Non-squamous Non-small Cell Lung Cancer
Conditions
Keywords
veliparib, carboplatin, paclitaxel, cisplatin, pemetrexed, Poly Adenosine diphosphate (ADP)-ribose Polymerase (PARP), Metastatic, Non-squamous, Non-small cell lung cancer
Brief summary
The purpose of this study is to evaluate the safety and efficacy of veliparib plus carboplatin and paclitaxel versus the Investigator's choice of standard chemotherapy in adults with metastatic or advanced non-squamous non-small cell lung cancer.
Interventions
Administered by Intravenous infusion on Day 1 of each 21-day cycle
Administered by Intravenous infusion on Day 1 of each 21-day cycle
Administered by Intravenous infusion on Day 1 of each 21-day cycle
Oral capsule, administered twice daily for 7 days in each 21-day cycle
Administered by Intravenous infusion on Day 1 of each 21-day cycle
Sponsors
Study design
Eligibility
Inclusion criteria
* Subject must be ≥ 18 years of age with life expectancy \> 12 weeks. * Subject must have cytologically or histologically confirmed advanced or metastatic non-squamous NSCLC and are current or former smokers. * Subject must have NSCLC that is not amenable to surgical resection or radiation with curative intent at time of screening. * Subject must have at least 1 unidimensional measurable NSCLC lesion on a computed tomography (CT) scan as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Exclusion criteria
* Subject has a known hypersensitivity to paclitaxel or to other drugs formulated with polyethoxylated castor oil (Cremophor). * Subject has a known hypersensitivity to platinum compounds. * Subject has peripheral neuropathy ≥ grade 2. * Subject has squamous NSCLC, or an untreated known epidermal growth factor receptor (EGFR) mutation of exon 19 deletion or L858R mutation in exon 21, or a known anaplastic lymphoma kinase (ALK) gene rearrangement. * Subject has received prior cytotoxic chemotherapy or chemoradiotherapy for NSCLC.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) in the Lung Subtype Panel Positive Subgroup | From randomization up to the data cut-off date of 15 July 2019; median follow-up time was 44.5 and 45.3 months in LSP+ participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively. | Overall survival is defined as the time from the date that the participant was randomized to the date of the participant's death. Overall survival was estimated using Kaplan-Meier methodology. Participants still alive at the data cut-off date were censored at the date they were last known to be alive. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) in the Lung Subtype Panel Positive Subgroup | From randomization up to the data cut-off date of 15 July 2019; the median follow-up time was 44.5 and 45.3 months in LSP+ participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively. | Progression-free survival is defined as the time from the date of randomization to the date of disease progression (PD) per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 or death (all causes of mortality), whichever occurred first. PD: At least a 20% increase in the size of target lesions, taking as reference the smallest size recorded since the treatment started (Baseline or after) with an absolute increase of at least 5 mm, the appearance of one or more new lesions, or unequivocal progression of existing non-target lesions. PFS was estimated using Kaplan-Meier methodology. Participants who did not have an event of disease progression or had not died on or before the cutoff date were censored at the date of their last disease progression assessment on or before the cut-off date. Any PD and death occurring \> 26 weeks and \> 12 weeks after the previous assessment, respectively, were excluded and patients were censored at last assessment before PD or death. |
| Objective Response Rate (ORR) in the Lung Subtype Panel Positive Subgroup | Assessed on Day 1 of Cycles 3 and 5 then every 9 weeks for 1 year or until maintenance therapy was discontinued, then every 12 weeks until radiographic progression or death; median time on follow-up was 5.2 and 6.3 months in each group, respectively. | Objective response rate is defined as the percentage of participants with a complete response (CR) or partial response (PR) per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 criteria. Response must have been confirmed at a consecutive assessment 28 days or more after the assessment at which response was first observed. CR: The disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the Baseline sum diameters, persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits, or any new lesions. |
