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A Study in Non-Small Cell Lung Cancer

An Open-label, Multicenter, Randomized Phase 2 Study Evaluating the Safety and Efficacy of Cisplatin and Pemetrexed With or Without Cixutumumab as First-Line Therapy in Patients With Advanced Nonsquamous Non-Small Cell Lung Carcinoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01232452
Enrollment
172
Registered
2010-11-02
Start date
2011-04-30
Completion date
2016-06-30
Last updated
2019-09-20

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

Conditions

Non-Small-Cell Lung Carcinoma

Keywords

lung cancer, advanced, non-small cell

Brief summary

The primary purpose of this study is to evaluate the hypothesis that cixutumumab given in combination with cisplatin and pemetrexed is superior to cisplatin and pemetrexed as first-line therapy for patients with advanced nonsquamous non-small cell lung carcinoma (NSCLC).

Interventions

DRUGPemetrexed

Administered intravenously (IV)

DRUGCisplatin

Administered IV

DRUGCixutumumab

Administered IV

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

* The participant has histologically or cytologically confirmed, nonsquamous (adenocarcinoma/large cell or other) NSCLC. * The participant has Stage IV disease at the time of study entry. * Participants with treated brain metastases are eligible if they are clinically stable with regard to neurologic function, off steroids after cranial irradiation (whole brain radiation therapy, focal radiation therapy, and stereotactic radiosurgery) ending at least 14 days prior to randomization, or after surgical resection performed at least 28 days prior to randomization. The participant may have no evidence of Grade 1 (or greater) Central Nervous System (CNS) hemorrhage based on pretreatment scans(performed within 21 days before randomization). * The participant has measurable or nonmeasurable disease according to Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1 guidelines. * The participant has an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0 or 1. * If prior adjuvant or neoadjuvant chemotherapy, the last dose of adjuvant or neoadjuvant treatment was administered at least 6 months prior to randomization. * The participant has adequate bone marrow reserve, and renal and hepatic function * The participant has fasting serum glucose less than or equal to 125 mg/dL, and hemoglobin A1C less than or equal to 6%. * Females with reproductive potential: Must have a negative serum or urine pregnancy test within 7 days prior to the first dose of any study drug. * Males and females with reproductive potential: Must agree to use medically approved contraceptive precautions during the study and for 6 months following the last dose of any study drug. * The participant has the ability to understand and the willingness to sign a written informed consent form. * Previous radiation therapy is allowed to less than 25% of the bone marrow, but should have been limited and must not have included whole pelvis radiation. * The participant has archived tumor tissue available for analysis (can be either primary tumor or metastases). * The participant has an estimated life expectancy of at least 12 weeks.

Exclusion criteria

* Are currently enrolled in, or discontinued within the last 30 days from, a clinical trial involving an investigational drug or device or off-label use of a drug or device, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study. * Participants who have squamous histology. * The participant's tumor fully or partially contains Small Cell Lung Cancer (SCLC). * The participant has leptomeningeal disease. * The participant is currently or has previously received chemotherapy for advanced (Stage IV) NSCLC. * The participant has a history of treatment with other agents targeting the Insulin-like or Epidermal Growth factor receptors. * Participants who have received prior Pemetrexed treatment. * The patient has a known allergy/history of hypersensitivity reaction to any of the treatment components. * The participant has diabetes mellitus as defined by being treated with glucose lowering medications in the past 3 months prior to enrollment. * The participant has an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring parenteral antibiotics, symptomatic congestive heart failure, uncontrolled hypertension, clinically significant cardiac arrhythmia,or psychiatric/social situations that would limit compliance with study requirements. * The participant has an ongoing or active infection requiring parenteral antibiotic, antifungal, or antiviral therapy. * The participant has undergone major surgery within 28 days prior to randomization. * The participant has received a prior autologous or allogeneic organ or tissue transplantation. * The participant is pregnant or lactating. * The participant has a history of another primary cancer, with the exception of the following: curatively resected nonmelanomatous skin cancer, curatively treated carcinoma in situ, or other primary solid tumor treated with curative intent and no known active disease present and no treatment administered during the last 5 years. * The participant has superior vena cava syndrome contraindicating hydration. * The participant has current clinically-relevant coronary artery disease (New York Heart Association III or IV) or uncontrolled congestive heart failure. * The participant has any Grade 2 (or greater) peripheral neuropathy. * The participant has 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. * The participant is unable to interrupt aspirin or other nonsteroidal anti-inflammatory agents, other than an aspirin dose less than or equal to 1.3 grams per day, for a 5-day period (8-day period for long-acting agents, such as piroxicam). * The participant is unwilling or unable to take premedications (folic acid, vitamin B12, or corticosteroids) required by the pemetrexed label. * The participant has received a recent (within 30 days of enrollment) or is receiving concurrent yellow fever vaccination.

