Advanced Solid Tumor
Conditions
Keywords
Solid tumors
Brief summary
This clinical trial evaluated the safety and potential benefits of combining two cancer treatments, tislelizumab and lenvatinib, in Chinese participants with advanced or metastatic cancers, including lung, head and neck, bladder, kidney, and stomach cancer. The study included two parts: the first part assessed how safe the drug combination was, and the second part examined how well it worked. A small group of participants initially received the drugs to determine the appropriate dose, and if the treatment was well tolerated, additional participants were treated at that dose. Participants remained on the treatment unless their cancer progressed, they experienced serious side effects, or they chose to stop.
Interventions
Administered at the dose of 20 mg orally, once daily.
400 mg administered intravenously on Day 1 of each 42-day cycle
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: 1. Participants had signed an informed consent form and were able to comply with all study requirements. 2. Participants had a histologically and/or cytologically confirmed diagnosis of advanced solid tumors, which included one of the following types: * Non-Small Cell Lung Cancer (NSCLC) * Squamous Cell Carcinoma of the Head and Neck (SCCHN) * Gastric Cancer (GC) * Urothelial Carcinoma (UC) * Renal Cell Carcinoma (RCC) 3. Participants had at least one measurable lesion as defined by the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. 4. Tumor tissue samples (approximately 10 unstained slides) were provided for central laboratory assessment of programmed death-ligand 1 (PD-L1) expression in the NSCLC cohort during the screening period. These samples were also used for retrospective exploratory biomarker analyses related to treatment response and resistance across the NSCLC, SCCHN, UC, or Gastric Cancer (GC) cohorts, in a central or designated test laboratory approved by BeiGene. 5. Participants had an Eastern Cooperative Oncology Group (ECOG) performance of 0 or 1 Key
Exclusion criteria
1. For participants in the NSCLC cohort, those with active leptomeningeal disease or uncontrolled, untreated brain metastases were excluded. In cohorts other than NSCLC, any participant with known leptomeningeal disease or brain metastases was excluded. 2. Participants who had received prior therapy with lenvatinib, or with antibodies targeting programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), programmed death-ligand 2 (PD-L2), or any other agents specifically targeting T-cell costimulatory or immune checkpoint pathways, were excluded. 3. Participants with a history of interstitial lung disease, non-infectious pneumonitis, or any uncontrolled pulmonary conditions (including but not limited to pulmonary fibrosis or acute lung diseases) were excluded. 4. Participants who were unable to swallow capsules, or who had diseases or previous procedures that significantly affected gastrointestinal function such as malabsorption syndrome, surgical resection of the stomach or small bowel, bariatric surgery, symptomatic inflammatory bowel disease, or partial/complete bowel obstruction were excluded. 5. Participants who had experienced clinically significant bleeding (classified as Grade 2 or higher according to the Common Terminology Criteria for Adverse Events \[CTCAE\]) within 21 days prior to the first dose were excluded. Note: Additional protocol-defined inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety Run-in: Number of Participants With Adverse Events (AEs) | From first dose through the end of the safety run-in part, up to 124 days; The DLT observation period was 28 days after first dose. | An adverse event refers to any unintended or unfavorable sign, symptom, or condition (including abnormal lab results) that occurs during the study, regardless of whether it is related to the study drug. A serious adverse event (SAE) is any untoward medical occurrence that, at any dose: * Resulted in death * Was life-threatening * Required hospitalization or prolongation of existing hospitalization * Resulted in disability/incapacity * Was a congenital anomaly/birth defect * Was considered a significant medical AE by the investigator based on medical judgement. A dose-limiting toxicity (DLT) was defined as a Grade 3 or 4 hematologic or nonhematologic toxicity occurring during the DLT assessment window and deemed related to one or more study drugs by the investigator. |
| Overall Response Rate (ORR) | From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months) | Overall response rate is defined as the percentage of participants who had a confirmed complete response (CR) or partial response (PR) as assessed by the investigator per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 Tumor assessments. CR is defined as the disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease Control Rate (DCR) | From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months) | DCR was defined as the percentage of participants who demonstrated a confirmed complete response (CR), partial response (PR), or stable disease (SD) as the best overall response, in accordance with the RECIST version 1.1 criteria. CR was defined as the disappearance of all target and non-target lesions with no new lesions observed. Any pathological lymph nodes (whether target or non-target) were required to have a reduction in short axis to less than 10 mm. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, using the baseline sum of diameters as the reference. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), using the smallest sum of diameters recorded while on study as the reference. |
