Non-Small Cell Lung Cancer (NSCLC)
Conditions
Brief summary
The purpose of this study was to evaluate the efficacy and safety of tislelizumab in combination with sitravatinib compared to docetaxel in participants with locally advanced or metastatic non-small cell lung cancer (NSCLC) who experienced disease progression following platinum-based chemotherapy and anti-programmed cell death protein-1 (PD-1)/programmed cell death ligand-1 (PD-L1) antibody treatment, with the anti-PD-(L)1 antibody administered either in combination with or sequentially before or after the platinum-based chemotherapy.
Interventions
200 mg intravenously once every 3 weeks
75 mg/m\^2 intravenously once every 3 weeks
100 mg orally once daily
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: 1. Metastatic or unresectable locally advanced histologically or cytologically confirmed Non-Small Cell Lung Cancer (NCSLC), not amenable to treatment with curative intent 2. Able to provide archival/fresh tumor tissues for biomarker analysis to assess PD-L1 expression and other biomarkers. 3. No known Epidermal Growth Factor Receptor (EGFR) or B-Raf proto-oncogene (BRAF) sensitizing mutation, or anaplastic lymphoma kinase (ALK) rearrangement or ROS proto oncogene 1 (ROS1) rearrangement 4. Radiographic progression per Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 on or after anti-PD-(L)1 containing therapy for locally advanced and unresectable or metastatic NSCLC. 5. No prior anticancer therapy having the same mechanism of action as sitravatinib (eg, tyrosine kinase inhibitor with a similar target profile or vascular endothelial growth factor (VEGF)- or VEGFR inhibitor) 6. At least 1 measurable lesion as defined based on RECIST v1.1 by investigator Key
Exclusion criteria
1. Has received docetaxel as monotherapy or in combination with other therapies. 2. Squamous NSCLC with central cavitation, or NSCLC with hemoptysis (\> 50 mL/day) 3. Participants with tumor shown by imaging to be located around important vascular structures or if the investigator determines that the tumor is likely to invade important blood vessels and may cause fatal bleeding. 4. Active leptomeningeal disease for metastatic NSCLC, or uncontrolled or untreated brain metastasis. 5. Active autoimmune diseases or history of autoimmune diseases that may relapse. NOTE: Other protocol defined Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the time from randomization until the date of death due to any cause. Kaplan-Meier methodology was used to estimate the median OS. |
| Progression Free Survival (PFS) as Assessed by the Independent Review Committee (IRC) | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the time from randomization until first documentation of disease progression as assessed by the IRC based on Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death from any cause, whichever occured first. Kaplan-Meier methodology was used to estimate the median PFS. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response (DOR) | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the time from the first occurrence of a documented objective response to the time of the first occurrence of disease progression, as determined by the IRC based on RECIST v1.1, or death from any cause, whichever occurs first. |
| Disease Control Rate (DCR) | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the percentage of participants whose best overall response (BOR) is complete response, partial response, or stable disease per RECIST v1.1. |
| Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18) | The EORTC QLQ-30 contains 30 questions that incorporate 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning), 1 global health status scale, 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). The participant answers questions about their health during the past week. There are 28 questions answered on a 4-point scale where 1 = Not at all (best) and 4 = Very Much (worst) and 2 global health quality of life (QOL) questions answered on a 7-point scale where 1 = Very poor and 7 = Excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. Higher scores in GHS and functional scales indicate better quality of life. |
| Overall Response Rate (ORR) | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) as assessed by the IRC per RECIST v1.1. |
| Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS) | Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18) | The EQ-5D-5L comprises a descriptive module that includes five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression and a Visual Analogue Scale. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The VAS records a participant's self-rated health on a vertical scale from 0 to 100, where 0 is 'the worst health you can imagine and 100 is 'the best health you can imagine'. A higher score indicates better health outcomes. |
| Number of Participants With Adverse Events | From the first dose through 30 days after the final dose or until new anticancer therapy, whichever came first, (a median treatment duration of approximately 4 months in Arm 1 and 2 months in Arm 2). | Number of participants with treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), according to National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0 |
| Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18) | The EORTC QLQ-LC13 is the lung cancer module of the QLQ-C30 and measures lung cancer-specific disease and treatment symptoms. It includes 13 questions about specific symptoms in which participants respond based on a 4-point scale, where 1 is not at all and 4 is very much. Raw scores are transformed into a 0 to 100 scale via linear transformation. Lower scores indicate an improvement in symptoms. |
| Progression Free Survival (PFS) as Assessed by the Investigator | Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months). | Defined as the time from randomization until first documentation of disease progression as determined by the investigator based on RECIST v1.1, or death from any cause, whichever occured first. Kaplan-Meier methodology was used to estimate the median PFS. |
Countries
Australia, China
Participant flow
Recruitment details
Participants were enrolled across multiple study centers in China and Australia. The first participant was dosed on July 27th, 2021, and the last participant completed the study on December 20th, 2023. A decision to terminate the study was made on September 25th, 2023.
Pre-assignment details
Patients were randomized in a 1:1 ratio to one of two treatment groups.
