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An Open-Label, Randomized, Phase 3 Trial of Nivolumab Versus Investigator's Choice Chemotherapy as First-Line Therapy for Stage IV or Recurrent PD-L1+ Non-Small Cell Lung Cancer (CheckMate 026)

An Open-Label, Randomized, Phase 3 Trial of Nivolumab Versus Investigator's Choice Chemotherapy as First-Line Therapy for Stage IV or Recurrent PD-L1+ Non-Small Cell Lung Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02041533
Enrollment
541
Registered
2014-01-22
Start date
2014-03-27
Completion date
2022-05-27
Last updated
2023-03-02

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

Conditions

Stage IV or Recurrent Non-Small Cell Lung Cancer

Brief summary

The purpose of this study is to show that Nivolumab will improve progression free survival in subjects with strongly Stage IV or Recurrent PD-L1+ non-small cell lung cancer when compared to chemotherapy

Interventions

DRUGCisplatin
BIOLOGICALNivolumab
DRUGGemcitabine
DRUGCarboplatin
DRUGPaclitaxel
DRUGPemetrexed

Sponsors

Ono Pharmaceutical Co. Ltd
CollaboratorINDUSTRY
Bristol-Myers Squibb
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

* Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≤ 1 * Histologically confirmed Stage IV, or Recurrent NSCLC with no prior systemic anticancer therapy * Measurable disease by computed tomography (CT) or magnetic resonance imaging (MRI) per response evaluation criteria in solid tumors version (RECIST) 1.1 criteria * PD-L1+ on immunohistochemistry testing performed by central lab * Men and women, ages ≥ 18 years of age

Exclusion criteria

* Known epidermal growth factor receptor (EGFR) mutations which are sensitive to available targeted inhibitor therapy * Known anaplastic lymphoma kinase (ALK) translocations * Untreated central nervous system (CNS) metastases * Previous malignancies * Active, known or suspected autoimmune disease

Design outcomes

Primary

MeasureTime frameDescription
Progression-Free Survival in Participants With PD-L1 Expression >= 5%From date of randomization until date of documented tumor progression (assessed up to August 2016, approximately 28 months)Progression-Free Survival (PFS) was defined as the time between the date of randomization and the first date of documented tumor progression, as determined by the Independent Radiology Review Committee (IRRC) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death due to any cause, whichever occurs first. Participants who die without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on-study tumor assessments and did not die were censored on the day they were randomized. Participants who received subsequent anti-cancer therapy prior to documented progression were censored at the last evaluable tumor assessment prior to the initiation of new therapy.

Secondary

MeasureTime frameDescription
Progression-Free Survival in All Randomized ParticipantsFrom date of randomization until date of documented tumor progression (assessed up to August 2016, approximately 28 months)Progression-Free Survival (PFS) was defined as the time between the date of randomization and the first date of documented tumor progression, as determined by the Independent Radiology Review Committee (IRRC) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death due to any cause, whichever occurs first. Participants who die without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on-study tumor assessments and did not die were censored on the day they were randomized. Participants who received subsequent anti-cancer therapy prior to documented progression were censored at the last evaluable tumor assessment prior to the initiation of new therapy.
Overall Survival in Participants With PD-L1 Expression >= 5%From date of randomization to date of death (up to approximately 89 months)Overall Survival (OS) was defined as the time from randomization to the date of death. A participant who had not died was censored at the last known alive date. OS was censored at the date of randomization for participants who were randomized but had no follow-up.
Overall Survival in All Randomized ParticipantsFrom date of randomization to date of death (up to approximately 89 months)Overall Survival (OS) was defined as the time from randomization to the date of death. A participant who had not died was censored at the last known alive date. OS was censored at the date of randomization for participants who were randomized but had no follow-up.
Objective Response Rate (ORR) in Participants With PD-L1 Expression >= 5%From date of randomization until date of documented tumor progression or subsequent anti-cancer therapy, whichever occurs first (assessed up to August 2016, approximately 28 months)ORR was defined as the proportion of randomized participants who achieved a Best Overall Response (BOR) of CR or PR using the RECIST v1.1 criteria per Independent Radiology Review Committee (IRRC) assessment. BOR was defined as the best response designation recorded between the date of randomization and the date of objectively documented progression or start of subsequent anti-cancer therapy, whichever occurred first. For participants without documented progression or subsequent therapy, all available response designations contributed to the BOR assessment. For participants who continued treatment beyond progression, BOR was determined from response designations recorded up to the time of initial progression. CR= Disappearance of all evidence of disease, confirmed by PET scan; PR= Regression of measureable disease and no new sites; Stable Disease (SD)= Failure to attain CR/PR or PD; Progressive Disease (PD)= Any new lesion or increase by \>=50% of previously involved sites from nadir.
Disease-related Symptom Improvement Rate by Week 12From date of randomization to week 12The Lung Cancer Symptom Score (LCSS) is a validated instrument designed to assess the impact of treatment on disease-related symptoms. It consists of 6 symptom-specific questions related to dyspnea, cough, fatigue, pain, hemoptysis and anorexia plus 3 summary items: symptom distress, interference with activity, and global HRQoL. The degree of impairment was recorded on a 100 mm visual analogue scale with scores from 0 to 100 with zero representing the best score. Disease-related symptom improvement rate by Week 12 is defined as the proportion of all randomized (all PD-L1+) participants who had 10 points or more decrease from baseline in average symptom burden index score at any time between randomization and Week 12.

