Non-Small Cell Lung Cancer
Conditions
Brief summary
This prospective, double-blind, randomized study will evaluate the safety and efficacy of two dose levels of erlotinib \[Tarceva\] on progression-free survival, response and disease control rates and overall survival in patients with advanced or metastatic non-small cell lung cancer (NSCLC) after failure of first-line platinum-based chemotherapy. Patients must be current smokers and not intending to stop smoking during the study. Patients will be randomized to receive either 150 mg or 300 mg of study drug as single daily oral doses. Treatment will continue until disease progression.
Interventions
Single daily oral dose
Sponsors
Study design
Eligibility
Inclusion criteria
* Adult patients aged ≥18 years * inoperable, locally advanced (stage IIIB/IV) with supraclavicular lymph node metastases or malignant pleural or pericardial effusion) or metastatic (stage IV) non-small cell lung cancer (NSCLC) * Disease must be characterized according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria * Patients have received one prior platinum-based chemotherapy regimen for advanced NSCLC, but must have recovered from any treatment-related toxicity * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Life expectancy ≥12 weeks * Current cigarette smoker (having smoked \>100 cigarettes in entire lifetime and currently smoking on average ≥1 cigarette per day), not intending to stop during the study
Exclusion criteria
* Prior antibody or small molecule therapy against Epidermal growth factor receptor (EGFR) * Radiotherapy within 28 days prior to enrollment * Received more than one line of chemotherapy for locally advanced/metastatic NSCLC (first-line maintenance chemotherapy after first-line platinum-based chemotherapy is allowed)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 Months) | PFS is defined as the time from randomization to the date of first occurrence of disease progression or death. For 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 of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions. |
| Progression-Free Survival (PFS) at the End of Study | Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months) | PFS is defined as the time from randomization to the date of first occurrence of disease progression or death. For 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 of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease Control Rate (DCR) | Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months) | Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans. Disease control rates were measured according to RECIST version 1.1 criteria. A participant was defined as having controlled disease if they sustained a Complete Response (CR) or Partial Response (PR) for at least 4 weeks during randomized treatment (confirmed response), or Stable Disease (SD) for at least 6 weeks. Patients with no tumor assessment after the start of study treatment were considered as having uncontrolled disease. The percentage of participants with Disease Control is presented. |
| Time to Progression (TTP) | Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months) | Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria. Time to progression (TTP) in weeks was defined as the time from randomization to the date of disease progression. Participants without event were censored at the date of the last tumor assessment when the patient was known to be progression free. |
| Overall Survival (OS) | Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months) | OS defined as the time from randomization to the date of death due to any cause. |
| Overall Survival (OS) at the End of Study | Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months) | OS defined as the time from randomization to the date of death due to any cause. |
| Number of Participants With Adverse Events (AEs) at the End of the Study | Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months) | An adverse event was considered any unfavorable and unintended sign, symptom, or disease associated with the use of the study drug, whether or not considered related to the study drug. Preexisting conditions that worsened during the study were reported as adverse events. A serious adverse event is any experience that suggests a significant hazard, contraindication, side effect or precaution that: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant. Adverse Events in the following categories are presented: Adverse Events, Serious Adverse Events, AEs leading to withdrawal from treatment and AEs leading to death. |
| Overall Response Rate (ORR) | Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months) | Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. A participant was defined as a responder if they sustained a complete response (CR) or partial response (PR) for at least 4 weeks during randomized treatment (confirmed response). Patients with no tumor assessment after the start of study treatment were to be considered as non-responders. The percentage of participants in each best response category is presented. |
Countries
China, Denmark, Egypt, France, Germany, Netherlands, Spain, Switzerland, Turkey (Türkiye)
Participant flow
Pre-assignment details
315 participants were randomized. 313 participants were included in the Intent-to -treat (ITT) population. The ITT population excluded 2 randomized participants: 1 participant randomized in error and 1 participant with missing source data.
Participants by arm
| Arm | Count |
|---|---|
| Erlotinib 150 mg Erlotinib 150 mg single daily oral dose until disease progression. | 154 |
| Erlotinib 300 mg Erlotinib 300 mg single daily oral dose until disease progression. | 159 |
| Total | 313 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative/Other | 6 | 6 |
| Overall Study | Adverse Event | 14 | 11 |
| Overall Study | Death not related to Progressive Disease | 5 | 6 |
| Overall Study | Death related to Progressive Disease | 4 | 5 |
| Overall Study | Discontinued Smoking | 3 | 1 |
| Overall Study | Insufficient Therapeutic Response | 2 | 0 |
| Overall Study | Investigator's Decision | 0 | 3 |
| Overall Study | Lost to Follow-up | 1 | 1 |
| Overall Study | Progressive Disease | 112 | 115 |
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Refused Treatment | 1 | 4 |
| Overall Study | Withdrew Consent | 4 | 4 |
Baseline characteristics
| Characteristic | Erlotinib 150 mg | Erlotinib 300 mg | Total |
|---|---|---|---|
| Age, Continuous | 59.7 years STANDARD_DEVIATION 9.25 | 59.2 years STANDARD_DEVIATION 9.14 | 59.4 years STANDARD_DEVIATION 9.18 |
| Sex: Female, Male Female | 34 Participants | 35 Participants | 69 Participants |
| Sex: Female, Male Male | 120 Participants | 124 Participants | 244 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 115 / 154 | 128 / 158 |
| serious Total, serious adverse events | 29 / 154 | 35 / 158 |
Outcome results
Progression-Free Survival (PFS)
PFS is defined as the time from randomization to the date of first occurrence of disease progression or death. For 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 of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions.
