Stage IV or Recurrent Non-Small Cell Lung Cancer
Conditions
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
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival in All Randomized Participants | 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. |
| 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 Participants | 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. |
| 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 12 | From date of randomization to 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 541 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Pre-Treatment Period | Disease Progression | 1 | 1 |
| Pre-Treatment Period | Participant no Longer Meets Study Criteria | 3 | 1 |
| Pre-Treatment Period | Participant Withdrew Consent | 0 | 5 |
| Treatment Period | Administrative reason by sponsor | 1 | 0 |
| Treatment Period | Adverse event unrelated to study drug | 22 | 23 |
| Treatment Period | Death | 1 | 0 |
| Treatment Period | Disease progression | 189 | 146 |
| Treatment Period | Maximum clinical benefit | 0 | 18 |
| Treatment Period | Not Reported | 0 | 1 |
| Treatment Period | Other reasons | 9 | 2 |
| Treatment Period | Participant request to discontinue study treatment | 12 | 9 |
| Treatment Period | Participant withdrew consent | 2 | 2 |
| Treatment Period | Poor/Non-compliance | 1 | 0 |
| Treatment Period | Study drug toxicity | 30 | 34 |
Baseline characteristics
| Characteristic | Total | Nivolumab | Investigator Choice of Chemotherapy |
|---|---|---|---|
| Age, Continuous | 63.1 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 Participants | 4 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 280 Participants | 141 Participants | 139 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 254 Participants | 126 Participants | 128 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 47 Participants | 30 Participants | 17 Participants |
| Race/Ethnicity, Customized Black or African American | 16 Participants | 6 Participants | 10 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 7 Participants | 6 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 470 Participants | 228 Participants | 242 Participants |
| Sex: Female, Male Female | 209 Participants | 87 Participants | 122 Participants |
| Sex: Female, Male Male | 332 Participants | 184 Participants | 148 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 233 / 271 | 92 / 270 | 136 / 159 |
| other Total, other adverse events | 245 / 267 | 252 / 263 | 137 / 159 |
| serious Total, serious adverse events | 195 / 267 | 203 / 263 | 110 / 159 |
Outcome results
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%
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Progression-Free Survival in Participants With PD-L1 Expression >= 5% | 4.21 Months |
| Investigator Choice of Chemotherapy | Progression-Free Survival in Participants With PD-L1 Expression >= 5% | 5.88 Months |
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab | Disease-related Symptom Improvement Rate by Week 12 | 35.4 Percentage of participants |
| Investigator Choice of Chemotherapy | Disease-related Symptom Improvement Rate by Week 12 | 33.7 Percentage of participants |
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%
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab | Objective Response Rate (ORR) in Participants With PD-L1 Expression >= 5% | 26.1 Percentage of participants |
| Investigator Choice of Chemotherapy | Objective Response Rate (ORR) in Participants With PD-L1 Expression >= 5% | 33.5 Percentage of participants |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Overall Survival in All Randomized Participants | 13.73 Months |
| Investigator Choice of Chemotherapy | Overall Survival in All Randomized Participants | 13.80 Months |
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%
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Overall Survival in Participants With PD-L1 Expression >= 5% | 14.36 Months |
| Investigator Choice of Chemotherapy | Overall Survival in Participants With PD-L1 Expression >= 5% | 13.21 Months |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Progression-Free Survival in All Randomized Participants | 4.21 Months |
| Investigator Choice of Chemotherapy | Progression-Free Survival in All Randomized Participants | 5.82 Months |