Lung Cancer
Conditions
Brief summary
In this study, all patients must have already completed first-line chemotherapy to treat extensive-stage disease small cell lung cancer. The purpose of this study is to show that nivolumab, or nivolumab plus ipilimumab followed by nivolumab by itself, will prolong overall survival when administered as consolidation treatment in patients that are stable or responding after chemotherapy. Patients receiving treatment will be compared with patients taking placebo.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Subjects with histologically or cytologically confirmed extensive stage disease SCLC * Ongoing response of stable disease or better following 4 cycles of platinum-based first line chemotherapy * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Exclusion criteria
* Subjects with symptomatic Central Nervous System (CNS) metastases * Subjects receiving consolidative chest radiation * Subjects with active, known, or suspected autoimmune disease are excluded * All side effects attributed to prior anti-cancer therapy must have resolved to Grade 1 or baseline Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo In The Global Population | From randomization to 400 deaths across the two treatment groups (Nivo+Ipi vs Placebo) (up to approximately 37 months) | OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) of Nivolumab Versus Placebo | From randomization to the date of death or last known alive date (up to approximately 73 months) | Overall Survival (OS) comparing nivolumab monotherapy versus placebo. OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug. |
| Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab | From randomization to the date of death or last known alive date (up to approximately 73 months) | Overall Survival (OS) comparing Nivolumab + Ipilimumab Versus Nivolumab. OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug. |
| Progression Free Survival (PFS) Per BICR | From randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 73 months) | PFS was defined as the time between the date of randomization and the first date of documented progression as determined by Blind Independent Central Review (BICR) or death due to any cause, whichever occurred first. Participants who died with no reported progression were considered to have progressed on the date of death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on study tumor assessments and did not die (or died after initiation of the subsequent anti- cancer therapy) were censored on their date of randomization. Participants who started any subsequent anti- cancer therapy without a prior reported Progressive Disease (PD) per BICR were censored at the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. |
| Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | From randomization to the date of death or last known alive date (up to approximately 73 months) | Tumor mutational burden (TMB) is measured using FoundationOne CDxTM (F1CDx) assay, a comprehensive genomic profile (CGP) assay based on baseline tumor tissue. TMB is defined as the number of somatic, coding, base substitution, and indel mutations per megabase of genome examined. OS in TMB by the following cutoff points: ≥10 mutations/mb, \< 10 mutations/mb, ≥13 mutations/mb, \<13 mutations/mb |
| Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | From randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 73 months) | Tumor mutational burden (TMB) is measured using FoundationOne CDxTM (F1CDx) assay, a comprehensive genomic profile (CGP) assay based on baseline tumor tissue. TMB is defined as the number of somatic, coding, base substitution, and indel mutations per megabase of genome examined. PFS in TMB by the following cutoff points: ≥10 mutations/mb, \< 10 mutations/mb, ≥13 mutations/mb, \<13 mutations/mb. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Canada, China, Colombia, Finland, France, Germany, Greece, Hong Kong, Ireland, Israel, Italy, Japan, Mexico, Netherlands, Peru, Poland, Romania, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom, United States
Participant flow
Pre-assignment details
907 participants were randomized and 903 were treated. 2 participants were in both the Global and China population.
