Non-small Cell Lung Cancer Stage III
Conditions
Keywords
veliparib, PARP inhibitor, ABT-888, first line, previously untreated, stage III, non-small cell lung cancer, radiotherapy, paclitaxel, carboplatin
Brief summary
This study seeks to establish * the recommended Phase 2 dose (RPTD) of veliparib in combination with concurrent paclitaxel/carboplatin-based chemoradiotherapy (CRT) and consolidation with paclitaxel/carboplatin-based chemotherapy (Phase 1 portion), and * to assess whether the addition of oral veliparib versus placebo to paclitaxel/carboplatin-based chemoradiotherapy with paclitaxel/carboplatin consolidation will improve progression-free survival (PFS) in adults with Stage III non-small cell lung cancer (Phase 2 portion). A strategy decision was made not to proceed to Phase 2 portion of this study due to change in standard of care.
Detailed description
This was to be a 2-phase study consisting of 1. A Phase 1, dose escalation study of veliparib to determine a RPTD for combination with concurrent paclitaxel/carboplatin-based CRT and paclitaxel/carboplatin-based consolidation chemotherapy; followed by 2. A Phase 2, randomized, double-blinded study to determine whether veliparib improved outcome relative to placebo when added to paclitaxel/carboplatin based CRT followed by consolidation paclitaxel/carboplatin in adults with previously untreated Stage III NSCLC. In the dose escalation phase (Phase 1) of the study participants will be assigned to ascending doses of veliparib in combination with carboplatin, paclitaxel, and thoracic radiotherapy for 7 weeks following a traditional 3 + 3 design. The first cohort of at least 3 - 6 participants will receive veliparib 60 mg twice a day (BID) throughout CRT. Dose limiting toxicity (DLT) events will be collected for each dosing cohort until a new dosing cohort is opened or until the RPTD is identified. Participants will also receive a consolidation dose of veliparib of 120 mg BID + carboplatin and paclitaxel for up to two 21-day cycles. Once the concurrent CRT RPTD is identified, an additional cohort will be enrolled to explore the tolerability of a consolidation dose of veliparib at 240 mg BID + carboplatin + paclitaxel for up to two 21-day cycles. Following the dose escalation portion of the study, the RPTD will be determined by the sponsor and the Phase 2 portion of the study will begin with patient randomization in a 1:1:1 ratio to concurrent paclitaxel/carboplatin/radiotherapy/veliparib followed by consolidation paclitaxel/carboplatin/veliparib, concurrent paclitaxel/carboplatin/radiotherapy/veliparib followed by consolidation paclitaxel/carboplatin/placebo, or concurrent paclitaxel/carboplatin/radiotherapy/placebo followed by consolidation paclitaxel/carboplatin/placebo. Randomization will be stratified by tumor volume (≤ 90 versus \> 90 cm³) and smoking history (current smoker versus former smoker versus never smoked). Phase 2 was not carried out since during the study there was a change in standard of care for patients with newly diagnosed, unresectable Stage III NSCLC.
Interventions
Administered via intravenous infusion on Day 1 of each treatment week (concurrent CRT) / cycle (consolidation)
Capsule for oral administration
Administered via intravenous infusion on Day 1 of each treatment week (concurrent CRT) / cycle (consolidation)
Capsule for oral administration
Radiation treatment with total dose of 60 - 63 Gy administered on Days 1 to 5 of each week for 7 weeks
Sponsors
Study design
Masking description
All participants will be treated with open-label paclitaxel and carboplatin (Phase 1 and Phase 2). Participants in Phase 1 will be treated with open-label veliparib. In Phase 2, the Sponsor, Investigator, study site personnel and participant were to be be blinded to each participant's treatment with veliparib or placebo throughout the course of the study.
Intervention model description
In the dose escalation phase (Phase 1) of the study participants will be enrolled sequentially to receive ascending dose of veliparib in combination with carboplatin + paclitaxel + thoracic radiotherapy. In the Phase 2 portion of the study participants were to be randomized in a 1:1:1 ratio to one of three treatment arms.
Eligibility
Inclusion criteria
1. Participants with histologically or cytologically confirmed Stage III non-small cell lung cancer (NSCLC). 2. Participants in the randomized portion of the study must have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1 criteria. 3. Participants must have V20 (volume of lung to receive 20 Gy radiotherapy according to simulation) \< 35%. 4. Participant must have an Eastern Cooperative Oncology Group (ECOG) performance score of 0 - 1. 5. Participant must have adequate hematologic, renal, hepatic, and lung function. 6. Participant must consent to provide archived tissue or cytology sample of NSCLC lesion for analysis.