Participants by arm
| Arm | Count |
|---|---|
| Tislelizumab + Sitravatinib Participants received 200 mg of intravenous tislelizumab every 3 weeks, combined with 100 mg of oral sitravatinib daily. | 187 |
| Docetaxel Participants received 75 mg/m² of intravenous docetaxel every 3 weeks. | 190 |
| Total | 377 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 92 | 82 |
| Overall Study | Lost to Follow-up | 3 | 6 |
| Overall Study | Study Terminated by Sponsor | 86 | 89 |
| Overall Study | Withdrawal by Subject | 6 | 13 |
Baseline characteristics
| Characteristic | Docetaxel | Total | Tislelizumab + Sitravatinib |
|---|---|---|---|
| Age, Continuous | 61.3 Years STANDARD_DEVIATION 8.77 | 61.3 Years STANDARD_DEVIATION 8.6 | 61.2 Years STANDARD_DEVIATION 8.43 |
| Histology Non-squamous | 93 Participants | 184 Participants | 91 Participants |
| Histology Squamous | 97 Participants | 193 Participants | 96 Participants |
| PD-L1 Expression Status < 1% Tumor Cells | 119 Participants | 235 Participants | 116 Participants |
| PD-L1 Expression Status >= 1% Tumor Cells | 71 Participants | 142 Participants | 71 Participants |
| Race/Ethnicity, Customized Asian | 177 Participants | 352 Participants | 175 Participants |
| Race/Ethnicity, Customized White | 13 Participants | 25 Participants | 12 Participants |
| Region of Enrollment Australia | 15 participants | 28 participants | 13 participants |
| Region of Enrollment China | 175 participants | 349 participants | 174 participants |
| Sex: Female, Male Female | 39 Participants | 73 Participants | 34 Participants |
| Sex: Female, Male Male | 151 Participants | 304 Participants | 153 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 92 / 187 | 82 / 190 |
| other Total, other adverse events | 181 / 186 | 150 / 177 |
| serious Total, serious adverse events | 83 / 186 | 66 / 177 |
Outcome results
Overall Survival (OS)
Defined as the time from randomization until the date of death due to any cause. Kaplan-Meier methodology was used to estimate the median OS.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: The Intent-to-Treat (ITT) analysis set consists of all participants who were randomized to a treatment arm.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tislelizumab + Sitravatinib | Overall Survival (OS) | 11.5 Months |
| Docetaxel | Overall Survival (OS) | 11.4 Months |
Progression Free Survival (PFS) as Assessed by the Independent Review Committee (IRC)
Defined as the time from randomization until first documentation of disease progression as assessed by the IRC based on Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death from any cause, whichever occured first. Kaplan-Meier methodology was used to estimate the median PFS.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tislelizumab + Sitravatinib | Progression Free Survival (PFS) as Assessed by the Independent Review Committee (IRC) | 4.4 Months |
| Docetaxel | Progression Free Survival (PFS) as Assessed by the Independent Review Committee (IRC) | 2.9 Months |
Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales
The EORTC QLQ-LC13 is the lung cancer module of the QLQ-C30 and measures lung cancer-specific disease and treatment symptoms. It includes 13 questions about specific symptoms in which participants respond based on a 4-point scale, where 1 is not at all and 4 is very much. Raw scores are transformed into a 0 to 100 scale via linear transformation. Lower scores indicate an improvement in symptoms.
Time frame: Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18)
Population: Participants in the ITT Analysis Set with available data at Baseline and each postbaseline visit
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Coughing at Cycle 7 | -5.2 score on a scale | Standard Deviation 25.08 |
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Coughing at Cycle 5 | 1.6 score on a scale | Standard Deviation 30.09 |
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Dyspnoea at Cycle 5 | 2.6 score on a scale | Standard Deviation 19.09 |
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Dyspnoea at Cycle 7 | -0.9 score on a scale | Standard Deviation 14.66 |
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Chest Pain at Cycle 5 | -0.6 score on a scale | Standard Deviation 24.45 |
| Tislelizumab + Sitravatinib | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Chest Pain at Cycle 7 | -2.4 score on a scale | Standard Deviation 22.43 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Chest Pain at Cycle 5 | -0.5 score on a scale | Standard Deviation 20.21 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Dyspnoea at Cycle 7 | 2.1 score on a scale | Standard Deviation 14.43 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Coughing at Cycle 5 | -2.4 score on a scale | Standard Deviation 27.61 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Coughing at Cycle 7 | -1.3 score on a scale | Standard Deviation 29.49 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Chest Pain at Cycle 7 | -1.3 score on a scale | Standard Deviation 16.12 |
| Docetaxel | Change From Baseline in EORTC Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) Coughing, Dyspnoea, and Chest Pain Scales | Dyspnoea at Cycle 5 | 4.5 score on a scale | Standard Deviation 16.76 |
Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores
The EORTC QLQ-30 contains 30 questions that incorporate 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning), 1 global health status scale, 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). The participant answers questions about their health during the past week. There are 28 questions answered on a 4-point scale where 1 = Not at all (best) and 4 = Very Much (worst) and 2 global health quality of life (QOL) questions answered on a 7-point scale where 1 = Very poor and 7 = Excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. Higher scores in GHS and functional scales indicate better quality of life.