| Progression Free Survival (PFS) | From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months) | PFS was defined as the time from randomization to the first objectively documented disease progression as assessed by the investigator per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) or death from any cause, whichever occurred first. Median PFS was estimated using the Kaplan-Meier method. |
| Number of Participants Experiencing Adverse Events (AEs) | From first dose of study drug to 30 days after last dose, up to the study completion date of 10 July 2024 (up to 32.5 months) | An adverse event refers to any unintended or unfavorable sign, symptom, or condition (including abnormal lab results) that occurs during the study, regardless of whether it is related to the study drug. |
| Overall Survival (OS) | From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months) | OS was defined as the time from randomization to the documented date of death for participants who died on or before the data cutoff date. Median OS was calculated using the Kaplan-Meier method. Data for participants who were alive at the data cutoff date were censored at their last known alive date, defined as either the clinical cutoff date for those still on treatment or the most recent available date confirming they were alive, whichever occurred first. |
| Duration of Response (DOR) | From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months) | DOR was defined as the time from the first documented objective response to documented radiological disease progression as assessed by the investigator using RECIST v1.1, or death from any cause, whichever occurred first. Median DOR was estimated using the Kaplan-Meier method. Progressive disease is captured as at least a 20% increase in the sum of diameters of target lesions, using the smallest sum on study as the reference (including the baseline sum if it was the smallest). In addition to the 20% relative increase, the sum also had to show an absolute increase of at least 5 mm. |
Countries
China
Participant flow
Recruitment details
Participants were enrolled in multiple study centers in China. The first participant dosed was on September 18th, 2021 and the last participant completed on July 10th, 2024. Enrollment began with a run-in phase to assess the safety and tolerability of tislelizumab plus lenvatinib combination therapy. Once the Safety Monitoring Committee confirmed that the combination therapy was tolerable, enrollment into the expansion phase began.
Pre-assignment details
This study included a safety run-in and expansion phase to evaluate treatment with tislelizumab plus lenvatinib. All participants enrolled in the run-in phase continued into the expansion phase and all participants received the same treatment dose. According to the planned analysis, all enrolled participants were analyzed together (including those who enrolled in the run-in phase) based on tumor type.
Participants by arm
| Arm | Count |
|---|---|
| Squamous Cell Carcinoma of the Head and Neck (SCCHN) Participants with previously untreated, advanced or metastatic SCCHN received tislelizumab (400 mg administered intravenously \[IV\] every 6 weeks \[Q6W\]) in combination with lenvatinib (20 mg taken orally once daily \[QD\]) until disease progression, start of new anticancer therapy, unacceptable toxicity, withdrawal of consent, or study termination. | 27 |
| Renal Cell Carcinoma (RCC) Systemic therapy naive participants with advanced or metastatic RCC received tislelizumab (400 mg IV Q6W) plus lenvatinib (20 mg orally QD) until disease progression, start of new anticancer therapy, unacceptable toxicity, withdrawal of consent, or study termination | 23 |
| Non-Small Cell Lung Cancer (NSCLC) Participants with NSCLC expressing programmed cell death-ligand 1 (PD-L1) in ≥1% of tumor cells (TC ≥1%) and who had not received prior systemic therapy received tislelizumab (400 mg IV Q6W) and lenvatinib (20 mg orally QD) until disease progression, start of new anticancer therapy, unacceptable toxicity, withdrawal of consent, or study termination; this cohort was closed early based on emerging external data. | 5 |
| Gastric Cancer (GC) Participants with advanced GC who had received one prior line of systemic therapy were enrolled to receive tislelizumab and lenvatinib at the RP2D (tislelizumab 400 mg IV Q6W; lenvatinib 20 mg orally QD) until disease progression, start of new anticancer therapy, unacceptable toxicity, withdrawal of consent, or study termination; this cohort was closed early due to changes in the first-line standard of care. | 3 |
| Total | 58 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Death | 11 | 6 | 0 | 0 |
