Squamous Non Small Cell Lung Cancer
Conditions
Keywords
NSCLC
Brief summary
The main purpose of this study is to evaluate if necitumumab added to standard chemotherapy of paclitaxel and carboplatin is more effective to treat cancer than the standard chemotherapy of paclitaxel and carboplatin alone.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically or cytologically confirmed squamous NSCLC * Stage IV disease at time of study entry based on American Joint Committee on Cancer (AJCC) 7th edition * Measurable disease at time of study entry as defined by Response Evaluation Criteria in Solid Tumors, (RECIST) Version 1.1 * Archived or recent tumor tissue (minimum of 5 unstained tissue slides or a paraffin-embedded tissue block) available for analysis of epidermal growth factor receptor (EGFR) protein expression by immunohistochemistry (IHC) and other biomarker assessments
Exclusion criteria
* Nonsquamous NSCLC * Prior anticancer therapy with monoclonal antibodies, signal transduction inhibitors, or any therapies targeting the EGFR, vascular endothelial growth factor (VEGF), or VEGF receptor * Previous chemotherapy for NSCLC * Major surgery or received any investigational therapy in the 4 weeks prior to randomization * Chest irradiation within 12 weeks prior to randomization (except palliative irradiation of bone lesions, which is allowed) * Brain metastases that are symptomatic or require ongoing treatment with steroids or anticonvulsants (Participants who have undergone previous radiotherapy for brain metastases, who are now nonsymptomatic and no longer require treatment with steroids or anticonvulsants, are eligible)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieve Best Overall Tumor Response of Complete Response (CR) or Partial Response (PR) (Objective Response Rates [ORR]) | Baseline to Disease Progression or Death (Up to 24 Months) | The denominator of ORR (Objective Response Rate) includes each participant enrolled who received any amount of study drug (necitumumab, gemcitabine, and/or cisplatin), and who had a complete radiographic assessment at baseline and at least one complete radiographic assessment post-baseline. The numerator includes those participants counted in the denominator with a confirmed best overall tumor response of partial or complete response (Complete Response (CR): disappearance of all non-nodal target lesions, with the short axes of any target lymph nodes reduced to \<10 millimeters (mm). Partial Response (PR): at least a 30% decrease in the sum of the diameters of target lesions (including the short axes of any target lymph nodes), taking as reference the baseline sum diameter.) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacokinetics (PK): Maximum Concentration (Cmax) of Necitumumab | Pre-infusion Cycle 1, Day 1; Cycle 3, Day 1; Cycle 5; Day 1 (within 2 hours prior to beginning of infusion) | — |
| Percentage of Participants With Anti Necitumumab Antibodies | Baseline to End of Cycle 6 | — |
| Progression-Free Survival | Randomization to Progressive Disease or Death (Up to 24 Months) | Progression-Free Survival (PFS) is defined as the time from randomization until the first radiographically documented progressive disease (PD) or death from any cause. PD defined by Response Evaluation Criteria in Solid Tumors Criteria (RECIST version 1.1) as at least a 20% increase in the sum of the diameters of target lesions,taking as reference the smallest sum on study (including the baseline sum if that is the smallest). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression. For participants not known to have died as of the data cut-off date and who do not have objective PD, PFS will be censored at the date of the last complete radiographic assessment. |
| Overall Survival (OS) | Randomization to Date of Death (Up to 24 Months) | OS defined as the time from the date of randomization to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS was censored at the last contact date (last contact for participants in post-discontinuation = last known alive date in mortality status). |
| Percent Change in Tumor Size (CTS) | Baseline to Progressive Disease or Death (Up to 24 Months) | CTS is defined as maximum percent change from baseline in the sum of target lesions. |
| Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 1, Day 8 ; Cycle 2, Day 1; Cycle 3, Day 1;Cycle 4, Day1;Cycle 5, Day 1; Cycle 6, Day 1 (within 2 hours prior to beginning of infusion) | — |
| Percentage of Participants Who Achieve Best Overall Disease Response of Complete Response (CR), Partial Response (PR) or Stable Disease (SD) (Disease Control Rate [DCR]) | Baseline to Progressive Disease and/or Death (Estimated up to 24 Months) | Defined using the same denominator as defined in ORR. Among participants counted in the denominator, the numerator counts those with a confirmed best tumor response of SD, PR, or CR per RECIST 1.1. (SD: neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD; PR at least 30% decrease in the sum of diameter of target lesions; CR: disappearance of all target lesions). |
Countries
Germany, Mexico, Poland, Russia, South Korea, United States
Participant flow
Pre-assignment details
A completer is defined as having a complete radiographic assessment at baseline and at least one complete post-baseline radiographic assessment of CR, PR , SD or PD.
