Non-Small Cell Lung Cancer
Conditions
Brief summary
The purpose of this study is to determine whether Nivolumab improves life expectancy compared to Docetaxel in Subjects with Advanced or Metastatic Non-small Cell Lung Cancer who have failed prior platinum-based doublet chemotherapy.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com Inclusion Criteria: * Disease progression experienced during or after one prior platinum containing doublet chemotherapy * Stage IIIb/IV or recurrent disease * Male and Female ≥ 18 years of age * Measurable disease per RECIST 1.1 * Performance Status ≤ 1
Exclusion criteria
* History of Carcinomatous meningitis * Active Central nervous system (CNS) metastases * History of auto immune diseases * Prior treatment with Docetaxel * Prior treatment with ipilimumab or any drug targeting T-Cell costimulation or checkpoint pathways
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Median Overall Survival | From randomization to the date of death or date participant was last known to be alive (assessed from December 2015 to Oct 2017 approximately 22 months) | OS was defined as the time between the date of randomization and the date of death. For subjects without documentation of death, OS was censored on the last date the subject was known to be alive |
| Overall Survival Rate | From first dose to the date of death or date participant was last known to be alive (assessed from December 2015 to Oct 2017 approximately 22 months) | OS was defined as the time between the date of randomization and the date of death. For subjects without documentation of death, OS was censored on the last date the subject was known to be alive. Rates provided are Kaplan-Meier estimates. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | From the time of randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 90 months) | PFS was defined as the time from randomization to the date of the first documented tumor progression as determined by investigators per RECIST 1.1, or death due to any cause. Clinical deterioration in the absence of unequivocal evidence of progression was not considered progression for purposes of determining PFS. Participants who died without a reported prior progression were considered to have progressed on the date of their death. Participants who did not have disease progression or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on study tumor assessments and did not die were censored at the randomization date. Participants who started any subsequent anti-cancer therapy (including on-treatment palliative RT of non-target bone lesions, skin lesions or CNS lesions) without a prior reported progression were censored at the last evaluable tumor assessment prior to or on initiation of the subsequent anti-cancer therapy. |
| Progression Free Survival Rate | From the time of randomization up to 6 months | Clinical deterioration in the absence of unequivocal evidence of progression (per RECIST 1.1) is not considered progression for purposes of determining PFS. Participants who die without a reported prior progression will be considered to have progressed on the date of their death. Participants who did not have disease progression or die will be censored on the date of their last evaluable tumor assessment. Participants who did not have any on study tumor assessments and did not die will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported progression will be censored at the last evaluable tumor assessment prior to or on initiation of the subsequent anti-cancer therapy. Six month progression-free survival rate as estimated using the Kaplan-Meier method |
| Time to Treatment Failure (TTF) | From randomization up to disease progression, death, or last dose (up to approximately 17 months) | TTF was defined as the minimum of the time from randomization to disease progression (per RECIST 1.1 or clinical), death or last dose date if a participant discontinued from treatment for any reasons other than maximum clinical benefit and administrative reasons by sponsor. TTF was considered as event at the randomization date for participants who were randomized but not treated. TTF was censored at the last dose date for participants who discontinued treatment due to maximum clinical benefit or administrative reasons by sponsor. TTF was censored at the last dose date for participants who continued on treatment without progression or death. This outcome measure was prespecified in the protocol to only be evaluated through the first Interim Analysis, which occurred in June 2017. |
| Objective Response Rate (ORR) | From date of first dose up to partial or complete response (up to approximately 90 months) | Investigator assessed ORR was defined as the number of participants whose best objective response (BOR) was a confirmed complete response (CR) or confirmed partial response (PR), as determined by the investigator, divided by the number of randomized participants. CR= Disappearance of all target 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. |
| Number of Participants Experiencing Treatment-Related Serious Adverse Events (SAEs) | From first dose up to 100 days after last dose (up to 93 months) | A treatment-related Serious Adverse Event (SAE) is defined as any untoward medical occurrence that, at any dose results in death, is life-threatening (defined as an event in which the participant was at risk of death at the time of the event; it does not refer to an event which hypothetically might have caused death if it were more severe), requires inpatient hospitalization or causes prolongation of existing hospitalization and is determined to be associated with the study treatment. |