Countries

Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechia, Finland, France, Germany, Greece, Hungary, Italy, Japan, Mexico, Netherlands, Poland, Romania, South Korea, Spain, Sweden, Switzerland, Taiwan, Turkey (Türkiye), United Kingdom, United States

Participant flow

Participants by arm

ArmCount
Nivolumab
Nivolumab 3mg/kg IV infusion, every 2 weeks until disease progression or unacceptable toxicity
271
Investigator Choice of Chemotherapy
Administered in 3-week cycles for up to 6 cycles: Squamous: * gemcitabine (1250 mg/mg2) with cisplatin (75 mg/m2); or * gemcitabine (1000 mg/m2) with carboplatin (AUC 5); or * paclitaxel (200 mg/m2) with carboplatin (AUC 6) Non-Squamous: * pemetrexed (500 mg/m2) with cisplatin (75 mg/m2); or * pemetrexed (500 mg/m2) with carboplatin (AUC 6) Subjects who discontinued cisplatin could be switched to gemcitabine/carboplatin for the remainder of the platinum doublet cycles (up to 6 cycles in total). Participants who progressed on or after chemotherapy could be eligible to receive optional crossover nivolumab 3 mg/kg administered every 2 weeks until disease progression, discontinuation due to unacceptable toxicity, withdrawal of consent or study closure.
270
Total541

Withdrawals & dropouts

PeriodReasonFG000FG001
Pre-Treatment PeriodDisease Progression11
Pre-Treatment PeriodParticipant no Longer Meets Study Criteria31
Pre-Treatment PeriodParticipant Withdrew Consent05
Treatment PeriodAdministrative reason by sponsor10
Treatment PeriodAdverse event unrelated to study drug2223
Treatment PeriodDeath10
Treatment PeriodDisease progression189146
Treatment PeriodMaximum clinical benefit018
Treatment PeriodNot Reported01
Treatment PeriodOther reasons92
Treatment PeriodParticipant request to discontinue study treatment129
Treatment PeriodParticipant withdrew consent22
Treatment PeriodPoor/Non-compliance10
Treatment PeriodStudy drug toxicity3034

Baseline characteristics

CharacteristicTotalNivolumabInvestigator Choice of Chemotherapy
Age, Continuous63.1 years
STANDARD_DEVIATION 9.94
62.8 years
STANDARD_DEVIATION 10.25
63.4 years
STANDARD_DEVIATION 9.63
Ethnicity (NIH/OMB)
Hispanic or Latino
7 Participants4 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
280 Participants141 Participants139 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
254 Participants126 Participants128 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Asian
47 Participants30 Participants17 Participants
Race/Ethnicity, Customized
Black or African American
16 Participants6 Participants10 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Other
7 Participants6 Participants1 Participants
Race/Ethnicity, Customized
White
470 Participants228 Participants242 Participants
Sex: Female, Male
Female
209 Participants87 Participants122 Participants
Sex: Female, Male
Male
332 Participants184 Participants148 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
233 / 27192 / 270136 / 159
other
Total, other adverse events
245 / 267252 / 263137 / 159
serious
Total, serious adverse events
195 / 267203 / 263110 / 159

Outcome results

Primary

Progression-Free Survival in Participants With PD-L1 Expression >= 5%

Progression-Free Survival (PFS) was defined as the time between the date of randomization and the first date of documented tumor progression, as determined by the Independent Radiology Review Committee (IRRC) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death due to any cause, whichever occurs first. Participants who die without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on-study tumor assessments and did not die were censored on the day they were randomized. Participants who received subsequent anti-cancer therapy prior to documented progression were censored at the last evaluable tumor assessment prior to the initiation of new therapy.