Exclusion criteria
1. Participants with prior chemotherapy or radiotherapy (RT) for current NSCLC. Participants curatively treated for past early stage NSCLC greater than 3 years ago may be included. 2. Participants with prior exposure to poly-adenosine diphosphate (ADP)-ribose polymerase (PARP) inhibitors. 3. Participants with known hypersensitivity to carboplatin, paclitaxel, or formulations containing polyethoxylated castor oil (Cremophor). 4. Participants with prior mediastinal or thoracic radiotherapy. Prior tangential radiotherapy to prior breast cancer is acceptable. 5. Participants with major surgery in the 4 weeks prior to randomization (Video-assisted thoracoscopic surgery (VATS) and/or mediastinoscopy is not considered major surgery). 6. Participants with a previous or concurrent malignancy except for treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient received potentially curative treatment and has been disease-free for 3 years or is considered cured by the investigator if has been disease-free for less than 3 years. 7. Participant is pregnant or lactating. 8. Participant with sensory peripheral neuropathy of ≥ Grade 2 at baseline, unable to swallow medication, or participants with prior history of seizure within the prior 12 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Dose-limiting Toxicities (DLTs) | For Cohorts 1 - 5, from the start of veliparib dosing through 28 days after RT completion or until initiation of consolidation CT, approx. 10 weeks; For Cohort 6, 21 days from start of consolidation CT or until the start of cycle 2 consolidation therapy. | DLTs were defined as the following events considered treatment-related by the Investigator, graded per Common Terminology Criteria for Adverse Events (CTCAE) v4.0. * Radiation-induced myelopathy/myelitis or ≥ Grade (G) 3 cardiac toxicity * Radiation-related pneumonitis resulting in delay in RT, CT, or veliparib of \>3 weeks or early discontinuation (DC) of RT (total dose \<50 Gy) * ≥G4 esophagitis or esophagitis, dysphagia, and odynophagia requiring treatment interruption of \>7 days despite medical management, neutropenia for \>7 days or neutropenic fever or thrombocytopenia * ≥G2 seizure * G4 diarrhea or nausea/vomiting despite antiemetic therapy for \>48 hours * Any other toxicity resulting in delay in RT, CT or veliparib \>14 days or early DC of RT * Other nonhematologic toxicities ≥G3, except anorexia, fatigue, G3 infection, G3 aspartate/alanine transferase (AST/ALT) elevations ≤7 days, infusion reactions, G3/4 lymphopenia or electrolyte abnormalities corrected to ≤G2 in \<48 hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate | Tumor assessments were performed prior to consolidation chemotherapy, 24 weeks after start of treatment, every 8 weeks until 1 year after start of treatment, and then every 12 weeks until disease progression; median time on follow-up was 11 months. | Objective response rate (ORR) is defined as the percentage of participants who have a confirmed complete response (CR) or partial response (PR) as assessed by the investigator using RECIST v1.1. Participants who did not meet complete response or partial response, including those who did not have post-baseline radiological assessments were considered as non-responders. Complete Response (CR): The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level. All lymph nodes must be non-pathological in size (\< 10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Response must have been confirmed 4 weeks after the first documentation. |
Countries
United States
Participant flow
Recruitment details
This study enrolled 48 participants at 10 sites in the United States. The study was designed as a 2-phase study consisting of a Phase 1, dose escalation of veliparib in combination with concurrent chemoradiotherapy (CRT) and consolidation chemotherapy (CT) and a Phase 2, randomized, double-blinded study.
Pre-assignment details
Participants in Phase 1 were sequentially assigned to ascending dose levels of veliparib in combination with carboplatin/paclitaxel chemoradiotherapy. Phase 2 was not conducted since there was a change in standard of care for newly diagnosed, unresectable Stage III non-small cell lung cancer (NSCLC). Results are reported for Phase 1.
Participants by arm
| Arm | Count |
|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT Participants received 60 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 120 mg BID with carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 7 |
| Veliparib 80 mg BID + CRT -> Veliparib 120 mg BID + CT Participants received 80 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 120 mg BID with carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 9 |
| Veliparib 120 mg BID + CRT -> Veliparib 120 mg BID + CT Participants received 120 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 120 mg BID with carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 7 |
| Veliparib 200 mg BID + CRT -> Veliparib 120 mg BID + CT Participants received 200 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 120 mg BID, carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 8 |
| Veliparib 240 mg BID + CRT -> Veliparib 120 mg BID + CT Participants received 240 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 120 mg BID with carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 12 |
| Veliparib 240 mg BID + CRT -> Veliparib 240 mg BID + CT Participants received 240 mg veliparib BID in combination with carboplatin at an AUC 2 mg/mL/min and paclitaxel 45 mg/m² once a week plus thoracic radiotherapy for 7 weeks.