| Disease Related Symptom Deterioration Rate by Week 12 and Week 24 | At Week 12 and Week 24 | Disease-Related Symptom Deterioration Rate is the percentage of participants with \>=10 points increase from baseline in Average Symptom Burden Index (ASBI) score at any time between randomization and the timepoints. The Lung Cancer Symptom Scale (LCSS) measures 6 items (loss of appetite, fatigue, coughing, shortness of breath, hemoptysis, pain) and 3 symptom burden items (disease-related functional limitations, quality of life) with responses captured using a 100mm visual analog scale (VAS). Scores range from 0 (highest quality of life) to 100 (worst quality of life) and is derived by dividing the length of the line drawn from the lowest possible response to the patient's response by the length of the VAS and multiplying the result by 100. An ASBI score can be derived as the mean of scores for the 6 symptom-related items with a clinically meaningful change in ASBI score being 10 points and a meaningful deterioration in symptoms is a mean post-baseline score change \>= 10 points. |
| Number of Participants Experiencing Treatment-Related Adverse Events (AEs) | From first dose up to 100 days after last dose (up to 93 months) | A treatment-related Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a clinical investigation participant administered study treatment and is determined to be associated with the study treatment. Adverse events are graded on a scale from 1 to 5, with Grade 1 being mild and asymptomatic; Grade 2 is moderate requiring minimal, local or noninvasive intervention; Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events are usually severe enough to require hospitalization; Grade 5 events are fatal. |
| Overall Survival (OS) in Subpopulations | From randomization to the date of death or date participant was last known to be alive (up to approximately 90 months) | OS was defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS was censored on the last date the participant was known to be alive. Test stratified by histology (SQ vs NSQ), PD-L1 status at 1% expression level (positive vs negative/unevaluable). |
Countries
China, Hong Kong, Russia, Singapore
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Nivolumab 3 mg/kg every 2 weeks until disease progression or unacceptable toxicity | 338 |
| Docetaxel 75 mg/m² every 3 weeks until disease progression or unacceptable toxicity | 166 |
| Total | 504 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Pre-Treamtent | Participant no longer meets study criteria | 1 | 1 |
| Pre-Treamtent | Participant request to discontinue study treatment | 0 | 5 |
| Pre-Treamtent | Participant withdrew consent | 0 | 4 |
| Treatment | Adverse event unrelated to study drug | 20 | 3 |
| Treatment | Death | 2 | 0 |
| Treatment | Disease progression | 263 | 110 |
| Treatment | Lost to Follow-up | 1 | 0 |
| Treatment | Maximum clinical benefit | 5 | 10 |
| Treatment | Not reported | 3 | 0 |
| Treatment | Other reasons | 8 | 0 |
| Treatment | Participant no longer meets criteria | 3 | 0 |
| Treatment | Participant request to discontinue study treatment | 13 | 17 |
| Treatment | Participant withdrew consent | 0 | 2 |
| Treatment | Study drug toxicity | 19 | 14 |
Baseline characteristics
| Characteristic | Nivolumab | Docetaxel | Total |
|---|---|---|---|
| Age, Continuous | 59.1 Years STANDARD_DEVIATION 9.07 | 59.3 Years STANDARD_DEVIATION 8.13 | 59.1 Years STANDARD_DEVIATION 8.77 |
| Race/Ethnicity, Customized Asian Other | 2 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Chinese | 306 Participants | 151 Participants | 457 Participants |
| Race/Ethnicity, Customized White | 30 Participants | 15 Participants | 45 Participants |
| Sex/Gender, Customized Female | 75 Participants | 32 Participants | 107 Participants |
| Sex/Gender, Customized Male | 263 Participants | 134 Participants | 397 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 294 / 337 | 146 / 156 | 8 / 9 |
| other Total, other adverse events | 318 / 337 | 146 / 156 | 9 / 9 |
| serious Total, serious adverse events | 183 / 337 | 73 / 156 | 4 / 9 |
Outcome results
Median Overall Survival
OS was defined as the time between the date of randomization and the date of death. For subjects without documentation of death, OS was censored on the last date the subject was known to be alive
Time frame: From randomization to the date of death or date participant was last known to be alive (assessed from December 2015 to Oct 2017 approximately 22 months)
Population: All randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Median Overall Survival | 11.99 Months |
| Docetaxel | Median Overall Survival | 9.63 Months |
Overall Survival Rate
OS was defined as the time between the date of randomization and the date of death. For subjects without documentation of death, OS was censored on the last date the subject was known to be alive. Rates provided are Kaplan-Meier estimates.
Time frame: From first dose to the date of death or date participant was last known to be alive (assessed from December 2015 to Oct 2017 approximately 22 months)
Population: All randomized participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nivolumab | Overall Survival Rate | Rate at 6 months | 72.4 percentage |
| Nivolumab | Overall Survival Rate | Rate at 12 months | 49.7 percentage |
| Docetaxel | Overall Survival Rate | Rate at 6 months | 64.8 percentage |
| Docetaxel | Overall Survival Rate | Rate at 12 months | 38.8 percentage |
Disease Related Symptom Deterioration Rate by Week 12 and Week 24
Disease-Related Symptom Deterioration Rate is the percentage of participants with \>=10 points increase from baseline in Average Symptom Burden Index (ASBI) score at any time between randomization and the timepoints. The Lung Cancer Symptom Scale (LCSS) measures 6 items (loss of appetite, fatigue, coughing, shortness of breath, hemoptysis, pain) and 3 symptom burden items (disease-related functional limitations, quality of life) with responses captured using a 100mm visual analog scale (VAS). Scores range from 0 (highest quality of life) to 100 (worst quality of life) and is derived by dividing the length of the line drawn from the lowest possible response to the patient's response by the length of the VAS and multiplying the result by 100. An ASBI score can be derived as the mean of scores for the 6 symptom-related items with a clinically meaningful change in ASBI score being 10 points and a meaningful deterioration in symptoms is a mean post-baseline score change \>= 10 points.