Time frame: From date of randomization until date of documented tumor progression (assessed up to August 2016, approximately 28 months)

Population: All randomized participants with PD-L1 expression levels \>= 5%

ArmMeasureValue (MEDIAN)
NivolumabProgression-Free Survival in Participants With PD-L1 Expression >= 5%4.21 Months
Investigator Choice of ChemotherapyProgression-Free Survival in Participants With PD-L1 Expression >= 5%5.88 Months
p-value: 0.251195% CI: [0.91, 1.45]Log Rank
Secondary

Disease-related Symptom Improvement Rate by Week 12

The Lung Cancer Symptom Score (LCSS) is a validated instrument designed to assess the impact of treatment on disease-related symptoms. It consists of 6 symptom-specific questions related to dyspnea, cough, fatigue, pain, hemoptysis and anorexia plus 3 summary items: symptom distress, interference with activity, and global HRQoL. The degree of impairment was recorded on a 100 mm visual analogue scale with scores from 0 to 100 with zero representing the best score. Disease-related symptom improvement rate by Week 12 is defined as the proportion of all randomized (all PD-L1+) participants who had 10 points or more decrease from baseline in average symptom burden index score at any time between randomization and Week 12.

Time frame: From date of randomization to week 12

Population: All randomized participants

ArmMeasureValue (NUMBER)
NivolumabDisease-related Symptom Improvement Rate by Week 1235.4 Percentage of participants
Investigator Choice of ChemotherapyDisease-related Symptom Improvement Rate by Week 1233.7 Percentage of participants
Secondary

Objective Response Rate (ORR) in Participants With PD-L1 Expression >= 5%

ORR was defined as the proportion of randomized participants who achieved a Best Overall Response (BOR) of CR or PR using the RECIST v1.1 criteria per Independent Radiology Review Committee (IRRC) assessment. BOR was defined as the best response designation recorded between the date of randomization and the date of objectively documented progression or start of subsequent anti-cancer therapy, whichever occurred first. For participants without documented progression or subsequent therapy, all available response designations contributed to the BOR assessment. For participants who continued treatment beyond progression, BOR was determined from response designations recorded up to the time of initial progression. CR= Disappearance of all evidence of disease, confirmed by PET scan; PR= Regression of measureable disease and no new sites; Stable Disease (SD)= Failure to attain CR/PR or PD; Progressive Disease (PD)= Any new lesion or increase by \>=50% of previously involved sites from nadir.

Time frame: From date of randomization until date of documented tumor progression or subsequent anti-cancer therapy, whichever occurs first (assessed up to August 2016, approximately 28 months)

Population: All randomized participants with PD-L1 expression \>= 5%

ArmMeasureValue (NUMBER)
NivolumabObjective Response Rate (ORR) in Participants With PD-L1 Expression >= 5%26.1 Percentage of participants
Investigator Choice of ChemotherapyObjective Response Rate (ORR) in Participants With PD-L1 Expression >= 5%33.5 Percentage of participants
95% CI: [0.46, 1.06]
Secondary

Overall Survival in All Randomized Participants

Overall Survival (OS) was defined as the time from randomization to the date of death. A participant who had not died was censored at the last known alive date. OS was censored at the date of randomization for participants who were randomized but had no follow-up.

Time frame: From date of randomization to date of death (up to approximately 89 months)

Population: All randomized participants

ArmMeasureValue (MEDIAN)
NivolumabOverall Survival in All Randomized Participants13.73 Months
Investigator Choice of ChemotherapyOverall Survival in All Randomized Participants13.80 Months
95% CI: [0.86, 1.24]
Secondary

Overall Survival in Participants With PD-L1 Expression >= 5%

Overall Survival (OS) was defined as the time from randomization to the date of death. A participant who had not died was censored at the last known alive date. OS was censored at the date of randomization for participants who were randomized but had no follow-up.

Time frame: From date of randomization to date of death (up to approximately 89 months)

Population: All randomized participants with PD-L1 expression \>= 5%

ArmMeasureValue (MEDIAN)
NivolumabOverall Survival in Participants With PD-L1 Expression >= 5%14.36 Months
Investigator Choice of ChemotherapyOverall Survival in Participants With PD-L1 Expression >= 5%13.21 Months
95% CI: [0.79, 1.2]
Secondary

Progression-Free Survival in All Randomized Participants

Progression-Free Survival (PFS) was defined as the time between the date of randomization and the first date of documented tumor progression, as determined by the Independent Radiology Review Committee (IRRC) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death due to any cause, whichever occurs first. Participants who die without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on-study tumor assessments and did not die were censored on the day they were randomized. Participants who received subsequent anti-cancer therapy prior to documented progression were censored at the last evaluable tumor assessment prior to the initiation of new therapy.

Time frame: From date of randomization until date of documented tumor progression (assessed up to August 2016, approximately 28 months)

Population: All randomized participants

ArmMeasureValue (MEDIAN)
NivolumabProgression-Free Survival in All Randomized Participants4.21 Months
Investigator Choice of ChemotherapyProgression-Free Survival in All Randomized Participants5.82 Months
95% CI: [0.95, 1.43]

Source: ClinicalTrials.gov · Data processed: Mar 9, 2026