Non Small Cell Lung Cancer
Conditions
Keywords
Therapy, Platinum, Kras +
Brief summary
The main purpose of this study is to evaluate how safe and effective the study drug known as abemaciclib is in participants with lung cancer.
Interventions
Administered orally
Administered orally
Sponsors
Study design
Eligibility
Inclusion criteria
* Have confirmed diagnosis of stage IV non-small cell lung cancer (NSCLC) according to the American Joint Committee on Cancer Staging Handbook. * Determined to have detectable mutations in codons 12 or 13 of the kirsten rat sarcoma (KRAS) oncogene by an investigational assay at the study central laboratory. A KRAS positive mutation result in codons 12 or 13 of the KRAS oncogene from tumor tissue per local laboratory will be permitted in no more than 10% of randomized participants. * Have progressed after platinum-based chemotherapy (with or without maintenance therapy) AND have received one additional therapy which may include an immune checkpoint inhibitor or other anti-cancer therapy for advanced and/or metastatic disease OR is judged by the physician as ineligible for further standard second-line chemotherapy. Participants who have progressed after platinum-based chemotherapy and an immune checkpoint inhibitor (immunotherapy) e.g. pembrolizumab or nivolumab alone or in combination with other agents are eligible. * Have measureable disease as defined by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). * Have a performance status (PS) of 0 to 1 on the Eastern Cooperative Oncology Group (ECOG) scale. * Have discontinued all previous therapies for cancer (including chemotherapy, radiotherapy, immunotherapy, and investigational therapy) for at least 21 days for myelosuppressive agents or 14 days for nonmyelosuppressive agents prior to receiving study drug.
Exclusion criteria
* Have received treatment with a drug that has not received regulatory approval for any indication within 14 or 21 days of the initial dose of study drug for a nonmyelosuppressive or myelosuppressive agent, respectively. * Have a personal history of any of the following conditions: presyncope or syncope of either unexplained or cardiovascular etiology, ventricular arrhythmia (including but not limited to ventricular tachycardia and ventricular fibrillation), or sudden cardiac arrest. * Have the presence of unstable central nervous system (CNS) metastasis. History of CNS metastasis or stable CNS metastases is allowed (no longer requiring active therapy such as steroid medications). Participants with a history of CNS metastases must have a brain scan (for example, magnetic resonance imaging \[MRI\]) within 28 days of randomization to document stability, even if there have been no changes in symptoms. * Have previously completed or withdrawn from this study or any other study investigating a cyclin-dependent kinase 4 (CDK4) and cyclin-dependent kinase 6 (CDK6) inhibitors, or have received treatment with a prior CDK4 and CDK6 inhibitors.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | From Randomization Date to Date of Death from Any Cause (Up to 32 Months) | OS defined as from randomization date to the date of death due to any cause. For each participant who is not known to have died as of the data-inclusion cutoff date for overall survival analysis, OS time was censored on the last date the participant is known to be alive. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR]) | From Randomization Date to Objective Progression (Up to 32 Months) | ORR was the percentage of participants achieving a best overall response (BOR) of complete response (CR) or partial response (PR) as per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions. PR defined as at least a 30% decrease in the sum of the longest diameters (LD) of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions. |
| Progression Free Survival (PFS) | From Randomization Date until Disease Progression or Death from Any Cause (Up to 32 Months) | PFS defined as the from randomization date to the first evidence of disease progression as defined by RECIST v1.1 or death from any cause. Progressive Disease (PD) was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions. If a participant does not have a complete baseline disease assessment, then the PFS time was censored at the date of first dose, regardless of whether or not objectively determined disease progression or death has been observed for the participant. If a participant was not known to have died or have objective progression as of the data inclusion cutoff date for the analysis, the PFS time was censored at the last adequate tumor assessment date. |
| Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | From Randomization Date through End of Study (Up to 32 Months) | The MDASI-LC included 22 items + 3 additional trial-specific items, resulting in 6 collected and reported single-construct scores including core symptoms (13-item), interference (6-item), lung cancer (3-item), and trial-specific single outcomes for headache, diarrhea, and rash. A 2-construct composite core + lung cancer symptom (16-item) score was calculated. Data for all 7 scores were collected by an 11-point numeric rating scale anchored at 0 (not present or does not interfere) and 10 (as bad as you can imagine or interfered completely). The measurement range was 10 (maximum score-minimum score). Mixed Model Repeated Measure (MMRM) regression with covariates for treatment, visit, treatment\*visit, and baseline score predicted between-group Least Squares (LS) mean differences from baseline. Group-level negative change from baseline indicated group improvement. |
| Pharmacokinetics (PK): Area Under the Concentration Versus Time Curve During 1 Dosing Interval at Steady State | Day 1 of Cycle 1 through Cycle 3 (28 Day Cycles) | PK is determined by the area under the plasma concentration versus time curve during 1 dosing interval at steady state |
| Change From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score | From Randomization Date through End of Study (Up to 32 Months) | There are 5 response levels on a good-to-bad continuum of 1-5 corresponding to none, slight, moderate, severe, and extreme/unable to. The EuroQol-developed crosswalk method was used to convert the EQ-5D-5L,using United Kingdom (UK) weights, health dimensions(mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) into a single index value; the dimensions are not separately scored. The index is marked missing when ≥1 dimensions are missing. The index scores for the response patterns were anchored on full health to dead with negative values assigned to response patterns/health states considered worse than death. The best pattern is assigned the index value of 1.0; the worst pattern is assigned an index value of -0.594. Between-group differences in regression-predicted change from baseline score were estimated for the index. LS Mean value was controlled for Treatment, visit, Treatment\*Visit and baseline. |
| Resource Utilization: Percentage of Participants Who Are Hospitalized | From Randomization Date through End of Study (Up to 32 Months) | Resource utilization is the percentage of participants who was hospitalized. |
Countries
Argentina, Austria, Brazil, Canada, China, France, Germany, Greece, Israel, Italy, Japan, Poland, Puerto Rico, Romania, Russia, South Korea, Spain, Taiwan, Turkey (Türkiye), Ukraine, United States
Contacts
Eli Lilly and Company
Participant flow
Pre-assignment details
Completers are defined as those participants who had progressive disease, death due to any cause or alive and on study at the end of study, but off treatment.
Participants by arm
| Arm | Count |
|---|---|
| Abemaciclib 200 mg abemaciclib administered, orally, every 12 hours plus BSC on Days 1 to 28 (28 day cycles). | 270 |
| Erlotinib 150 mg erlotinib administered, orally, every 24 hours plus BSC on Days 1 to 28 (28 day cycles). | 183 |
| Total | 453 |
Baseline characteristics
| Characteristic | Abemaciclib | Total | Erlotinib |
|---|---|---|---|
| Age, Continuous | 62.3 years STANDARD_DEVIATION 8.9 | 62.5 years STANDARD_DEVIATION 8.7 | 62.9 years STANDARD_DEVIATION 8.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 13 Participants | 25 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 197 Participants | 329 Participants | 132 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 60 Participants | 99 Participants | 39 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 56 Participants | 97 Participants | 41 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 3 Participants | 4 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 45 Participants | 77 Participants | 32 Participants |
| Race (NIH/OMB) White | 165 Participants | 271 Participants | 106 Participants |
| Region of Enrollment Argentina | 1 Participants | 3 Participants | 2 Participants |
| Region of Enrollment Austria | 0 Participants | 2 Participants | 2 Participants |
| Region of Enrollment Brazil | 7 Participants | 12 Participants | 5 Participants |
| Region of Enrollment Canada | 4 Participants | 8 Participants | 4 Participants |
| Region of Enrollment China | 7 Participants | 11 Participants | 4 Participants |
| Region of Enrollment France | 35 Participants | 67 Participants | 32 Participants |
