at Month 6 | 30.0 percentage of participants |
Duration of Response (DoR)
DoR was defined for participants who had achieved an objective response (CR/PR) (whichever status was recorded first) as the time period from first documentation of a response to the date of first occurrence of investigator documented disease progression or death. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions. Disease progression was defined as increase by at least 20% in the sum of the longest diameters of each target lesion, taking as a reference the smallest sum of the longest diameters or appearance of one or more new lesions. DoR was estimated using Kaplan Meier method.
Time frame: Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death or consent withdrawal (up to 53 months)
Population: ITT set.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Gemcitabine | Duration of Response (DoR) | 5.23 months |
| Bevacizumab + Gemcitabine + Cisplatin | Duration of Response (DoR) | 5.97 months |
Overall Survival (OS)
OS was defined as the interval between the date of randomization and death from any cause. OS was estimated using Kaplan Meier method.
Time frame: From randomization to death or end of the study (up to 53 months)
Population: ITT set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Gemcitabine | Overall Survival (OS) | 5.66 months |
| Bevacizumab + Gemcitabine + Cisplatin | Overall Survival (OS) | 12.0 months |
Percentage of Participants Alive at 12 Months After Randomization
Time frame: 1 year
Population: ITT set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants Alive at 12 Months After Randomization | 37.2 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants Alive at 12 Months After Randomization | 47.5 percentage of participants |
Percentage of Participants by Best Overall Response
Best overall response was defined as the best response recorded from the start of the treatment until disease progression/recurrence, assessed according to RECIST criteria v 1.1. Complete Response (CR): disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to less than (\<) 10 millimeter (mm) in short axis; Partial Response (PR): at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesion, and no new lesions; Progressive Disease (PD): at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions; Stable Disease (SD): neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time frame: Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death or consent withdrawal (up to 53 months)
Population: ITT set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants by Best Overall Response | PR | 14.0 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants by Best Overall Response | PD | 16.3 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants by Best Overall Response | SD | 39.5 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants by Best Overall Response | Not Assessable | 30.2 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants by Best Overall Response | CR | 0.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants by Best Overall Response | Not Assessable | 15.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants by Best Overall Response | CR | 0.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants by Best Overall Response | PR | 35.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants by Best Overall Response | SD | 37.5 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants by Best Overall Response | PD | 12.5 percentage of participants |
Percentage of Participants Who Died
Time frame: From randomization to death or end of the study (up to 53 months)
Population: ITT set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants Who Died | 69.8 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants Who Died | 72.5 percentage of participants |
Percentage of Participants With an Objective Response
Objective response was defined as having a CR or PR according to a RECIST criteria v 1.1. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions.
Time frame: Cycle 3 Day 15, Cycle 6 Day 15 and at Month 6
Population: ITT set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants With an Objective Response | Cycle 3 | 11.6 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants With an Objective Response | Cycle 6 | 9.3 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants With an Objective Response | Month 6 | 4.7 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With an Objective Response | Cycle 6 | 15.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With an Objective Response | Cycle 3 | 27.5 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With an Objective Response | Month 6 | 10.0 percentage of participants |
Percentage of Participants With Disease Control
Disease control was defined as having CR/PR/SD as per RECIST criteria v 1.1. CR was defined as disappearance of all target and non-target lesions and no new lesions, all pathological lymph nodes must have decreased to \<10 mm in short axis. PR was defined as at least a 30% decrease in the sum of diameters of target lesions (taking as reference the baseline sum diameters), no progression in non-target lesions, and no new lesions. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. PD was defined as at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions.
Time frame: Cycle 3 Day 15, Cycle 6 Day 15 and at Month 6
Population: ITT set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants With Disease Control | Cycle 3 | 53.5 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants With Disease Control | Cycle 6 | 27.9 percentage of participants |
| Bevacizumab + Gemcitabine | Percentage of Participants With Disease Control | Month 6 | 25.6 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With Disease Control | Cycle 3 | 67.5 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With Disease Control | Cycle 6 | 37.5 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With Disease Control | Month 6 | 30.0 percentage of participants |
Percentage of Participants With Disease Progression or Death
Disease progression was assessed according to RECIST criteria v1.1. Disease progression was defined as at least a 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions.
Time frame: Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death, or consent withdrawal (up to 53 months)
Population: ITT set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Gemcitabine | Percentage of Participants With Disease Progression or Death | 86.0 percentage of participants |
| Bevacizumab + Gemcitabine + Cisplatin | Percentage of Participants With Disease Progression or Death | 90.0 percentage of participants |
Progression Free Survival (PFS)
PFS was defined as the interval between the date of randomization and the first documentation of progressive disease or death from any cause. Disease progression was assessed according to RECIST criteria v 1.1. Disease progression was defined at least 20% increase in the sum of diameters of target lesions compared to smallest sum of diameters on-study and absolute increase of at least 5 mm, progression of existing non-target lesions, or presence of new lesions. PFS was estimated using Kaplan Meier method.
Time frame: Baseline; Day 15 of Cycles 3 and 6; Month 6 and then every 3 months until disease progression, death, or consent withdrawal (up to 53 months)
Population: ITT set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Gemcitabine | Progression Free Survival (PFS) | 4.33 months |
| Bevacizumab + Gemcitabine + Cisplatin | Progression Free Survival (PFS) | 6.82 months |