Participants by arm
| Arm | Count |
|---|---|
| Placebo 100 mL of 0.9% Sodium Chloride Solution or 5% Dextrose administered as placebo for nivolumab and ipilimumab as an IV infusion | 300 |
| Nivolumab 240 mg Nivolumab 240 mg administered every 2 weeks as a 30-minute IV infusion | 304 |
| Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg Nivolumab 1 mg/kg (30-minute IV infusion) + Ipilimumab 3 mg/kg (90-minute IV infusion) administered every 3 weeks for 4 doses, followed by nivolumab 240 mg every 2 weeks | 303 |
| Total | 907 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Pre-Treatment | Disease progression | 1 | 0 | 0 |
| Pre-Treatment | no longer meets study criteria | 1 | 0 | 0 |
| Pre-Treatment | Withdrew Consent | 0 | 1 | 1 |
| Treatment | Administrative reason by sponsor | 0 | 0 | 1 |
| Treatment | Adverse event unrelated to study drug | 8 | 10 | 15 |
| Treatment | Death | 0 | 2 | 3 |
| Treatment | Disease progression | 270 | 227 | 165 |
| Treatment | Lost to Follow-up | 0 | 1 | 1 |
| Treatment | Maximum clinical benefit | 4 | 3 | 4 |
| Treatment | Not reported | 2 | 2 | 2 |
| Treatment | Other reasons | 8 | 15 | 5 |
| Treatment | Participant no longer meets study criteria | 0 | 2 | 0 |
| Treatment | Participant request to discontinue study treatment | 3 | 6 | 11 |
| Treatment | Participant withdrew consent | 2 | 5 | 3 |
| Treatment | Poor/non-compliance | 0 | 1 | 0 |
| Treatment | Study drug toxicity | 1 | 29 | 92 |
Baseline characteristics
| Characteristic | Placebo | Nivolumab 240 mg | Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Total |
|---|---|---|---|---|
| Age, Customized < 65 | 161 Participants | 149 Participants | 152 Participants | 462 Participants |
| Age, Customized ≥ 65 and < 75 | 113 Participants | 120 Participants | 115 Participants | 348 Participants |
| Age, Customized ≥ 75 and < 85 | 26 Participants | 35 Participants | 35 Participants | 96 Participants |
| Age, Customized ≥ 85 | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 14 Participants | 11 Participants | 15 Participants | 40 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 160 Participants | 164 Participants | 171 Participants | 495 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 126 Participants | 129 Participants | 117 Participants | 372 Participants |
| Race/Ethnicity, Customized Asian | 94 Participants | 82 Participants | 82 Participants | 258 Participants |
| Race/Ethnicity, Customized Black or African American | 2 Participants | 6 Participants | 1 Participants | 9 Participants |
| Race/Ethnicity, Customized Not Reported | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Other | 6 Participants | 3 Participants | 3 Participants | 12 Participants |
| Race/Ethnicity, Customized White | 198 Participants | 213 Participants | 216 Participants | 627 Participants |
| Sex: Female, Male Female | 103 Participants | 105 Participants | 101 Participants | 309 Participants |
| Sex: Female, Male Male | 197 Participants | 199 Participants | 202 Participants | 598 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 | 250 / 275 | 231 / 280 | 240 / 279 | 24 / 26 | 23 / 25 | 23 / 24 |
| other Total, other adverse events | 228 / 273 | 244 / 279 | 263 / 278 | 22 / 26 | 23 / 25 | 24 / 24 |
| serious Total, serious adverse events | 117 / 273 | 131 / 279 | 198 / 278 | 8 / 26 | 10 / 25 | 19 / 24 |
Outcome results
Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo In The Global Population
OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug
Time frame: From randomization to 400 deaths across the two treatment groups (Nivo+Ipi vs Placebo) (up to approximately 37 months)
Population: All randomized participants in the nivolumab + ipilimumab and placebo arms in the global population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Global Placebo | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo In The Global Population | 9.56 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo In The Global Population | 9.17 Months |
Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population
Tumor mutational burden (TMB) is measured using FoundationOne CDxTM (F1CDx) assay, a comprehensive genomic profile (CGP) assay based on baseline tumor tissue. TMB is defined as the number of somatic, coding, base substitution, and indel mutations per megabase of genome examined. OS in TMB by the following cutoff points: ≥10 mutations/mb, \< 10 mutations/mb, ≥13 mutations/mb, \<13 mutations/mb
Time frame: From randomization to the date of death or last known alive date (up to approximately 73 months)
Population: All TMB evaluable participants in the global population
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Global Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 11.96 Months |
| Global Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 10.02 Months |
| Global Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 9.69 Months |
| Global Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 9.20 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 9.76 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 12.98 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 9.89 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 12.81 Months |
| China Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 7.85 Months |
| China Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 10.55 Months |
| China Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 13.47 Months |
| China Placebo | Overall Survival (OS) in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 8.11 Months |
Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab
Overall Survival (OS) comparing Nivolumab + Ipilimumab Versus Nivolumab. OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug.