Design outcomes

Primary

MeasureTime frameDescription
Progression-free Survival (PFS)Randomization Date to Disease Progression or Death From Any Cause Up to 18.3 MonthsPFS was defined as the time from date of randomization until the date of disease progression, or death from any cause, whichever was first. Disease progression was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing nontarget lesions. Participants without documentation for disease progression or death were censored at the date of last tumor assessment. The PFS was estimated following the Kaplan-Meier method.

Secondary

MeasureTime frameDescription
Pharmacodynamics (PD) Markers: Free Insulin-like Growth Factor-I (IGF-I, Total IGF-I, and IGF Binding Proteins (IGFBP-3)Preinfusion, Cycle 2, Cycle 4, Cycle 8, Postinfusion, 30-Day Follow-UpBlood samples for the determination of PD marker concentrations were collected at the specified time points for all participants. Analysis of the following markers include free IGF-I, total IGF-I, and IGFBP-3.
Percentage of Participants Achieving an Objective Response Rate (ORR)Randomization to Disease Progression Up to 18.3 MonthsThe ORR is the percentage of all participants with Partial Response (PR) or Complete Response (CR) according to RECIST v1.1. Disease progression was defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing nontarget lesions. ORR is confirmed best overall tumor response of CR and PR. CR was defined as the disappearance of all target and non-target lesions; PR defined as a \>30% decrease in the sum of the longest diameters (LD) of the target lesions, taking as reference the baseline sum of the LD.
Overall Survival (OS)Randomization Date to Death From Any Cause Up to 20 MonthsOverall survival is defined as the time from the date of randomization to the date of death from any cause. If the participant is alive at the end of the follow-up period or is lost to follow-up, OS will be censored on the last date the participant is known to be alive. OS was estimated using the Kaplan-Meier method.
Duration of Response (DOR)Time from Response to Disease Progression or Death from Any Cause Up to 20 MonthsDuration of response is measured from the time measurement criteria are first met for CR/PR (whichever is first recorded) until the first date that the criteria for PD is met, or death, is objectively documented. DOR was estimated using the Kaplan-Meier method. Disease progression was assessed via RECIST version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing non-target lesions
Time to Progressive Disease (TTPS)Randomization Date to Disease Progression Up to 18.3 MonthsTTPS was defined as the time from the date of randomization until the date of disease progression. Disease progression was assessed via RECIST version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing non-target lesions.TTPS was estimated using the Kaplan-Meier method.
Immunogenicity of CixutumumabPreinfusion, Cycle1(C1): 1, 72, 168, 240, 336 hours(hrs); C2 and C3: 1, 168, 336 hrs; C4: 1, 24,72,120,168, 240, 336, 504 hrs, Postinfusion; 30 Day Follow Up
Change in Tumor Size (CTS)Change from baseline measurement to the end of Cycle 2, average of 42 daysCTS was measured by percentage change of tumor size at the end of Cycle 2 comparing to baseline tumor size.
Pharmacokinetics (PK): Maximum Serum Concentration (Cmax) of Cixutumumab, Cycle 1 (First Infusion) and Cycle 4 (Fourth Infusion)First Infusion: [Prior to Infusion (of Cycle1): 1, 72, 168, 336 hours(hrs) and 504 hrs (i.e. Prior to Infusion of Cycle 2)] and Fourth Infusion; [Prior to Infusion (of Cycle 4),1,24,72,120,168,240,336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 5)]
PK: Area Under the Concentration Time Curve (AUC[0-inf]) of Cixutumumab, Cycle 1 (i.e. First Infusion)Prior to Infusion (of Cycle 1), 1, 72, 168, 336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 2)
PK: Area Under the Concentration Time Curve During 1 Dosing Interval (i.e. 504 hr, AUC(0-tau) of Cixutumumab, Cycle 4 (i.e. Fourth Infusion)Prior to Infusion (of Cycle 4), 1, 24, 72, 120, 168, 240, 336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 5)
Time to Worsening of Symptoms as Measured by Lung Cancer Symptom Scale (LCSS) ScoreTime to worsening of symptoms as measured by LCSS score Up to 18.3 MonthsTTPS was defined as the time from the date of randomization until the date of worsening of symptoms as measured by Lung Cancer Symptom Scale (LCSS) score. Symptomatic progression was defined as an increase (worsening) of the Average Symptomatic Burden Index (ASBI) that is, the mean of the six major lung cancer specific symptom scores of the LCSS patient scale - ranging from 0 to 100 where higher score indicates worst outcome). For each participant, the maximum improvement over baseline score was calculated for each of the 9 LCSS items, ASBI and LCSS total score. Participants without event are censored at the date of the last LCSS assessment. TTPS was estimated using the Kaplan-Meier method.