| Overall Survival in All Participants | From randomization up to the data cut-off date of 15 July 2019; the median OS follow-up time was 45.4 and 44.6 months in all participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively. | Overall survival is defined as the time from the date that the participant was randomized to the date of the participant's death. OS was estimated using Kaplan-Meier methodology. Participants still alive at the data cut-off date were censored at the date they were last known to be alive. |
| Progression Free Survival (PFS) in All Participants | From randomization up to the data cut-off date of 15 July 2019; the median follow-up time was 45.4 and 44.6 months in all participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively. | Progression-free survival is defined as the time from the date of randomization to the date of disease progression (PD) per RECIST version 1.1 or death (all causes of mortality), whichever occurred first. PD: At least a 20% increase in the size of target lesions, taking as reference the smallest size recorded since the treatment started (Baseline or after) with an absolute increase of at least 5 mm, the appearance of one or more new lesions, or unequivocal progression of existing non-target lesions. PFS was estimated using Kaplan-Meier methodology. Participants who did not have an event of disease progression or had not died on or before the cut-off date were censored at the date of their last disease progression assessment on or before the cut-off date. Any PD and death occurring \> 26 weeks and \> 12 weeks after the previous assessment, respectively, were excluded and patients were censored at last assessment before PD or death. |
| Objective Response Rate (ORR) in All Participants | Assessed on Day 1 of Cycles 3 and 5 then every 9 weeks for 1 year or until maintenance therapy was discontinued, then every 12 weeks until radiographic progression or death; median time on follow-up was 6.7 and 5.9 months in each group, respectively. | Objective response rate is defined as the percentage of participants with a complete response (CR) or partial response (PR) per RECIST version 1.1 criteria. Response must have been confirmed at a consecutive assessment 28 days or more after the assessment at which response was first observed. CR: The disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the Baseline sum diameters, persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits, or any new lesions. |
Countries
Argentina, Australia, Canada, Czechia, Denmark, Finland, Germany, Hungary, Israel, Japan, Netherlands, New Zealand, Russia, South Africa, South Korea, Spain, Taiwan, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
Participants were enrolled at 131 sites in 20 countries (Argentina, Australia, Canada, Czech Republic, Denmark, Finland, Germany, Hungary, Israel, Japan, South Korea, Netherlands, New Zealand, Russian Federation, South Africa, Spain, Taiwan, Turkey, United Kingdom, and United States).
Pre-assignment details
Participants were randomized in a 1:1 ratio to veliparib in combination with carboplatin and paclitaxel (C/P) or investigator's choice of platinum doublet chemotherapy. Randomization was stratified by smoking status (current versus former), by the investigators' preferred platinum doublet therapy (carboplatin/paclitaxel versus cisplatin/pemetrexed versus carboplatin/pemetrexed), by gender (male versus female) and by Eastern Cooperative Oncology Group (ECOG) performance status (0 versus 1).
Participants by arm
| Arm | Count |
|---|---|
| Investigator's Choice Chemotherapy Participants received investigator's choice of standard doublet chemotherapy consisting of 1 of the following 3 options, administered on Day 1 of each 21-day cycle for a maximum of 6 cycles:
* Carboplatin AUC 6 mg/mL\*min + paclitaxel 200 mg/m²
* Cisplatin 75 mg/m² + pemetrexed 500 mg/m²
* Carboplatin AUC 6 or AUC 5 mg/mL\*min + pemetrexed 500 mg/m²
After completion of up to 6 cycles, optional maintenance pemetrexed was administered as 500 mg/m² on Day 1 of each 21-day cycle until toxicity required cessation of therapy, or radiographic progression occurred. | 297 |
| Veliparib + Carboplatin + Paclitaxel Participants received 120 mg veliparib BID on Days -2 to 5 (7 days), carboplatin at an AUC of 6 mg/mL\*min on Day 1 and paclitaxel 200 mg/m² on Day 1 of each 21-day cycle for a maximum of 6 cycles.