Time frame: From randomization to the date of death or last known alive date (up to approximately 73 months)
Population: All randomized participants in the Nivolumab + Ipilimumab and Nivolumab arms
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Global Placebo | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab | 10.18 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab | 9.17 Months |
| China Placebo | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab | 8.18 Months |
| China Nivolumab 240 mg | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Nivolumab | 10.48 Months |
Overall Survival (OS) of Nivolumab Versus Placebo
Overall Survival (OS) comparing nivolumab monotherapy versus placebo. OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug.
Time frame: From randomization to the date of death or last known alive date (up to approximately 73 months)
Population: All randomized participants in the nivolumab monotherapy and placebo arms
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Global Placebo | Overall Survival (OS) of Nivolumab Versus Placebo | 9.56 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) of Nivolumab Versus Placebo | 10.18 Months |
| China Placebo | Overall Survival (OS) of Nivolumab Versus Placebo | 9.28 Months |
| China Nivolumab 240 mg | Overall Survival (OS) of Nivolumab Versus Placebo | 8.18 Months |
Progression Free Survival (PFS) Per BICR
PFS was defined as the time between the date of randomization and the first date of documented progression as determined by Blind Independent Central Review (BICR) or death due to any cause, whichever occurred first. Participants who died with no reported progression were considered to have progressed on the date of death. Participants who did not progress or die were censored on the date of their last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on study tumor assessments and did not die (or died after initiation of the subsequent anti- cancer therapy) were censored on their date of randomization. Participants who started any subsequent anti- cancer therapy without a prior reported Progressive Disease (PD) per BICR were censored at the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy.
Time frame: From randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 73 months)
Population: All randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Global Placebo | Progression Free Survival (PFS) Per BICR | 1.41 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR | 1.94 Months |
| China Placebo | Progression Free Survival (PFS) Per BICR | 1.74 Months |
| China Nivolumab 240 mg | Progression Free Survival (PFS) Per BICR | 1.38 Months |
| China Nivolumab 240 mg | Progression Free Survival (PFS) Per BICR | 1.58 Months |
| China Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR | 1.54 Months |
Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population
Tumor mutational burden (TMB) is measured using FoundationOne CDxTM (F1CDx) assay, a comprehensive genomic profile (CGP) assay based on baseline tumor tissue. TMB is defined as the number of somatic, coding, base substitution, and indel mutations per megabase of genome examined. PFS in TMB by the following cutoff points: ≥10 mutations/mb, \< 10 mutations/mb, ≥13 mutations/mb, \<13 mutations/mb.
Time frame: From randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 73 months)
Population: All TMB evaluable participants in the global population
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Global Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 1.58 Months |
| Global Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 1.41 Months |
| Global Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 1.58 Months |
| Global Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 1.41 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 1.84 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 2.79 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 1.61 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 2.76 Months |
| China Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥10 mutations/mb | 2.33 Months |
| China Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | ≥13 mutations/mb | 2.63 Months |
| China Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | <13 mutations/mb | 1.48 Months |
| China Placebo | Progression Free Survival (PFS) Per BICR in Tumor Mutational Burden (TMB) High and Low Subgroups by TMB Cutoff In The Global Population | < 10 mutations/mb | 1.48 Months |
Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo - Extended Collection
Overall survival (OS) comparing nivolumab + ipilimumab versus placebo. OS was defined as the time from randomization to the date of death. A participant who had not died was censored at last known alive date. OS was followed up during the blinded study drug treatment and every 3 months via in-person or phone contact after participant discontinued the blinded study drug. Note: This outcome measure represents an updated version of the primary endpoint to include additional data collection that has occurred after the primary completion date. (Assessments were made until 11-Nov-2021).
Time frame: From randomization to the date of death or last known alive date (up to approximately 73 months)
Population: All randomized participants in the nivolumab + ipilimumab and placebo arms
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Global Placebo | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo - Extended Collection | 9.56 Months |
| Global Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo - Extended Collection | 9.17 Months |
| China Placebo | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo - Extended Collection | 9.28 Months |
| China Nivolumab 240 mg | Overall Survival (OS) of Nivolumab + Ipilimumab Versus Placebo - Extended Collection | 10.48 Months |