Countries

Argentina, Belgium, Brazil, Canada, France, Germany, Israel, Italy, Netherlands, Spain, Turkey (Türkiye), United States

Participant flow

Pre-assignment details

Completers are those participants who died or had progressive disease (PD).

Participants by arm

ArmCount
Pemetrexed + Cisplatin + Cixutumumab
Induction Treatment: Pemetrexed 500 mg/m\^2 plus cisplatin 75 mg/m\^2 plus cixutumumab 20 mg/kg given IV on Day 1 of a 21 day cycle for up to 4 cycles. Two additional cycles of cisplatin may be given (6 cycles total) for participants with significant tumor size reduction, after sponsor approval. Maintenance Therapy: Pemetrexed 500 mg/m\^2 plus cixutumumab 20 mg/kg given IV every 21 days until progression of disease, unacceptable toxicity, or another withdrawal criterion is met.
87
Pemetrexed + Cisplatin
Induction Treatment: Pemetrexed 500 mg/m\^2 plus cisplatin 75 mg/m\^2 given IV on Day 1 of a 21 day cycle for up to 4 cycles. Two additional cycles of cisplatin may be given (6 cycles total) for participants with significant tumor size reduction, after sponsor approval. Maintenance Therapy: Pemetrexed 500 mg/m\^2 given IV every 21 days until progression of disease, unacceptable toxicity, or another withdrawal criterion is met.
85
Total172

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1715
Overall StudyPhysician Decision812
Overall StudyProtocol entry criterion not met02
Overall StudyProtocol Violation01
Overall StudySponsor Decision31
Overall StudyWithdrawal by Subject118

Baseline characteristics

CharacteristicPemetrexed + Cisplatin + CixutumumabTotalPemetrexed + Cisplatin
Age, Continuous59.5 years
STANDARD_DEVIATION 9.87
59.4 years
STANDARD_DEVIATION 9.89
59.3 years
STANDARD_DEVIATION 9.96
Ethnicity (NIH/OMB)
Hispanic or Latino
13 Participants37 Participants24 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
45 Participants78 Participants33 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
29 Participants57 Participants28 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants3 Participants2 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
4 Participants6 Participants2 Participants
Race (NIH/OMB)
White
81 Participants161 Participants80 Participants
Region of Enrollment
Argentina
5 Participants13 Participants8 Participants
Region of Enrollment
Belgium
7 Participants13 Participants6 Participants
Region of Enrollment
Brazil
13 Participants34 Participants21 Participants
Region of Enrollment
Canada
1 Participants2 Participants1 Participants
Region of Enrollment
France
3 Participants5 Participants2 Participants
Region of Enrollment
Germany
17 Participants25 Participants8 Participants
Region of Enrollment
Israel
6 Participants8 Participants2 Participants
Region of Enrollment
Italy
9 Participants17 Participants8 Participants
Region of Enrollment
Netherlands
4 Participants5 Participants1 Participants
Region of Enrollment
Spain
6 Participants12 Participants6 Participants
Region of Enrollment
Turkey
5 Participants12 Participants7 Participants
Region of Enrollment
United States
9 Participants20 Participants11 Participants
Sex: Female, Male
Female
33 Participants65 Participants32 Participants
Sex: Female, Male
Male
54 Participants107 Participants53 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
83 / 8579 / 81
serious
Total, serious adverse events
49 / 8531 / 81

Outcome results

Primary

Progression-free Survival (PFS)

PFS was defined as the time from date of randomization until the date of disease progression, or death from any cause, whichever was first. Disease progression was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing nontarget lesions. Participants without documentation for disease progression or death were censored at the date of last tumor assessment. The PFS was estimated following the Kaplan-Meier method.

Time frame: Randomization Date to Disease Progression or Death From Any Cause Up to 18.3 Months

Population: All randomized participants. Participants censored in Cixutumumab arm = 20 and Pemetrexed + Cisplatin arm = 21.