Participants by arm
| Arm | Count |
|---|---|
| Necitumumab +Paclitaxel+Carboplatin Necitumumab 800 milligram (mg) administered intravenously (IV) on Days 1 and 8 of every 3 week cycle.
Paclitaxel 200 milligram per square meter (mg/m\^2) administered IV on Day 1 of every 3 week cycle.
Carboplatin AUC6 administered IV on Day 1 of every 3 week cycle. | 110 |
| Paclitaxel + Carboplatin Paclitaxel 200 mg/m² administered IV on Day 1 of every 3 week cycle. Carboplatin AUC6 administered IV on Day 1 of every 3 week cycle. The combination of paclitaxel-carboplatin may continue for a maximum of 6 cycles. | 57 |
| Total | 167 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 0 | 3 |
| Overall Study | Death | 10 | 1 |
| Overall Study | Investigator Decision | 2 | 0 |
| Overall Study | Progressive Disease | 1 | 2 |
| Overall Study | Withdrawal by Subject | 4 | 3 |
Baseline characteristics
| Characteristic | Total | Paclitaxel + Carboplatin | Necitumumab +Paclitaxel+Carboplatin |
|---|---|---|---|
| Age, Continuous | 65.3 years STANDARD_DEVIATION 8.98 | 64.7 years STANDARD_DEVIATION 8.27 | 65.5 years STANDARD_DEVIATION 9.36 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 7 Participants | 4 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 158 Participants | 53 Participants | 105 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 2 Participants | 2 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 16 Participants | 6 Participants | 10 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 144 Participants | 47 Participants | 97 Participants |
| Region of Enrollment Germany | 8 Participants | 4 Participants | 4 Participants |
| Region of Enrollment Mexico | 6 Participants | 3 Participants | 3 Participants |
| Region of Enrollment Poland | 19 Participants | 7 Participants | 12 Participants |
| Region of Enrollment Russia | 40 Participants | 12 Participants | 28 Participants |
| Region of Enrollment South Korea | 16 Participants | 6 Participants | 10 Participants |
| Region of Enrollment United States | 78 Participants | 25 Participants | 53 Participants |
| Sex: Female, Male Female | 36 Participants | 13 Participants | 23 Participants |
| Sex: Female, Male Male | 131 Participants | 44 Participants | 87 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 102 / 106 | 49 / 55 |
| serious Total, serious adverse events | 43 / 106 | 21 / 55 |
Outcome results
Percentage of Participants Who Achieve Best Overall Tumor Response of Complete Response (CR) or Partial Response (PR) (Objective Response Rates [ORR])
The denominator of ORR (Objective Response Rate) includes each participant enrolled who received any amount of study drug (necitumumab, gemcitabine, and/or cisplatin), and who had a complete radiographic assessment at baseline and at least one complete radiographic assessment post-baseline. The numerator includes those participants counted in the denominator with a confirmed best overall tumor response of partial or complete response (Complete Response (CR): disappearance of all non-nodal target lesions, with the short axes of any target lymph nodes reduced to \<10 millimeters (mm). Partial Response (PR): at least a 30% decrease in the sum of the diameters of target lesions (including the short axes of any target lymph nodes), taking as reference the baseline sum diameter.) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
Time frame: Baseline to Disease Progression or Death (Up to 24 Months)
Population: All randomized participants that received at least 1 dose of study drug, who had a complete radiographic assessment at baseline and at least 1 complete radiographic assessment post-baseline.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Percentage of Participants Who Achieve Best Overall Tumor Response of Complete Response (CR) or Partial Response (PR) (Objective Response Rates [ORR]) | 48.9 percentage of participants |
| Paclitaxel + Carboplatin | Percentage of Participants Who Achieve Best Overall Tumor Response of Complete Response (CR) or Partial Response (PR) (Objective Response Rates [ORR]) | 40.0 percentage of participants |
Overall Survival (OS)
OS defined as the time from the date of randomization to the date of death from any cause. For participants not known to have died as of the data cut-off date, OS was censored at the last contact date (last contact for participants in post-discontinuation = last known alive date in mortality status).
Time frame: Randomization to Date of Death (Up to 24 Months)
Population: All randomized participants; (49 and 19 censored participants in Paclitaxel + Carboplatin + Necitumumab and Paclitaxel + Carboplatin Arms, respectively.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Overall Survival (OS) | 13.2 months |
| Paclitaxel + Carboplatin | Overall Survival (OS) | 11.2 months |
Percentage of Participants Who Achieve Best Overall Disease Response of Complete Response (CR), Partial Response (PR) or Stable Disease (SD) (Disease Control Rate [DCR])
Defined using the same denominator as defined in ORR. Among participants counted in the denominator, the numerator counts those with a confirmed best tumor response of SD, PR, or CR per RECIST 1.1. (SD: neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD; PR at least 30% decrease in the sum of diameter of target lesions; CR: disappearance of all target lesions).