Time frame: At Week 12 and Week 24
Population: All randomized participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nivolumab | Disease Related Symptom Deterioration Rate by Week 12 and Week 24 | Week 12 | 29.9 Percentage of participants |
| Nivolumab | Disease Related Symptom Deterioration Rate by Week 12 and Week 24 | Week 24 | 34.6 Percentage of participants |
| Docetaxel | Disease Related Symptom Deterioration Rate by Week 12 and Week 24 | Week 12 | 40.4 Percentage of participants |
| Docetaxel | Disease Related Symptom Deterioration Rate by Week 12 and Week 24 | Week 24 | 42.2 Percentage of participants |
Number of Participants Experiencing Treatment-Related Adverse Events (AEs)
A treatment-related Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a clinical investigation participant administered study treatment and is determined to be associated with the study treatment. Adverse events are graded on a scale from 1 to 5, with Grade 1 being mild and asymptomatic; Grade 2 is moderate requiring minimal, local or noninvasive intervention; Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events are usually severe enough to require hospitalization; Grade 5 events are fatal.
Time frame: From first dose up to 100 days after last dose (up to 93 months)
Population: All treated participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nivolumab | Number of Participants Experiencing Treatment-Related Adverse Events (AEs) | 220 Participants |
| Docetaxel | Number of Participants Experiencing Treatment-Related Adverse Events (AEs) | 131 Participants |
Number of Participants Experiencing Treatment-Related Serious Adverse Events (SAEs)
A treatment-related Serious Adverse Event (SAE) is defined as any untoward medical occurrence that, at any dose results in death, is life-threatening (defined as an event in which the participant was at risk of death at the time of the event; it does not refer to an event which hypothetically might have caused death if it were more severe), requires inpatient hospitalization or causes prolongation of existing hospitalization and is determined to be associated with the study treatment.
Time frame: From first dose up to 100 days after last dose (up to 93 months)
Population: All treated participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nivolumab | Number of Participants Experiencing Treatment-Related Serious Adverse Events (SAEs) | 34 Participants |
| Docetaxel | Number of Participants Experiencing Treatment-Related Serious Adverse Events (SAEs) | 25 Participants |
Objective Response Rate (ORR)
Investigator assessed ORR was defined as the number of participants whose best objective response (BOR) was a confirmed complete response (CR) or confirmed partial response (PR), as determined by the investigator, divided by the number of randomized participants. CR= Disappearance of all target 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.
Time frame: From date of first dose up to partial or complete response (up to approximately 90 months)
Population: All randomized participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nivolumab | Objective Response Rate (ORR) | All randomized participants | 17.5 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | Squamous NSCLC | 21.1 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | Non-Squamous NSCLC | 15.1 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | PD-L1 >= 1% | 17.3 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | PD-L1 < 1% | 18.1 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | PD-L1 Non-quantifiable | 15.6 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | Chinese | 17.2 Percentage of participants |
| Nivolumab | Objective Response Rate (ORR) | Non-Chinese | 19.4 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | Non-Chinese | 11.8 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | All randomized participants | 4.2 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | PD-L1 < 1% | 3.0 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | Squamous NSCLC | 1.5 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | Chinese | 3.4 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | Non-Squamous NSCLC | 6.1 Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | PD-L1 Non-quantifiable | NA Percentage of participants |
| Docetaxel | Objective Response Rate (ORR) | PD-L1 >= 1% | 6.0 Percentage of participants |
Overall Survival (OS) in Subpopulations
OS was defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS was censored on the last date the participant was known to be alive. Test stratified by histology (SQ vs NSQ), PD-L1 status at 1% expression level (positive vs negative/unevaluable).