ArmMeasureValue (MEDIAN)
Pemetrexed + Cisplatin + CixutumumabProgression-free Survival (PFS)5.45 months
Pemetrexed + CisplatinProgression-free Survival (PFS)5.22 months
p-value: 0.84895% CI: [0.73, 1.47]Log Rank
Secondary

Change in Tumor Size (CTS)

CTS was measured by percentage change of tumor size at the end of Cycle 2 comparing to baseline tumor size.

Time frame: Change from baseline measurement to the end of Cycle 2, average of 42 days

Population: All randomized participants.

ArmMeasureValue (MEAN)Dispersion
Pemetrexed + Cisplatin + CixutumumabChange in Tumor Size (CTS)-23.88 Percent ChangeStandard Deviation 18.859
Pemetrexed + CisplatinChange in Tumor Size (CTS)-16.04 Percent ChangeStandard Deviation 26.143
Secondary

Duration of Response (DOR)

Duration of response is measured from the time measurement criteria are first met for CR/PR (whichever is first recorded) until the first date that the criteria for PD is met, or death, is objectively documented. DOR was estimated using the Kaplan-Meier method. Disease progression was assessed via RECIST version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing non-target lesions

Time frame: Time from Response to Disease Progression or Death from Any Cause Up to 20 Months

Population: All randomized participants who had CR or PR. Participants censored in Cixutumumab arm = 10 and Pemetrexed + Cisplatin arm = 8.

ArmMeasureValue (MEDIAN)
Pemetrexed + Cisplatin + CixutumumabDuration of Response (DOR)4.90 Months
Pemetrexed + CisplatinDuration of Response (DOR)3.91 Months
Secondary

Immunogenicity of Cixutumumab

Time frame: Preinfusion, Cycle1(C1): 1, 72, 168, 240, 336 hours(hrs); C2 and C3: 1, 168, 336 hrs; C4: 1, 24,72,120,168, 240, 336, 504 hrs, Postinfusion; 30 Day Follow Up

Population: Zero participants were analyzed due to no immunogenicity analysis was done and the assay was never developed.

Secondary

Overall Survival (OS)

Overall survival is defined as the time from the date of randomization to the date of death from any cause. If the participant is alive at the end of the follow-up period or is lost to follow-up, OS will be censored on the last date the participant is known to be alive. OS was estimated using the Kaplan-Meier method.

Time frame: Randomization Date to Death From Any Cause Up to 20 Months

Population: All randomized participants. Participants censored cixutumumab arm = 47 and pemetrexed + cisplatin arm = 39.

ArmMeasureValue (MEDIAN)
Pemetrexed + Cisplatin + CixutumumabOverall Survival (OS)10.68 Months
Pemetrexed + CisplatinOverall Survival (OS)10.38 Months
Secondary

Percentage of Participants Achieving an Objective Response Rate (ORR)

The ORR is the percentage of all participants with Partial Response (PR) or Complete Response (CR) according to RECIST v1.1. Disease progression was defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing nontarget lesions. ORR is confirmed best overall tumor response of CR and PR. CR was defined as the disappearance of all target and non-target lesions; PR defined as a \>30% decrease in the sum of the longest diameters (LD) of the target lesions, taking as reference the baseline sum of the LD.

Time frame: Randomization to Disease Progression Up to 18.3 Months

Population: All randomized participants

ArmMeasureValue (NUMBER)
Pemetrexed + Cisplatin + CixutumumabPercentage of Participants Achieving an Objective Response Rate (ORR)37.9 percentage of participants
Pemetrexed + CisplatinPercentage of Participants Achieving an Objective Response Rate (ORR)30.6 percentage of participants
p-value: 0.338Fisher Exact
Secondary

Pharmacodynamics (PD) Markers: Free Insulin-like Growth Factor-I (IGF-I, Total IGF-I, and IGF Binding Proteins (IGFBP-3)

Blood samples for the determination of PD marker concentrations were collected at the specified time points for all participants. Analysis of the following markers include free IGF-I, total IGF-I, and IGFBP-3.

Time frame: Preinfusion, Cycle 2, Cycle 4, Cycle 8, Postinfusion, 30-Day Follow-Up

Population: Zero participants were analyzed for PD Biomarker IGF-I, total IGF-I, and IGFBP-3 due to blood samples were not collected in order to assess biomarker data.