After completion of concurrent CRT participants received up to 2 cycles of consolidation therapy consisting of veliparib 240 mg BID, carboplatin AUC 6 mg/mL/min and paclitaxel 200 mg/m² administered on Day 1 of each 21-day cycle. | 5 |
| Total | 48 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Death | 4 | 2 | 1 | 3 | 5 | 2 |
| Overall Study | Other | 2 | 1 | 0 | 0 | 1 | 3 |
| Overall Study | Sponsor Discontinued Study | 1 | 4 | 6 | 4 | 5 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 2 | 0 | 1 | 1 | 0 |
Baseline characteristics
| Characteristic | Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Veliparib 80 mg BID + CRT -> Veliparib 120 mg BID + CT | Veliparib 120 mg BID + CRT -> Veliparib 120 mg BID + CT | Veliparib 200 mg BID + CRT -> Veliparib 120 mg BID + CT | Veliparib 240 mg BID + CRT -> Veliparib 120 mg BID + CT | Veliparib 240 mg BID + CRT -> Veliparib 240 mg BID + CT | Total |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 69.1 years STANDARD_DEVIATION 6.39 | 65.7 years STANDARD_DEVIATION 7.55 | 66.9 years STANDARD_DEVIATION 9.84 | 59.8 years STANDARD_DEVIATION 6.07 | 67.3 years STANDARD_DEVIATION 9.39 | 65.6 years STANDARD_DEVIATION 11.84 | 65.8 years STANDARD_DEVIATION 8.6 |
| Age, Customized 40 - < 60 years | 0 Participants | 1 Participants | 2 Participants | 3 Participants | 2 Participants | 1 Participants | 9 Participants |
| Age, Customized ≥ 60 years | 7 Participants | 8 Participants | 5 Participants | 5 Participants | 10 Participants | 4 Participants | 39 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Score Grade 0 (Fully active) | 3 Participants | 3 Participants | 3 Participants | 4 Participants | 6 Participants | 4 Participants | 23 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Score Grade 1 (Restricted but ambulatory) | 4 Participants | 6 Participants | 4 Participants | 4 Participants | 6 Participants | 1 Participants | 25 Participants |
| Race/Ethnicity, Customized Black | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants | 2 Participants | 5 Participants |
| Race/Ethnicity, Customized White | 6 Participants | 9 Participants | 6 Participants | 8 Participants | 11 Participants | 3 Participants | 43 Participants |
| Sex: Female, Male Female | 4 Participants | 6 Participants | 5 Participants | 6 Participants | 5 Participants | 3 Participants | 29 Participants |
| Sex: Female, Male Male | 3 Participants | 3 Participants | 2 Participants | 2 Participants | 7 Participants | 2 Participants | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 5 / 7 | 3 / 9 | 1 / 7 | 3 / 8 | 6 / 12 | 3 / 5 |
| other Total, other adverse events | 7 / 7 | 9 / 9 | 7 / 7 | 8 / 8 | 12 / 12 | 5 / 5 |
| serious Total, serious adverse events | 2 / 7 | 5 / 9 | 4 / 7 | 3 / 8 | 3 / 12 | 2 / 5 |
Outcome results
Number of Participants With Dose-limiting Toxicities (DLTs)
DLTs were defined as the following events considered treatment-related by the Investigator, graded per Common Terminology Criteria for Adverse Events (CTCAE) v4.0. * Radiation-induced myelopathy/myelitis or ≥ Grade (G) 3 cardiac toxicity * Radiation-related pneumonitis resulting in delay in RT, CT, or veliparib of \>3 weeks or early discontinuation (DC) of RT (total dose \<50 Gy) * ≥G4 esophagitis or esophagitis, dysphagia, and odynophagia requiring treatment interruption of \>7 days despite medical management, neutropenia for \>7 days or neutropenic fever or thrombocytopenia * ≥G2 seizure * G4 diarrhea or nausea/vomiting despite antiemetic therapy for \>48 hours * Any other toxicity resulting in delay in RT, CT or veliparib \>14 days or early DC of RT * Other nonhematologic toxicities ≥G3, except anorexia, fatigue, G3 infection, G3 aspartate/alanine transferase (AST/ALT) elevations ≤7 days, infusion reactions, G3/4 lymphopenia or electrolyte abnormalities corrected to ≤G2 in \<48 hours
Time frame: For Cohorts 1 - 5, from the start of veliparib dosing through 28 days after RT completion or until initiation of consolidation CT, approx. 10 weeks; For Cohort 6, 21 days from start of consolidation CT or until the start of cycle 2 consolidation therapy.