Time frame: From randomization to the date of death or date participant was last known to be alive (up to approximately 90 months)
Population: All randomized participants
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Nivolumab | Overall Survival (OS) in Subpopulations | Less than 1% PD-L1 expression | 11.37 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Histologically Squamous | 11.70 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Greater than/equal to 1% PD-L1 expression | 11.99 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Histologically Non-squamous | 11.86 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Non-quantifiable PD-L1 Expression | 15.57 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Chinese participants | 11.76 Months |
| Nivolumab | Overall Survival (OS) in Subpopulations | Non-Chinese participants | 12.98 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Chinese participants | 8.57 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Non-Chinese participants | 16.30 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Greater than/equal to 1% PD-L1 expression | 7.89 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Less than 1% PD-L1 expression | 10.25 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Non-quantifiable PD-L1 Expression | 16.30 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Histologically Squamous | 7.89 Months |
| Docetaxel | Overall Survival (OS) in Subpopulations | Histologically Non-squamous | 10.22 Months |
Progression Free Survival (PFS)
PFS was defined as the time from randomization to the date of the first documented tumor progression as determined by investigators per RECIST 1.1, or death due to any cause. Clinical deterioration in the absence of unequivocal evidence of progression was not considered progression for purposes of determining PFS. Participants who died without a reported prior progression were considered to have progressed on the date of their death. Participants who did not have disease progression or die were censored on the date of their last evaluable tumor assessment. Participants who did not have any on study tumor assessments and did not die were censored at the randomization date. Participants who started any subsequent anti-cancer therapy (including on-treatment palliative RT of non-target bone lesions, skin lesions or CNS lesions) without a prior reported progression were censored at the last evaluable tumor assessment prior to or on initiation of the subsequent anti-cancer therapy.
Time frame: From the time of randomization to the date of the first documented tumor progression or death due to any cause (up to approximately 90 months)
Population: All randomized participants
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Nivolumab | Progression Free Survival (PFS) | All randomized participants | 2.79 Months |
| Nivolumab | Progression Free Survival (PFS) | Histologically Squamous | 2.92 Months |
| Nivolumab | Progression Free Survival (PFS) | Histologically Non-Squamous | 2.60 Months |
| Nivolumab | Progression Free Survival (PFS) | PD-L1 >= 1% | 2.76 Months |
| Nivolumab | Progression Free Survival (PFS) | PD-L1 < 1% | 2.86 Months |
| Nivolumab | Progression Free Survival (PFS) | PD-L1 Non-quantifiable | 2.00 Months |
| Nivolumab | Progression Free Survival (PFS) | Chinese participants | 2.76 Months |
| Nivolumab | Progression Free Survival (PFS) | Non-Chinese participants | 3.50 Months |
| Docetaxel | Progression Free Survival (PFS) | PD-L1 >= 1% | 2.56 Months |
| Docetaxel | Progression Free Survival (PFS) | All randomized participants | 2.76 Months |
| Docetaxel | Progression Free Survival (PFS) | PD-L1 Non-quantifiable | 4.07 Months |
| Docetaxel | Progression Free Survival (PFS) | Histologically Squamous | 2.66 Months |
| Docetaxel | Progression Free Survival (PFS) | Non-Chinese participants | 8.48 Months |
| Docetaxel | Progression Free Survival (PFS) | PD-L1 < 1% | 2.78 Months |
| Docetaxel | Progression Free Survival (PFS) | Histologically Non-Squamous | 2.83 Months |
| Docetaxel | Progression Free Survival (PFS) | Chinese participants | 2.69 Months |
Progression Free Survival Rate
Clinical deterioration in the absence of unequivocal evidence of progression (per RECIST 1.1) is not considered progression for purposes of determining PFS. Participants who die without a reported prior progression will be considered to have progressed on the date of their death. Participants who did not have disease progression or die will be censored on the date of their last evaluable tumor assessment. Participants who did not have any on study tumor assessments and did not die will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported progression will be censored at the last evaluable tumor assessment prior to or on initiation of the subsequent anti-cancer therapy. Six month progression-free survival rate as estimated using the Kaplan-Meier method
Time frame: From the time of randomization up to 6 months
Population: All randomized participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab | Progression Free Survival Rate | 29.3 Percentage |
| Docetaxel | Progression Free Survival Rate | 24.8 Percentage |
Time to Treatment Failure (TTF)
TTF was defined as the minimum of the time from randomization to disease progression (per RECIST 1.1 or clinical), death or last dose date if a participant discontinued from treatment for any reasons other than maximum clinical benefit and administrative reasons by sponsor. TTF was considered as event at the randomization date for participants who were randomized but not treated. TTF was censored at the last dose date for participants who discontinued treatment due to maximum clinical benefit or administrative reasons by sponsor. TTF was censored at the last dose date for participants who continued on treatment without progression or death. This outcome measure was prespecified in the protocol to only be evaluated through the first Interim Analysis, which occurred in June 2017.
Time frame: From randomization up to disease progression, death, or last dose (up to approximately 17 months)
Population: All randomized participants with at least 8 months of follow-up at the time of TTF analysis. The clinical database cutoff date will occur when the first approximately 380 randomized participants will have at least 8-month of follow-up.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab | Time to Treatment Failure (TTF) | 2.60 Months |
| Docetaxel | Time to Treatment Failure (TTF) | 1.51 Months |