Secondary

Pharmacokinetics (PK): Maximum Serum Concentration (Cmax) of Cixutumumab, Cycle 1 (First Infusion) and Cycle 4 (Fourth Infusion)

Time frame: First Infusion: [Prior to Infusion (of Cycle1): 1, 72, 168, 336 hours(hrs) and 504 hrs (i.e. Prior to Infusion of Cycle 2)] and Fourth Infusion; [Prior to Infusion (of Cycle 4),1,24,72,120,168,240,336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 5)]

Population: Participants who were randomized to the cixutumumab arm and had evaluable PK data.

ArmMeasureGroupValue (GEOMETRIC_MEAN)Dispersion
Pemetrexed + Cisplatin + CixutumumabPharmacokinetics (PK): Maximum Serum Concentration (Cmax) of Cixutumumab, Cycle 1 (First Infusion) and Cycle 4 (Fourth Infusion)First Infusion481 microgram/milliliter (ug/mL)Geometric Coefficient of Variation 33
Pemetrexed + Cisplatin + CixutumumabPharmacokinetics (PK): Maximum Serum Concentration (Cmax) of Cixutumumab, Cycle 1 (First Infusion) and Cycle 4 (Fourth Infusion)Fourth Infusion556 microgram/milliliter (ug/mL)Geometric Coefficient of Variation 17
Secondary

PK: Area Under the Concentration Time Curve (AUC[0-inf]) of Cixutumumab, Cycle 1 (i.e. First Infusion)

Time frame: Prior to Infusion (of Cycle 1), 1, 72, 168, 336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 2)

Population: Participants who were randomized to the cixutumumab arm and had evaluable PK data.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Pemetrexed + Cisplatin + CixutumumabPK: Area Under the Concentration Time Curve (AUC[0-inf]) of Cixutumumab, Cycle 1 (i.e. First Infusion)73200 microgram*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 35
Secondary

PK: Area Under the Concentration Time Curve During 1 Dosing Interval (i.e. 504 hr, AUC(0-tau) of Cixutumumab, Cycle 4 (i.e. Fourth Infusion)

Time frame: Prior to Infusion (of Cycle 4), 1, 24, 72, 120, 168, 240, 336 hrs and 504 hrs (i.e. Prior to Infusion of Cycle 5)

Population: Participants who were randomized to the cixutumumab arm and had evaluable PK data.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Pemetrexed + Cisplatin + CixutumumabPK: Area Under the Concentration Time Curve During 1 Dosing Interval (i.e. 504 hr, AUC(0-tau) of Cixutumumab, Cycle 4 (i.e. Fourth Infusion)79700 (ug*hr/mL)Geometric Coefficient of Variation 30
Secondary

Time to Progressive Disease (TTPS)

TTPS was defined as the time from the date of randomization until the date of disease progression. Disease progression was assessed via RECIST version 1.1, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing non-target lesions.TTPS was estimated using the Kaplan-Meier method.

Time frame: Randomization Date to Disease Progression Up to 18.3 Months

Population: All randomized participants. Participants censored in Cixutumumab arm = 39 and in the Pemetrexed + Cisplatin arm = 36.

ArmMeasureValue (MEDIAN)
Pemetrexed + Cisplatin + CixutumumabTime to Progressive Disease (TTPS)6.05 Months
Pemetrexed + CisplatinTime to Progressive Disease (TTPS)6.05 Months
Secondary

Time to Worsening of Symptoms as Measured by Lung Cancer Symptom Scale (LCSS) Score

TTPS was defined as the time from the date of randomization until the date of worsening of symptoms as measured by Lung Cancer Symptom Scale (LCSS) score. Symptomatic progression was defined as an increase (worsening) of the Average Symptomatic Burden Index (ASBI) that is, the mean of the six major lung cancer specific symptom scores of the LCSS patient scale - ranging from 0 to 100 where higher score indicates worst outcome). For each participant, the maximum improvement over baseline score was calculated for each of the 9 LCSS items, ASBI and LCSS total score. Participants without event are censored at the date of the last LCSS assessment. TTPS was estimated using the Kaplan-Meier method.

Time frame: Time to worsening of symptoms as measured by LCSS score Up to 18.3 Months

Population: All randomized participants. Participants censored in Cixutumumab arm = 38 and Pemetrexed + Cisplatin arm = 46.

ArmMeasureValue (MEDIAN)
Pemetrexed + Cisplatin + CixutumumabTime to Worsening of Symptoms as Measured by Lung Cancer Symptom Scale (LCSS) Score2.14 Months
Pemetrexed + CisplatinTime to Worsening of Symptoms as Measured by Lung Cancer Symptom Scale (LCSS) Score4.21 Months

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