Time frame: Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18)
Population: Participants in the ITT Analysis Set with available at Baseline and each postbaseline visit
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tislelizumab + Sitravatinib | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Global Health Status at Cycle 5 | -5.5 score on a scale | Standard Deviation 16.05 |
| Tislelizumab + Sitravatinib | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Global Health Status at Cycle 7 | -6.1 score on a scale | Standard Deviation 15.86 |
| Tislelizumab + Sitravatinib | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Physical Functioning at Cycle 5 | -4.1 score on a scale | Standard Deviation 12.76 |
| Tislelizumab + Sitravatinib | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Physical Functioning at Cycle 7 | -2.8 score on a scale | Standard Deviation 12.3 |
| Docetaxel | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Physical Functioning at Cycle 7 | -3.1 score on a scale | Standard Deviation 16.98 |
| Docetaxel | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Global Health Status at Cycle 5 | -3.0 score on a scale | Standard Deviation 18.69 |
| Docetaxel | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Physical Functioning at Cycle 5 | -5.1 score on a scale | Standard Deviation 15.89 |
| Docetaxel | Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status (GHS) and Physical Functioning Scores | Global Health Status at Cycle 7 | -3.4 score on a scale | Standard Deviation 17.25 |
Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS)
The EQ-5D-5L comprises a descriptive module that includes five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression and a Visual Analogue Scale. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The VAS records a participant's self-rated health on a vertical scale from 0 to 100, where 0 is 'the worst health you can imagine and 100 is 'the best health you can imagine'. A higher score indicates better health outcomes.
Time frame: Baseline and Cycle 5 Day 1 (Week 12) and Cycle 7 Day 1 (Week 18)
Population: Participants in the ITT Analysis Set with available at Baseline and each postbaseline visit
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tislelizumab + Sitravatinib | Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS) | Cycle 5 | -6.1 score on a scale | Standard Deviation 14.27 |
| Tislelizumab + Sitravatinib | Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS) | Cycle 7 | -5.9 score on a scale | Standard Deviation 12.31 |
| Docetaxel | Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS) | Cycle 5 | -3.5 score on a scale | Standard Deviation 13.76 |
| Docetaxel | Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D-5L) Visual Analogue Scale (VAS) | Cycle 7 | -3.2 score on a scale | Standard Deviation 12.6 |
Disease Control Rate (DCR)
Defined as the percentage of participants whose best overall response (BOR) is complete response, partial response, or stable disease per RECIST v1.1.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: ITT Analysis Set.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tislelizumab + Sitravatinib | Disease Control Rate (DCR) | 69.5 percentage of participants |
| Docetaxel | Disease Control Rate (DCR) | 53.7 percentage of participants |
Duration of Response (DOR)
Defined as the time from the first occurrence of a documented objective response to the time of the first occurrence of disease progression, as determined by the IRC based on RECIST v1.1, or death from any cause, whichever occurs first.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: ITT Analysis Set. Only participants with best overall response of complete response or partial response confirmed per RECIST v1.1 were included in the analysis, and percentages were based on the number of responders.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tislelizumab + Sitravatinib | Duration of Response (DOR) | 6.0 months |
| Docetaxel | Duration of Response (DOR) | NA months |
Number of Participants With Adverse Events
Number of participants with treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), according to National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0
Time frame: From the first dose through 30 days after the final dose or until new anticancer therapy, whichever came first, (a median treatment duration of approximately 4 months in Arm 1 and 2 months in Arm 2).
Population: The Safety analysis set includes all participants who were randomized and received any dose of any study drug
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Tislelizumab + Sitravatinib | Number of Participants With Adverse Events | TEAEs | 183 Participants |
| Tislelizumab + Sitravatinib | Number of Participants With Adverse Events | SAEs | 83 Participants |
| Docetaxel | Number of Participants With Adverse Events | SAEs | 66 Participants |
| Docetaxel | Number of Participants With Adverse Events | TEAEs | 162 Participants |
Overall Response Rate (ORR)
Defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) as assessed by the IRC per RECIST v1.1.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tislelizumab + Sitravatinib | Overall Response Rate (ORR) | 12.3 percentage of participants |
| Docetaxel | Overall Response Rate (ORR) | 12.6 percentage of participants |
Progression Free Survival (PFS) as Assessed by the Investigator
Defined as the time from randomization until first documentation of disease progression as determined by the investigator based on RECIST v1.1, or death from any cause, whichever occured first. Kaplan-Meier methodology was used to estimate the median PFS.
Time frame: Until the study completion data cut-off date of December 20, 2023, or the last available date confirming participants were alive (a median follow-up of approximately 8 months).
Population: ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tislelizumab + Sitravatinib | Progression Free Survival (PFS) as Assessed by the Investigator | 4.4 Months |
| Docetaxel | Progression Free Survival (PFS) as Assessed by the Investigator | 2.9 Months |