Population: Participants who received at least 1 dose of veliparib
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 0 Participants |
| Veliparib 80 mg BID + CRT -> Veliparib 120 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 0 Participants |
| Veliparib 120 mg BID + CRT -> Veliparib 120 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 0 Participants |
| Veliparib 200 mg BID + CRT -> Veliparib 120 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 1 Participants |
| Veliparib 240 mg BID + CRT -> Veliparib 120 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 0 Participants |
| Veliparib 240 mg BID + CRT -> Veliparib 240 mg BID + CT | Number of Participants With Dose-limiting Toxicities (DLTs) | 2 Participants |
Objective Response Rate
Objective response rate (ORR) is defined as the percentage of participants who have a confirmed complete response (CR) or partial response (PR) as assessed by the investigator using RECIST v1.1. Participants who did not meet complete response or partial response, including those who did not have post-baseline radiological assessments were considered as non-responders. Complete Response (CR): The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level. All lymph nodes must be non-pathological in size (\< 10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Response must have been confirmed 4 weeks after the first documentation.
Time frame: Tumor assessments were performed prior to consolidation chemotherapy, 24 weeks after start of treatment, every 8 weeks until 1 year after start of treatment, and then every 12 weeks until disease progression; median time on follow-up was 11 months.
Population: Participants who received at least 1 dose of veliparib and with at least one post-baseline tumor assessment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Objective Response Rate | 50.0 percentage of participants |
| Veliparib 80 mg BID + CRT -> Veliparib 120 mg BID + CT | Objective Response Rate | 50.0 percentage of participants |
| Veliparib 120 mg BID + CRT -> Veliparib 120 mg BID + CT | Objective Response Rate | 100.0 percentage of participants |
| Veliparib 200 mg BID + CRT -> Veliparib 120 mg BID + CT | Objective Response Rate | 62.5 percentage of participants |
| Veliparib 240 mg BID + CRT -> Veliparib 120 mg BID + CT | Objective Response Rate | 72.7 percentage of participants |
| Veliparib 240 mg BID + CRT -> Veliparib 240 mg BID + CT | Objective Response Rate | 0.0 percentage of participants |
Duration of Overall Response (DOR)
Duration of overall response was defined as time from the date of first response (CR or PR) to the earliest documentation of radiographic progressive disease or death due to disease progression, calculated using Kaplan-Meier methods. Participants who did not experience radiographic disease progression or death were censored at the date of the last disease assessment.
Time frame: Tumor assessments were performed prior to consolidation chemotherapy, 24 weeks after start of treatment, every 8 weeks until 1 year after start of treatment, and then every 12 weeks until disease progression; median time on follow-up was 11 months.
Population: Participants who received at least 1 dose of veliparib with at least 1 post-baseline tumor assessment and a confirmed response; DOR was prespecified as a secondary endpoint in Phase 2, which was not conducted. For Phase 1 DOR was not a prespecified endpoint and was only analyzed for all cohorts combined due to the small sample size of each cohort.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Duration of Overall Response (DOR) | 30.4 months |
Overall Survival
Overall survival (OS) was defined as the time from the participant's first dose of study drug to the date of death, and was calculated using Kaplan-Meier methods. Participants who did not die were censored at the date of last study visit or the last known date to be alive, whichever was later.
Time frame: From first dose of study drug until end of study; maximum time on follow-up was approximately 46 months.
Population: All participants who received veliparib; OS was pre-specified in the Protocol as a secondary endpoint in Phase 2, which was not conducted. For Phase 1 OS was not a pre-specified endpoint, and was only analyzed for all treatment cohorts combined due to the small sample sizes within each cohort.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Overall Survival | 32.6 months |
Progression-free Survival
Progression-free survival (PFS) was defined as the time from first dose of study drug to the date of earliest radiographic disease progression per investigator assessment based on Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death, and was calculated using Kaplan-Meier methods. All radiographic disease progression was included regardless whether the event occurred while the participant was taking study drug or had previously discontinued study drug. Participants who did not experience radiographic disease progression or death were censored at the date of the last disease assessment. Participants with no post-baseline disease assessment were censored at first dose date plus 1 day. Progressive disease (PD) was defined as at least a 20% increase in the size of target lesions with an absolute increase of at least 5 mm, unequivocal progression of existing non-target lesions, or the appearance of one or more new lesions.
Time frame: From first dose until end of study; maximum time on follow-up was approximately 46 months.
Population: All participants who received veliparib; PFS was pre-specified in the Protocol as a primary endpoint in Phase 2, which was not conducted. For Phase 1 PFS was not a pre-specified endpoint, and was only analyzed for all treatment cohorts combined due to the small sample sizes within each cohort.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Veliparib 60 mg BID + CRT -> Veliparib 120 mg BID + CT | Progression-free Survival | 19.6 months |