| Region of Enrollment Germany | 30 Participants | 44 Participants | 14 Participants |
| Region of Enrollment Greece | 1 Participants | 7 Participants | 6 Participants |
| Region of Enrollment Israel | 5 Participants | 6 Participants | 1 Participants |
| Region of Enrollment Italy | 5 Participants | 17 Participants | 12 Participants |
| Region of Enrollment Japan | 22 Participants | 39 Participants | 17 Participants |
| Region of Enrollment Poland | 6 Participants | 8 Participants | 2 Participants |
| Region of Enrollment Romania | 7 Participants | 14 Participants | 7 Participants |
| Region of Enrollment Russia | 8 Participants | 12 Participants | 4 Participants |
| Region of Enrollment South Korea | 13 Participants | 26 Participants | 13 Participants |
| Region of Enrollment Spain | 26 Participants | 39 Participants | 13 Participants |
| Region of Enrollment Taiwan | 12 Participants | 19 Participants | 7 Participants |
| Region of Enrollment Turkey | 21 Participants | 29 Participants | 8 Participants |
| Region of Enrollment Ukraine | 6 Participants | 11 Participants | 5 Participants |
| Region of Enrollment United States | 44 Participants | 74 Participants | 30 Participants |
| Sex: Female, Male Female | 107 Participants | 181 Participants | 74 Participants |
| Sex: Female, Male Male | 163 Participants | 272 Participants | 109 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 186 / 265 | 123 / 175 |
| other Total, other adverse events | 247 / 265 | 161 / 175 |
| serious Total, serious adverse events | 112 / 265 | 43 / 175 |
Outcome results
Overall Survival (OS)
OS defined as from randomization date to the date of death due to any cause. For each participant who is not known to have died as of the data-inclusion cutoff date for overall survival analysis, OS time was censored on the last date the participant is known to be alive.
Time frame: From Randomization Date to Date of Death from Any Cause (Up to 32 Months)
Population: All randomized participants. 81 participants were censored in the Abemaciclib arm and 56 participants were censored in the Erlotinib arm.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Abemaciclib | Overall Survival (OS) | 7.4 months |
| Erlotinib | Overall Survival (OS) | 7.8 months |
Change From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score
There are 5 response levels on a good-to-bad continuum of 1-5 corresponding to none, slight, moderate, severe, and extreme/unable to. The EuroQol-developed crosswalk method was used to convert the EQ-5D-5L,using United Kingdom (UK) weights, health dimensions(mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) into a single index value; the dimensions are not separately scored. The index is marked missing when ≥1 dimensions are missing. The index scores for the response patterns were anchored on full health to dead with negative values assigned to response patterns/health states considered worse than death. The best pattern is assigned the index value of 1.0; the worst pattern is assigned an index value of -0.594. Between-group differences in regression-predicted change from baseline score were estimated for the index. LS Mean value was controlled for Treatment, visit, Treatment\*Visit and baseline.
Time frame: From Randomization Date through End of Study (Up to 32 Months)
Population: All randomized participants who received at least one dose of study drug and with a baseline and at least 1 post-baseline result.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Abemaciclib | Change From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score | -0.08 units on a scale | Standard Error 0.01 |
| Erlotinib | Change From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score | -0.08 units on a scale | Standard Error 0.02 |
Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score
The MDASI-LC included 22 items + 3 additional trial-specific items, resulting in 6 collected and reported single-construct scores including core symptoms (13-item), interference (6-item), lung cancer (3-item), and trial-specific single outcomes for headache, diarrhea, and rash. A 2-construct composite core + lung cancer symptom (16-item) score was calculated. Data for all 7 scores were collected by an 11-point numeric rating scale anchored at 0 (not present or does not interfere) and 10 (as bad as you can imagine or interfered completely). The measurement range was 10 (maximum score-minimum score). Mixed Model Repeated Measure (MMRM) regression with covariates for treatment, visit, treatment\*visit, and baseline score predicted between-group Least Squares (LS) mean differences from baseline. Group-level negative change from baseline indicated group improvement.