After completion of up to 6 cycles, optional maintenance pemetrexed was administered as 500 mg/m² on Day 1 of each 21-day cycle until toxicity required cessation of therapy, or radiographic progression occurred. | 298 |
| Total | 595 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 255 | 250 |
| Overall Study | Lost to Follow-up | 1 | 3 |
| Overall Study | Other | 0 | 1 |
| Overall Study | Withdrawal by Subject | 4 | 5 |
Baseline characteristics
| Characteristic | Investigator's Choice Chemotherapy | Veliparib + Carboplatin + Paclitaxel | Total |
|---|---|---|---|
| Age, Continuous | 63.1 years STANDARD_DEVIATION 8.99 | 62.7 years STANDARD_DEVIATION 9.02 | 62.9 years STANDARD_DEVIATION 9 |
| Age, Customized < 65 years | 153 Participants | 163 Participants | 316 Participants |
| Age, Customized ≥ 65 years | 144 Participants | 135 Participants | 279 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status Grade 0 (fully active) | 113 Participants | 116 Participants | 229 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status Grade 1 (restricted but ambulatory) | 184 Participants | 182 Participants | 366 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 22 Participants | 26 Participants | 48 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 275 Participants | 272 Participants | 547 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Investigators' Preferred Platinum Doublet Therapy Carboplatin/paclitaxel | 71 Participants | 70 Participants | 141 Participants |
| Investigators' Preferred Platinum Doublet Therapy Carboplatin/pemetrexed | 131 Participants | 128 Participants | 259 Participants |
| Investigators' Preferred Platinum Doublet Therapy Cisplatin/pemetrexed | 95 Participants | 100 Participants | 195 Participants |
| Lung Subtype Panel (LSP) Assay Results LSP negative | 53 Participants | 74 Participants | 127 Participants |
| Lung Subtype Panel (LSP) Assay Results LSP positive | 40 Participants | 40 Participants | 80 Participants |
| Race/Ethnicity, Customized Asian | 53 Participants | 57 Participants | 110 Participants |
| Race/Ethnicity, Customized Black | 11 Participants | 11 Participants | 22 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 233 Participants | 229 Participants | 462 Participants |
| Region Eastern Europe/Russia | 68 Participants | 88 Participants | 156 Participants |
| Region Japan | 37 Participants | 35 Participants | 72 Participants |
| Region Other Asian | 15 Participants | 18 Participants | 33 Participants |
| Region US and Western Europe and Australia and Canada | 177 Participants | 157 Participants | 334 Participants |
| Sex: Female, Male Female | 90 Participants | 92 Participants | 182 Participants |
| Sex: Female, Male Male | 207 Participants | 206 Participants | 413 Participants |
| Smoking Status Current smoker | 153 Participants | 152 Participants | 305 Participants |
| Smoking Status Past smoker | 144 Participants | 146 Participants | 290 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 255 / 297 | 250 / 298 |
| other Total, other adverse events | 269 / 288 | 275 / 293 |
| serious Total, serious adverse events | 98 / 288 | 121 / 293 |
Outcome results
Overall Survival (OS) in the Lung Subtype Panel Positive Subgroup
Overall survival is defined as the time from the date that the participant was randomized to the date of the participant's death. Overall survival was estimated using Kaplan-Meier methodology. Participants still alive at the data cut-off date were censored at the date they were last known to be alive.
Time frame: From randomization up to the data cut-off date of 15 July 2019; median follow-up time was 44.5 and 45.3 months in LSP+ participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively.
Population: Participants in the ITT population who were LSP positive (LSP+)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigator's Choice Chemotherapy | Overall Survival (OS) in the Lung Subtype Panel Positive Subgroup | 9.2 months |
| Veliparib + Carboplatin + Paclitaxel | Overall Survival (OS) in the Lung Subtype Panel Positive Subgroup | 11.2 months |
Objective Response Rate (ORR) in All Participants
Objective response rate is defined as the percentage of participants with a complete response (CR) or partial response (PR) per RECIST version 1.1 criteria. Response must have been confirmed at a consecutive assessment 28 days or more after the assessment at which response was first observed. CR: The disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the Baseline sum diameters, persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits, or any new lesions.
Time frame: Assessed on Day 1 of Cycles 3 and 5 then every 9 weeks for 1 year or until maintenance therapy was discontinued, then every 12 weeks until radiographic progression or death; median time on follow-up was 6.7 and 5.9 months in each group, respectively.