Time frame: Baseline to Progressive Disease and/or Death (Estimated up to 24 Months)
Population: All randomized participants who received at least 1 dose of study drug and who had a complete radiographic assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Percentage of Participants Who Achieve Best Overall Disease Response of Complete Response (CR), Partial Response (PR) or Stable Disease (SD) (Disease Control Rate [DCR]) | 87.2 percentage of participants |
| Paclitaxel + Carboplatin | Percentage of Participants Who Achieve Best Overall Disease Response of Complete Response (CR), Partial Response (PR) or Stable Disease (SD) (Disease Control Rate [DCR]) | 84.0 percentage of participants |
Percentage of Participants With Anti Necitumumab Antibodies
Time frame: Baseline to End of Cycle 6
Population: All participants who received any amount of necitumumab and had post baseline antibody data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Percentage of Participants With Anti Necitumumab Antibodies | 2.8 percentage of participants |
Percent Change in Tumor Size (CTS)
CTS is defined as maximum percent change from baseline in the sum of target lesions.
Time frame: Baseline to Progressive Disease or Death (Up to 24 Months)
Population: All randomized participants who received at least 1 dose of study drug and who had a decrease from baseline in the sum of target lesions.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Percent Change in Tumor Size (CTS) | -44.3 percent change in tumor size | Standard Deviation 22.8 |
| Paclitaxel + Carboplatin | Percent Change in Tumor Size (CTS) | -38.65 percent change in tumor size | Standard Deviation 24.4 |
Pharmacokinetics (PK): Maximum Concentration (Cmax) of Necitumumab
Time frame: Pre-infusion Cycle 1, Day 1; Cycle 3, Day 1; Cycle 5; Day 1 (within 2 hours prior to beginning of infusion)
Population: All participants who received at least one dose of necitumumab and had evaluable PK data.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Maximum Concentration (Cmax) of Necitumumab | Cycle 1, Day 1 (n=92) | 262.418 microgram/milliliter (μg/mL) | Geometric Coefficient of Variation 32.84 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Maximum Concentration (Cmax) of Necitumumab | Cycle 3, Day 1 (n=72) | 296.843 microgram/milliliter (μg/mL) | Geometric Coefficient of Variation 62.97 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Maximum Concentration (Cmax) of Necitumumab | Cycle 5, Day 1 (n=62) | 303.475 microgram/milliliter (μg/mL) | Geometric Coefficient of Variation 53.75 |
Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab
Time frame: Cycle 1, Day 8 ; Cycle 2, Day 1; Cycle 3, Day 1;Cycle 4, Day1;Cycle 5, Day 1; Cycle 6, Day 1 (within 2 hours prior to beginning of infusion)
Population: All participants who received at least one dose of study drug and had evaluable PK data.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 1, Day 8 (n-85) | 59.269 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 59.06 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 2, Day 1 (n=79) | 47.874 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 79.89 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 3, Day 1 (n=76) | 78.142 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 70.99 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 4, Day 1 (n=70) | 80.392 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 74.42 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 5, Day 1 (n=62) | 89.137 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 88.94 |
| Necitumumab +Paclitaxel+Carboplatin | Pharmacokinetics (PK): Minimum Concentration (Cmin) of Necitumumab | Cycle 6, Day 1 (n=59) | 87.043 nanogram/milliliter (ng/mL) | Geometric Coefficient of Variation 85.02 |
Progression-Free Survival
Progression-Free Survival (PFS) is defined as the time from randomization until the first radiographically documented progressive disease (PD) or death from any cause. PD defined by Response Evaluation Criteria in Solid Tumors Criteria (RECIST version 1.1) as at least a 20% increase in the sum of the diameters of target lesions,taking as reference the smallest sum on study (including the baseline sum if that is the smallest). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression. For participants not known to have died as of the data cut-off date and who do not have objective PD, PFS will be censored at the date of the last complete radiographic assessment.
Time frame: Randomization to Progressive Disease or Death (Up to 24 Months)
Population: All randomized participants; with 15 and 7 censored participants in Paclitaxel +Carboplatin + Necitumumab and Paclitaxel +Carboplatin Arms, respectively.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Necitumumab +Paclitaxel+Carboplatin | Progression-Free Survival | 5.4 months |
| Paclitaxel + Carboplatin | Progression-Free Survival | 5.6 months |