Time frame: Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 Months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib 150 mg | Progression-Free Survival (PFS) | 6.86 weeks |
| Erlotinib 300 mg | Progression-Free Survival (PFS) | 7.00 weeks |
Progression-Free Survival (PFS) at the End of Study
PFS is defined as the time from randomization to the date of first occurrence of disease progression or death. For 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 of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions.
Time frame: Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib 150 mg | Progression-Free Survival (PFS) at the End of Study | 6.86 weeks |
| Erlotinib 300 mg | Progression-Free Survival (PFS) at the End of Study | 7.00 weeks |
Disease Control Rate (DCR)
Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans. Disease control rates were measured according to RECIST version 1.1 criteria. A participant was defined as having controlled disease if they sustained a Complete Response (CR) or Partial Response (PR) for at least 4 weeks during randomized treatment (confirmed response), or Stable Disease (SD) for at least 6 weeks. Patients with no tumor assessment after the start of study treatment were considered as having uncontrolled disease. The percentage of participants with Disease Control is presented.
Time frame: Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Erlotinib 150 mg | Disease Control Rate (DCR) | 40.3 percentage of participants |
| Erlotinib 300 mg | Disease Control Rate (DCR) | 36.5 percentage of participants |
Number of Participants With Adverse Events (AEs) at the End of the Study
An adverse event was considered any unfavorable and unintended sign, symptom, or disease associated with the use of the study drug, whether or not considered related to the study drug. Preexisting conditions that worsened during the study were reported as adverse events. A serious adverse event is any experience that suggests a significant hazard, contraindication, side effect or precaution that: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant. Adverse Events in the following categories are presented: Adverse Events, Serious Adverse Events, AEs leading to withdrawal from treatment and AEs leading to death.
Time frame: Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months)
Population: Safety population included all randomized participants who received at least one dose of study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Erlotinib 150 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | Adverse Events (AEs) | 130 participants |
| Erlotinib 150 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | Serious Adverse Events | 29 participants |
| Erlotinib 150 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | AEs leading to withdrawal | 18 participants |
| Erlotinib 150 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | AEs leading to death | 12 participants |
| Erlotinib 300 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | AEs leading to death | 13 participants |
| Erlotinib 300 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | Adverse Events (AEs) | 141 participants |
| Erlotinib 300 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | AEs leading to withdrawal | 15 participants |
| Erlotinib 300 mg | Number of Participants With Adverse Events (AEs) at the End of the Study | Serious Adverse Events | 35 participants |
Overall Response Rate (ORR)
Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. A participant was defined as a responder if they sustained a complete response (CR) or partial response (PR) for at least 4 weeks during randomized treatment (confirmed response). Patients with no tumor assessment after the start of study treatment were to be considered as non-responders. The percentage of participants in each best response category is presented.
Time frame: Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Erlotinib 150 mg | Overall Response Rate (ORR) | Partial Response | 7.1 percentage of participants |
| Erlotinib 150 mg | Overall Response Rate (ORR) | Progressive Disease | 44.8 percentage of participants |
| Erlotinib 150 mg | Overall Response Rate (ORR) | Stable Disease | 33.1 percentage of participants |
| Erlotinib 150 mg | Overall Response Rate (ORR) | Not Evaluable | 14.9 percentage of participants |
| Erlotinib 150 mg | Overall Response Rate (ORR) | Complete Response | 0.0 percentage of participants |
| Erlotinib 300 mg | Overall Response Rate (ORR) | Not Evaluable | 17.6 percentage of participants |
| Erlotinib 300 mg | Overall Response Rate (ORR) | Complete Response | 0.0 percentage of participants |
| Erlotinib 300 mg | Overall Response Rate (ORR) | Partial Response | 2.5 percentage of participants |
| Erlotinib 300 mg | Overall Response Rate (ORR) | Stable Disease | 34.0 percentage of participants |
| Erlotinib 300 mg | Overall Response Rate (ORR) | Progressive Disease | 45.9 percentage of participants |
Overall Survival (OS)
OS defined as the time from randomization to the date of death due to any cause.
Time frame: Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib 150 mg | Overall Survival (OS) | 6.77 months |
| Erlotinib 300 mg | Overall Survival (OS) | 6.83 months |
Overall Survival (OS) at the End of Study
OS defined as the time from randomization to the date of death due to any cause.
Time frame: Randomization to End of Study: 14 October 2010 - 7 February 2014 (Up to 39.8 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib 150 mg | Overall Survival (OS) at the End of Study | 7.00 months |
| Erlotinib 300 mg | Overall Survival (OS) at the End of Study | 6.90 months |
Time to Progression (TTP)
Tumor response was assessed by the investigator using computer tomography (CT) or magnetic resonance imaging (MRI) scans according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria. Time to progression (TTP) in weeks was defined as the time from randomization to the date of disease progression. Participants without event were censored at the date of the last tumor assessment when the patient was known to be progression free.
Time frame: Randomization to Clinical Cutoff: 28 October 2013 (Up to 36.5 months)
Population: Intent-to-treat Population included all randomized participants. 2 participants were excluded from analysis: 1 participant randomized in error and 1 participant with missing source data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib 150 mg | Time to Progression (TTP) | 9.86 weeks |
| Erlotinib 300 mg | Time to Progression (TTP) | 9.14 weeks |