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A Study of Abemaciclib (LY2835219) in Participants With Previously Treated KRAS Mutated Lung Cancer

JUNIPER: A Randomized Phase 3 Study of Abemaciclib Plus Best Supportive Care Versus Erlotinib Plus Best Supportive Care in Patients With Stage IV NSCLC With a Detectable KRAS Mutation Who Have Progressed After Platinum-Based Chemotherapy

Status
Active, not recruiting
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02152631
Acronym
JUNIPER
Enrollment
453
Registered
2014-06-02
Start date
2014-10-03
Completion date
2026-12-01
Last updated
2026-02-06

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

Conditions

Non Small Cell Lung Cancer

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

DRUGAbemaciclib

Administered orally

DRUGErlotinib

Administered orally

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

* 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

MeasureTime frameDescription
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

MeasureTime frameDescription
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) ScoreFrom 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 StateDay 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) ScoreFrom 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 HospitalizedFrom 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

STUDY_DIRECTORCall 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST)

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

ArmCount
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
Total453

Baseline characteristics

CharacteristicAbemaciclibTotalErlotinib
Age, Continuous62.3 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 Participants25 Participants12 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
197 Participants329 Participants132 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
60 Participants99 Participants39 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
56 Participants97 Participants41 Participants
Race (NIH/OMB)
Black or African American
1 Participants3 Participants2 Participants
Race (NIH/OMB)
More than one race
3 Participants4 Participants1 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
45 Participants77 Participants32 Participants
Race (NIH/OMB)
White
165 Participants271 Participants106 Participants
Region of Enrollment
Argentina
1 Participants3 Participants2 Participants
Region of Enrollment
Austria
0 Participants2 Participants2 Participants
Region of Enrollment
Brazil
7 Participants12 Participants5 Participants
Region of Enrollment
Canada
4 Participants8 Participants4 Participants
Region of Enrollment
China
7 Participants11 Participants4 Participants
Region of Enrollment
France
35 Participants67 Participants32 Participants
Region of Enrollment
Germany
30 Participants44 Participants14 Participants
Region of Enrollment
Greece
1 Participants7 Participants6 Participants
Region of Enrollment
Israel
5 Participants6 Participants1 Participants
Region of Enrollment
Italy
5 Participants17 Participants12 Participants
Region of Enrollment
Japan
22 Participants39 Participants17 Participants
Region of Enrollment
Poland
6 Participants8 Participants2 Participants
Region of Enrollment
Romania
7 Participants14 Participants7 Participants
Region of Enrollment
Russia
8 Participants12 Participants4 Participants
Region of Enrollment
South Korea
13 Participants26 Participants13 Participants
Region of Enrollment
Spain
26 Participants39 Participants13 Participants
Region of Enrollment
Taiwan
12 Participants19 Participants7 Participants
Region of Enrollment
Turkey
21 Participants29 Participants8 Participants
Region of Enrollment
Ukraine
6 Participants11 Participants5 Participants
Region of Enrollment
United States
44 Participants74 Participants30 Participants
Sex: Female, Male
Female
107 Participants181 Participants74 Participants
Sex: Female, Male
Male
163 Participants272 Participants109 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
186 / 265123 / 175
other
Total, other adverse events
247 / 265161 / 175
serious
Total, serious adverse events
112 / 26543 / 175

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
AbemaciclibOverall Survival (OS)7.4 months
ErlotinibOverall Survival (OS)7.8 months
Comparison: The stratification factors used in the analysis were: number of prior chemotherapy regimens (1 versus 2), Eastern Cooperative Oncology Group (ECOG) Performance Score (PS) (0 versus 1), gender (male versus female), and kirsten rat sarcoma (KRAS) mutation (GLY12CYS \[G12C\] vs. all others)p-value: 0.77195% CI: [0.768, 1.219]Stratified Log-Rank
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
AbemaciclibChange From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score-0.08 units on a scaleStandard Error 0.01
ErlotinibChange From Baseline in European Quality of Life - 5 Dimensions - 5 Level (EQ-5D-5L) Score-0.08 units on a scaleStandard Error 0.02
p-value: 0.95195% CI: [-0.05, 0.05]Mixed Models Analysis
Secondary

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.

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreDiarrhea1.91 units on a scaleStandard Error 0.17
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Lung Cancer Symptom Severity0.16 units on a scaleStandard Error 0.09
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreRash0.65 units on a scaleStandard Error 0.17
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Core Plus Lung Cancer Symptom Severity0.44 units on a scaleStandard Error 0.09
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Interference0.70 units on a scaleStandard Error 0.14
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreHeadache0.20 units on a scaleStandard Error 0.11
AbemaciclibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Core Symptom Severity0.49 units on a scaleStandard Error 0.1
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Core Plus Lung Cancer Symptom Severity0.65 units on a scaleStandard Error 0.12
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Interference0.85 units on a scaleStandard Error 0.18
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreHeadache0.27 units on a scaleStandard Error 0.15
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreDiarrhea1.32 units on a scaleStandard Error 0.23
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Core Symptom Severity0.73 units on a scaleStandard Error 0.13
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreMean Lung Cancer Symptom Severity0.23 units on a scaleStandard Error 0.12
ErlotinibChange From Baseline in MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) ScoreRash3.05 units on a scaleStandard Error 0.22
Comparison: Headachep-value: 0.69895% CI: [-0.44, 0.29]Mixed Models Analysis
Comparison: Diarrheap-value: 0.03895% CI: [0.03, 1.15]Mixed Models Analysis
Comparison: Rashp-value: <0.00195% CI: [-2.94, -1.86]Mixed Models Analysis
Comparison: Mean Core Symptom Severityp-value: 0.14295% CI: [-0.56, 0.08]Mixed Models Analysis
Comparison: Mean Interferencep-value: 0.51495% CI: [-0.59, 0.3]Mixed Models Analysis
Comparison: Mean Lung Cancerp-value: 0.64695% CI: [-0.37, 0.23]Mixed Models Analysis
Comparison: Mean Core Plus Lung Cancerp-value: 0.18895% CI: [-0.51, 0.1]Mixed Models Analysis
Secondary

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.

ArmMeasureValue (NUMBER)
AbemaciclibPercentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR])8.9 percentage of participants
ErlotinibPercentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR])2.7 percentage of participants
Comparison: Stratified by number of prior chemotherapy regimens (1 versus 2), ECOG PS (0 versus 1), gender (male versus female), and KRAS mutation (GLY12CYS \[G12C\] vs. all others)p-value: 0.01Cochran-Mantel-Haenszel
Secondary

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.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
AbemaciclibPharmacokinetics (PK): Area Under the Concentration Versus Time Curve During 1 Dosing Interval at Steady State3350 Hour*nanogram/milliliter (h*ng/mL)Geometric Coefficient of Variation 52
Secondary

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.

ArmMeasureValue (NUMBER)
AbemaciclibProgression Free Survival (PFS)3.6 months
ErlotinibProgression Free Survival (PFS)1.9 months
p-value: <0.00000195% CI: [0.47, 0.723]Stratified Log-Rank
Secondary

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.

ArmMeasureValue (NUMBER)
AbemaciclibResource Utilization: Percentage of Participants Who Are Hospitalized40.4 percentage of participants
ErlotinibResource Utilization: Percentage of Participants Who Are Hospitalized22.9 percentage of participants

Source: ClinicalTrials.gov · Data processed: Mar 7, 2026