Time frame: From Randomization Date through End of Study (Up to 32 Months)
Population: All randomized participants for cycles which at least 25% of participants in each arm have a score. MDASI-LC population included all randomized participants who completed at least 1 baseline assessment followed by at least 1 MDASI-LC result.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Diarrhea | 1.91 units on a scale | Standard Error 0.17 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Lung Cancer Symptom Severity | 0.16 units on a scale | Standard Error 0.09 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Rash | 0.65 units on a scale | Standard Error 0.17 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Core Plus Lung Cancer Symptom Severity | 0.44 units on a scale | Standard Error 0.09 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Interference | 0.70 units on a scale | Standard Error 0.14 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Headache | 0.20 units on a scale | Standard Error 0.11 |
| Abemaciclib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Core Symptom Severity | 0.49 units on a scale | Standard Error 0.1 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Core Plus Lung Cancer Symptom Severity | 0.65 units on a scale | Standard Error 0.12 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Interference | 0.85 units on a scale | Standard Error 0.18 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Headache | 0.27 units on a scale | Standard Error 0.15 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Diarrhea | 1.32 units on a scale | Standard Error 0.23 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Core Symptom Severity | 0.73 units on a scale | Standard Error 0.13 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Mean Lung Cancer Symptom Severity | 0.23 units on a scale | Standard Error 0.12 |
| Erlotinib | Change From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) Score | Rash | 3.05 units on a scale | Standard Error 0.22 |
Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR])
ORR was the percentage of participants achieving a best overall response (BOR) of complete response (CR) or partial response (PR) as per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions. PR defined as at least a 30% decrease in the sum of the longest diameters (LD) of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions.
Time frame: From Randomization Date to Objective Progression (Up to 32 Months)
Population: All randomized participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Abemaciclib | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR]) | 8.9 percentage of participants |
| Erlotinib | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR]) | 2.7 percentage of participants |
Pharmacokinetics (PK): Area Under the Concentration Versus Time Curve During 1 Dosing Interval at Steady State
PK is determined by the area under the plasma concentration versus time curve during 1 dosing interval at steady state
Time frame: Day 1 of Cycle 1 through Cycle 3 (28 Day Cycles)
Population: All randomized participants who received Abemaciclib and had evaluable PK data.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Abemaciclib | Pharmacokinetics (PK): Area Under the Concentration Versus Time Curve During 1 Dosing Interval at Steady State | 3350 Hour*nanogram/milliliter (h*ng/mL) | Geometric Coefficient of Variation 52 |
Progression Free Survival (PFS)
PFS defined as the from randomization date to the first evidence of disease progression as defined by RECIST v1.1 or death from any cause. Progressive Disease (PD) was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions. If a participant does not have a complete baseline disease assessment, then the PFS time was censored at the date of first dose, regardless of whether or not objectively determined disease progression or death has been observed for the participant. If a participant was not known to have died or have objective progression as of the data inclusion cutoff date for the analysis, the PFS time was censored at the last adequate tumor assessment date.
Time frame: From Randomization Date until Disease Progression or Death from Any Cause (Up to 32 Months)
Population: All randomized participants. 36 participants were censored in the abemaciclib arm and 24 were censored in the erlotinib arm.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Abemaciclib | Progression Free Survival (PFS) | 3.6 months |
| Erlotinib | Progression Free Survival (PFS) | 1.9 months |
Resource Utilization: Percentage of Participants Who Are Hospitalized
Resource utilization is the percentage of participants who was hospitalized.
Time frame: From Randomization Date through End of Study (Up to 32 Months)
Population: All randomized participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Abemaciclib | Resource Utilization: Percentage of Participants Who Are Hospitalized | 40.4 percentage of participants |
| Erlotinib | Resource Utilization: Percentage of Participants Who Are Hospitalized | 22.9 percentage of participants |