Safety and Efficacy Study of Abraxane in Combination With Carboplatin to Treat Advanced NSCL Cancer in the Elderly

Non-Small Cell Lung Cancer Clinical Trial

— ABOUND 70+  

Official title:

Safety and Efficacy of Nab-paclitaxel (Abraxane) in Combination With Carboplatin as First Line Treatment in Elderly Subjects With Advance Non-Small Cell Lung Cancer (NSCLC): A Phase IV, Randomized, Open-Label, Multicenter Study (Abound.70+)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02151149
• Other study ID #: ABI-007-NSCL-005
• Status: Completed
• Phase: Phase 4
• Start date: June 9, 2014
• Est. completion date: July 14, 2017

Study information

• Verified date: August 2018
• Source: Celgene
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Study comparing two regimens of nab-paclitaxel and carboplatin combination in elderly subjects (≥ 70 years old) with advanced NSCLC

Description:

This is a Phase IV, randomized, open-label, multicenter study of continuous weekly versus weekly times three with one-week break nab-paclitaxel in combination with carboplatin as first-line treatment in elderly subjects (≥ 70 years old) with advanced non small cell lung cancer who have not received prior chemotherapy for their advanced disease and are not candidates for curative surgery or radiation therapy. The primary study endpoint is the percentage of subjects with either peripheral neuropathy or myelosuppression adverse events. Patients will continue treatment until they develop progressive disease, unacceptable side-effects or wish to withdraw from the study, according to local standard of care. Patients will have radiographic evaluations every 6 weeks while on treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 143
• Est. completion date: July 14, 2017
• Est. primary completion date: July 14, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 70 Years and older

Eligibility

Inclusion Criteria: -

• Inclusion Criteria: -

1. Age = 70 years at the time of signing the Informed Consent Form.

2. Understand and voluntarily provide written informed consent prior to the conduct of any study related assessments/procedures.

3. Able to adhere to the study visit schedule and other protocol requirements.

4. Histologically or cytologically confirmed locally advanced or metastatic non small cell lung cancer who are not candidates for curative surgery or radiation therapy.

5. No other current active malignancy requiring anticancer therapy.

6. Radiographically documented measurable disease per RECIST v 1.1

7. No prior chemotherapy for the treatment of metastatic disease. Adjuvant chemotherapy is permitted providing that cytotoxic chemotherapy was completed 12 months prior to signing the informed consent form (ICF) and without disease recurrence. Participans with previously known epidermal growth factor receptor mutation or anaplastic lymphoma kinase gene translocation must have failed or had intolerance to one treatment with epidermal growth factor receptor tyrosine kinase inhibitor or anaplastic lymphoma kinase inhibitor therapy, respectively.

8. Absolute neutrophil count = 1500 cells/cubic millimetre.

9. Platelets = 100,000 cells/cubic millimetre.

10. Hemoglobin = 9 grams/decilitre.

11. Aspartate transaminase/serum glutamic oxaloacetic transaminase/ alanine transaminase/serum glutamic pyruvic transaminase = 2.5 × upper limit of normal range or = 5.0 × upper limit of normal range if liver metastases.

12. Total bilirubin = 1.5 millilitre/decilitre (unless there is a known history of Gilberts Syndrome).

13. Creatinine clearance > 40 millilitre/minute calculated using Cockcroft-Gault equation (if renal impairment is suspected 24 hour urine collection for measurement is required).

14. Eastern Cooperative Oncology Group performance status 0 or 1.

15. Females who (1) have undergone hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or (2) have been naturally postmenopausal for at least 24 consecutive months (ie, has not had menses at any time during the preceding 24 consecutive months).

16. Male subjects must: Practice true abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for 6 months following study drug discontinuation, even if he has undergone a successful vasectomy.

Exclusion Criteria:

• 1. Evidence of active brain metastases, including leptomeningeal involvement (prior evidence of brain metastasis are permitted only if treated and stable and off therapy for = 4 weeks prior to signing Informed consent form. Magnetic Resonance Imaging of the brain (or Computed Tomography scan w/contrast) is preferred for diagnosis.

2. History of leptomeningeal disease. 3. Only evidence of disease is non measurable.

4. Preexisting peripheral neuropathy of Grade 2, 3, or 4 (per Common Terminology Criteria for Adverse Events v4.0).

5. Participant has received radiotherapy = 4 weeks or limited field radiation for palliation = 2 weeks prior to starting investigational product, and/or from whom = 30% of the bone marrow was irradiated. Prior radiation therapy to a target lesion is permitted only if there has been clear progression of the lesion since radiation was completed.