Population: Participants in the ITT population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Investigator's Choice Chemotherapy | Objective Response Rate (ORR) in All Participants | 29.0 percentage of participants |
| Veliparib + Carboplatin + Paclitaxel | Objective Response Rate (ORR) in All Participants | 26.2 percentage of participants |
Objective Response Rate (ORR) in the Lung Subtype Panel Positive Subgroup
Objective response rate is defined as the percentage of participants with a complete response (CR) or partial response (PR) per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 criteria. Response must have been confirmed at a consecutive assessment 28 days or more after the assessment at which response was first observed. CR: The disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the Baseline sum diameters, persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits, or any new lesions.
Time frame: Assessed on Day 1 of Cycles 3 and 5 then every 9 weeks for 1 year or until maintenance therapy was discontinued, then every 12 weeks until radiographic progression or death; median time on follow-up was 5.2 and 6.3 months in each group, respectively.
Population: Participants in the ITT population who were LSP positive
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Investigator's Choice Chemotherapy | Objective Response Rate (ORR) in the Lung Subtype Panel Positive Subgroup | 30.0 percentage of participants |
| Veliparib + Carboplatin + Paclitaxel | Objective Response Rate (ORR) in the Lung Subtype Panel Positive Subgroup | 22.5 percentage of participants |
Overall Survival in All Participants
Overall survival is defined as the time from the date that the participant was randomized to the date of the participant's death. OS was estimated using Kaplan-Meier methodology. Participants still alive at the data cut-off date were censored at the date they were last known to be alive.
Time frame: From randomization up to the data cut-off date of 15 July 2019; the median OS follow-up time was 45.4 and 44.6 months in all participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively.
Population: Participants in the ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigator's Choice Chemotherapy | Overall Survival in All Participants | 12.1 months |
| Veliparib + Carboplatin + Paclitaxel | Overall Survival in All Participants | 12.1 months |
Progression Free Survival (PFS) in All Participants
Progression-free survival is defined as the time from the date of randomization to the date of disease progression (PD) per RECIST version 1.1 or death (all causes of mortality), whichever occurred first. PD: At least a 20% increase in the size of target lesions, taking as reference the smallest size recorded since the treatment started (Baseline or after) with an absolute increase of at least 5 mm, the appearance of one or more new lesions, or unequivocal progression of existing non-target lesions. PFS was estimated using Kaplan-Meier methodology. Participants who did not have an event of disease progression or had not died on or before the cut-off date were censored at the date of their last disease progression assessment on or before the cut-off date. Any PD and death occurring \> 26 weeks and \> 12 weeks after the previous assessment, respectively, were excluded and patients were censored at last assessment before PD or death.
Time frame: From randomization up to the data cut-off date of 15 July 2019; the median follow-up time was 45.4 and 44.6 months in all participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively.
Population: Participants in the ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigator's Choice Chemotherapy | Progression Free Survival (PFS) in All Participants | 6.7 months |
| Veliparib + Carboplatin + Paclitaxel | Progression Free Survival (PFS) in All Participants | 5.9 months |
Progression Free Survival (PFS) in the Lung Subtype Panel Positive Subgroup
Progression-free survival is defined as the time from the date of randomization to the date of disease progression (PD) per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 or death (all causes of mortality), whichever occurred first. PD: At least a 20% increase in the size of target lesions, taking as reference the smallest size recorded since the treatment started (Baseline or after) with an absolute increase of at least 5 mm, the appearance of one or more new lesions, or unequivocal progression of existing non-target lesions. PFS was estimated using Kaplan-Meier methodology. Participants who did not have an event of disease progression or had not died on or before the cutoff date were censored at the date of their last disease progression assessment on or before the cut-off date. Any PD and death occurring \> 26 weeks and \> 12 weeks after the previous assessment, respectively, were excluded and patients were censored at last assessment before PD or death.
Time frame: From randomization up to the data cut-off date of 15 July 2019; the median follow-up time was 44.5 and 45.3 months in LSP+ participants for the investigator's choice chemotherapy and veliparib + C/P arms, respectively.
Population: Participants in the ITT population who were LSP positive
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigator's Choice Chemotherapy | Progression Free Survival (PFS) in the Lung Subtype Panel Positive Subgroup | 5.2 months |
| Veliparib + Carboplatin + Paclitaxel | Progression Free Survival (PFS) in the Lung Subtype Panel Positive Subgroup | 6.3 months |