| Overall Study | Lost to Follow-up | 0 | 0 | 2 | 0 |
| Overall Study | Miscellaneous. | 0 | 1 | 0 | 0 |
| Overall Study | Study Completed by Sponsor | 16 | 16 | 3 | 3 |
Baseline characteristics
| Characteristic | Gastric Cancer (GC) | Total | Squamous Cell Carcinoma of the Head and Neck (SCCHN) | Renal Cell Carcinoma (RCC) | Non-Small Cell Lung Cancer (NSCLC) |
|---|---|---|---|---|---|
| Age, Continuous | 61.3 years STANDARD_DEVIATION 9.29 | 62.3 years STANDARD_DEVIATION 8.75 | 61.9 years STANDARD_DEVIATION 10.14 | 62.3 years STANDARD_DEVIATION 7.38 | 65.6 years STANDARD_DEVIATION 7.92 |
| Race/Ethnicity, Customized Chinese | 3 Participants | 58 Participants | 27 Participants | 23 Participants | 5 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 0 Participants | 15 Participants | 8 Participants | 6 Participants | 1 Participants |
| Sex: Female, Male Male | 3 Participants | 43 Participants | 19 Participants | 17 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 11 / 27 | 6 / 23 | 0 / 5 | 0 / 3 |
| other Total, other adverse events | 27 / 27 | 21 / 23 | 5 / 5 | 3 / 3 |
| serious Total, serious adverse events | 17 / 27 | 11 / 23 | 2 / 5 | 2 / 3 |
Outcome results
Overall Response Rate (ORR)
Overall response rate is defined as the percentage of participants who had a confirmed complete response (CR) or partial response (PR) as assessed by the investigator per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 Tumor assessments. CR is defined as the disappearance of all target and non-target lesions and no new lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months)
Population: Safety Analysis Set: Participants who received ≥ 1 dose of study drug(s) Evaluable Analysis Set: Participants who received ≥ 1 dose of study drug(s), have evaluable disease at baseline, and have ≥ 1 evaluable postbaseline tumor response assessment unless any clinical progressive disease or death occurred before the first postbaseline tumor assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Safety Run-In | Overall Response Rate (ORR) | Evaluable Analysis Set | 33.3 Percentage of participants |
| Safety Run-In | Overall Response Rate (ORR) | Safety Analysis Set | 29.6 Percentage of participants |
| Renal Cell Carcinoma (RCC) | Overall Response Rate (ORR) | Safety Analysis Set | 60.9 Percentage of participants |
| Renal Cell Carcinoma (RCC) | Overall Response Rate (ORR) | Evaluable Analysis Set | 66.7 Percentage of participants |
| Non-Small Cell Lung Cancer (NSCLC) | Overall Response Rate (ORR) | Safety Analysis Set | 20.0 Percentage of participants |
| Non-Small Cell Lung Cancer (NSCLC) | Overall Response Rate (ORR) | Evaluable Analysis Set | 20.0 Percentage of participants |
| Gastric Cancer (GC) | Overall Response Rate (ORR) | Evaluable Analysis Set | 33.3 Percentage of participants |
| Gastric Cancer (GC) | Overall Response Rate (ORR) | Safety Analysis Set | 33.3 Percentage of participants |
Safety Run-in: Number of Participants With Adverse Events (AEs)
An adverse event refers to any unintended or unfavorable sign, symptom, or condition (including abnormal lab results) that occurs during the study, regardless of whether it is related to the study drug. A serious adverse event (SAE) is any untoward medical occurrence that, at any dose: * Resulted in death * Was life-threatening * Required hospitalization or prolongation of existing hospitalization * Resulted in disability/incapacity * Was a congenital anomaly/birth defect * Was considered a significant medical AE by the investigator based on medical judgement. A dose-limiting toxicity (DLT) was defined as a Grade 3 or 4 hematologic or nonhematologic toxicity occurring during the DLT assessment window and deemed related to one or more study drugs by the investigator.
Time frame: From first dose through the end of the safety run-in part, up to 124 days; The DLT observation period was 28 days after first dose.
Population: The Safety run-in set is defined as all participants in the safety run-in stage.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Safety Run-In | Safety Run-in: Number of Participants With Adverse Events (AEs) | Number of Participants with any SAEs | 4 Participants |
| Safety Run-In | Safety Run-in: Number of Participants With Adverse Events (AEs) | Number of Participants with any TEAEs | 6 Participants |
| Safety Run-In | Safety Run-in: Number of Participants With Adverse Events (AEs) | Number of Participants with any DLTs | 0 Participants |
Disease Control Rate (DCR)
DCR was defined as the percentage of participants who demonstrated a confirmed complete response (CR), partial response (PR), or stable disease (SD) as the best overall response, in accordance with the RECIST version 1.1 criteria. CR was defined as the disappearance of all target and non-target lesions with no new lesions observed. Any pathological lymph nodes (whether target or non-target) were required to have a reduction in short axis to less than 10 mm. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, using the baseline sum of diameters as the reference. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), using the smallest sum of diameters recorded while on study as the reference.