6. Venous thromboembolism within 1 month prior to signing informed consent form.

7. Current congestive heart failure (New York Heart Association Class II-IV). 8. History of the following within 6 months prior to first administration of a study drug: a myocardial infarction, severe/unstable angina pectoris,coronary/peripheral artery bypass graft, New York Heart Association Class III-IV heart failure, uncontrolled hypertension, clinically significant cardiac dysrhythmia or clinically significant Electrocardiogram abnormality, cerebrovascular accident, transient ischemic attack, or seizure disorder.

9. Participant has a known infection with hepatitis B or C, or history of human immunodeficiency virus infection, or participant is receiving immunosuppressive or myelosuppressive medications that would in the opinion of the investigator, increase the risk of serious neutropenic complications.

10. Participant has an active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy, defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment.

11.History of interstitial lung disease, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, or pulmonary hypersensitivity pneumonitis.

12. Treatment with any investigational product within 28 days prior to signing the informed consent form.

13. History of allergy or hypersensitivity to nab-paclitaxel or carboplatin. 14. Currently enrolled in any other clinical protocol or investigational trial that involves administration of experimental therapy and/or therapeutic devices. 15. Any other clinically significant medical condition, psychiatric illness, and/or organ dysfunction that will interfere with the administration of the therapy according to this protocol or which, in the views of investigator, preclude combination chemotherapy.

16. Participant has any other malignancy within 5 years prior to randomization. Exceptions include the following: squamous cell carcinoma of the skin, in-situ carcinoma of the cervix, uteri, non-melanomatous skin cancer, carcinoma in situ of the breast, or incidental histological finding of prostate cancer Tumor, Lymph Node, Metastatic (TNM stage of T1a or T1b). All treatment of which should have been completed 6 months prior to signing Informed consent form.

17. Any condition including the presence of laboratory abnormalities, which places the participant at unacceptable risk if he/she were to participate in the study.

18. Any medical condition that confounds the ability to interpret data from the study.

19. Females who (1) have not undergone hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or (2) have not been naturally postmenopausal for at least 24 consecutive months (ie, has had menses at any time during the preceding 24 consecutive months).

Related Conditions & MeSH terms

• Adenocarcinoma
• Carcinoma
• Carcinoma, Large Cell
• Carcinoma, Non-Small-Cell Lung
• Carcinoma, Squamous Cell
• Lung Neoplasm
• Lung Neoplasms
• Non-Small Cell Lung Cancer
• Squamous Cell Carcinoma