Time frame: From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months)
Population: Evaluable analysis set and Safety Analysis Set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Safety Run-In | Disease Control Rate (DCR) | Safety Analysis Set | 70.4 Percentage of Participants |
| Safety Run-In | Disease Control Rate (DCR) | Evaluable Analysis Set | 79.2 Percentage of Participants |
| Renal Cell Carcinoma (RCC) | Disease Control Rate (DCR) | Evaluable Analysis Set | 95.2 Percentage of Participants |
| Renal Cell Carcinoma (RCC) | Disease Control Rate (DCR) | Safety Analysis Set | 87.0 Percentage of Participants |
| Non-Small Cell Lung Cancer (NSCLC) | Disease Control Rate (DCR) | Safety Analysis Set | 100.0 Percentage of Participants |
| Non-Small Cell Lung Cancer (NSCLC) | Disease Control Rate (DCR) | Evaluable Analysis Set | 100.0 Percentage of Participants |
| Gastric Cancer (GC) | Disease Control Rate (DCR) | Safety Analysis Set | 66.7 Percentage of Participants |
| Gastric Cancer (GC) | Disease Control Rate (DCR) | Evaluable Analysis Set | 66.7 Percentage of Participants |
Duration of Response (DOR)
DOR was defined as the time from the first documented objective response to documented radiological disease progression as assessed by the investigator using RECIST v1.1, or death from any cause, whichever occurred first. Median DOR was estimated using the Kaplan-Meier method. Progressive disease is captured as at least a 20% increase in the sum of diameters of target lesions, using the smallest sum on study as the reference (including the baseline sum if it was the smallest). In addition to the 20% relative increase, the sum also had to show an absolute increase of at least 5 mm.
Time frame: From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months)
Population: Evaluable Analysis Set. Only participants with best overall response of complete response or partial response confirmed per RECIST v1.1 were included in this analysis,
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In | Duration of Response (DOR) | 9.6 Months |
| Renal Cell Carcinoma (RCC) | Duration of Response (DOR) | NA Months |
| Non-Small Cell Lung Cancer (NSCLC) | Duration of Response (DOR) | 18.5 Months |
| Gastric Cancer (GC) | Duration of Response (DOR) | NA Months |
Number of Participants Experiencing Adverse Events (AEs)
An adverse event refers to any unintended or unfavorable sign, symptom, or condition (including abnormal lab results) that occurs during the study, regardless of whether it is related to the study drug.
Time frame: From first dose of study drug to 30 days after last dose, up to the study completion date of 10 July 2024 (up to 32.5 months)
Population: Safety Analysis Set
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Safety Run-In | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any TEAEs | 27 Participants |
| Safety Run-In | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any SAEs | 17 Participants |
| Renal Cell Carcinoma (RCC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any SAEs | 11 Participants |
| Renal Cell Carcinoma (RCC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any TEAEs | 22 Participants |
| Non-Small Cell Lung Cancer (NSCLC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any TEAEs | 5 Participants |
| Non-Small Cell Lung Cancer (NSCLC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any SAEs | 2 Participants |
| Gastric Cancer (GC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any TEAEs | 3 Participants |
| Gastric Cancer (GC) | Number of Participants Experiencing Adverse Events (AEs) | Number of Participants with any SAEs | 2 Participants |
Overall Survival (OS)
OS was defined as the time from randomization to the documented date of death for participants who died on or before the data cutoff date. Median OS was calculated using the Kaplan-Meier method. Data for participants who were alive at the data cutoff date were censored at their last known alive date, defined as either the clinical cutoff date for those still on treatment or the most recent available date confirming they were alive, whichever occurred first.
Time frame: From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months)
Population: Safety Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In | Overall Survival (OS) | NA Month |
| Renal Cell Carcinoma (RCC) | Overall Survival (OS) | NA Month |
| Non-Small Cell Lung Cancer (NSCLC) | Overall Survival (OS) | NA Month |
| Gastric Cancer (GC) | Overall Survival (OS) | NA Month |
Progression Free Survival (PFS)
PFS was defined as the time from randomization to the first objectively documented disease progression as assessed by the investigator per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) or death from any cause, whichever occurred first. Median PFS was estimated using the Kaplan-Meier method.
Time frame: From the first dose up to the primary analysis data cut-off date of 10 October 2023 (maximum time on study was 24.7 months)
Population: Safety analysis set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In | Progression Free Survival (PFS) | 6.1 Months |
| Renal Cell Carcinoma (RCC) | Progression Free Survival (PFS) | 15.4 Months |
| Non-Small Cell Lung Cancer (NSCLC) | Progression Free Survival (PFS) | 6.0 Months |
| Gastric Cancer (GC) | Progression Free Survival (PFS) | NA Months |