Intervention

Drug:
• nab-paclitaxel

• Carboplatin

Locations

Country	Name	City	State
United States	Texas Oncology, P.A.-Amarillo	Amarillo	Texas
United States	Comprehensive Blood and Cancer Center	Bakersfield	California
United States	Medstar Health Research Institute	Baltimore	Maryland
United States	Lynn Cancer Institute	Boca Raton	Florida
United States	Montefiore Medical Center	Bronx	New York
United States	Brookdale University Hospital and Medical Center	Brooklyn	New York
United States	Lineberger Cancer Center	Chapel Hill	North Carolina
United States	Levine Cancer Institute	Charlotte	North Carolina
United States	Center for Cancer and Hematologic Disease	Cherry Hill	New Jersey
United States	Good Samaritan Hospital Corvalis	Corvallis	Oregon
United States	Baylor University Medical Center at Dallas	Dallas	Texas
United States	Rocky Mountain Cancer Centers, LLP	Denver	Colorado
United States	Henry Ford Health System	Detroit	Michigan
United States	Regional Cancer Care Associates LLC	East Brunswick	New Jersey
United States	Northshore University Healthsystem Research Institute	Evanston	Illinois
United States	Saint Jude Heritage Medical Center	Fullerton	California
United States	UTMB Galveston	Galveston	Texas
United States	Global Cancer Research Institute (GCRI), Inc.	Gilroy	California
United States	St Mary's Hospital and Regional Medical Center	Grand Junction	Colorado
United States	Penn State Milton S Hershey Medical Center	Hershey	Pennsylvania
United States	Genesis Cancer Center	Hot Springs	Arkansas
United States	Franciscan St. Francis Health	Indianapolis	Indiana
United States	Baptist Cancer Inst	Jacksonville	Florida
United States	Broome Oncology, LLC	Johnson City	New York
United States	Clinical Research Alliance	Lake Success	New York
United States	Cancer Centres of Southwest Okahoma Research	Lawton	Oklahoma
United States	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire
United States	Saint Barnabas Medical Center	Livingston	New Jersey
United States	Texas Oncology, PA - Longview	Longview	Texas
United States	West Jeffersion Medical Center	Marrero	Louisiana
United States	Carol G Simon Cancer Center	Morristown	New Jersey
United States	Ochsner Medical Institutions	New Orleans	Louisiana
United States	Oncology Specialists, S.C.	Niles	Illinois
United States	Ocala Oncology Center	Ocala	Florida
United States	Nebraska Methodist Hospital	Omaha	Nebraska
United States	Florida Hospital Cancer Institute	Orlando	Florida
United States	Ventura County Hematology-Oncology Specialists	Oxnard	California
United States	Western Kentucky Hematology and Oncology Group	Paducah	Kentucky
United States	Fox Chase Cancer Center	Philadelphia	Pennsylvania
United States	Perelman Center for Advanced Medicine	Philadelphia	Pennsylvania
United States	Thomas Jefferson University Medical College	Philadelphia	Pennsylvania
United States	Allegheny General Hospital	Pittsburgh	Pennsylvania
United States	Oregon Health and Science University	Portland	Oregon
United States	Central Coast Medical Oncology Corporation	Santa Maria	California
United States	University of California Los Angeles	Santa Monica	California
United States	Virginia Mason Cancer Center	Seattle	Washington
United States	Somerset Hematology-Oncology Associates	Somerville	New Jersey
United States	Regional Cancer Care Associates LLC- Sparta division	Sparta	New Jersey
United States	SUNY Upstate Medical University Medicine Oncology	Syracuse	New York
United States	Arizona Clinical Research Center	Tucson	Arizona
United States	Northwest Cancer Specialists, P.C.	Vancouver	Washington
United States	Cancer Center of Kansas	Wichita	Kansas
United States	Forsyth Memorial Hospital, Inc.	Winston-Salem	North Carolina
United States	Reliant Medical Group	Worcester	Massachusetts
United States	St Elizabeth Hospital	Youngstown	Ohio

Sponsors (1)

Lead Sponsor	Collaborator
Celgene

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage of Participants With Either Peripheral Neuropathy = Grade 2 or Myelosuppression Adverse Events (AEs) = Grade 3 Based on Local Laboratory Values	Peripheral neuropathy (sensory or motor) assessment was done at screening, on Days 1, 8, 15 of every treatment cycle, at the End-of-Treatment visit and at the 28-day Follow-up Visit. Changes in neuropathy grade from baseline was reported as an AE as assessed using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Myelosuppression in participants receiving chemotherapy may have manifested as neutropenia, thrombocytopenia, or anemia. Grade 3 neutropenia including an absolute neutropenia count (ANC) of 500 to 1,000 cells/mm^3; anemia hemoglobain levels (Hgb) <8.0 - 6.5 g/dL; <4.9 - 4.0 mmol/L; <80 - 65 g/L; transfusion indicated; and thrombocytopenia with platelet levels <100,000 cells/mm^3.	From the date of the first dose of investigational product (IP) until 28 days after the last dose of IP; up to data cut-off date of 20 November 2016; The median treatment duration for Arms A and B were 3.04 months and 5.17 months respectively.
Secondary	Number of Participants With Treatment Emergent Adverse Events During the Treatment Period	Treatment-emergent adverse events (TEAEs) were defined as any AE or serious adverse event (SAE) that occurred or worsened on or after the day of the first dose of the IP through 28 days after the last dose of IP. Any SAE with an onset date more than 28 day after the last dose of IP that was assessed by the investigator as related to IP was considered a TEAE. The severity of AEs was graded based on National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0 and based on the scale: Grade 1 = Mild - transient or mild discomfort; Grade 2 = Moderate - mild to moderate limitation in activity, assistance may be needed; minimal medical intervention required; Grade 3 = Severe - marked limitation in activity, assistance usually required; medical intervention required, hospitalization is possible; Grade 4 = Life threatening - extreme limitation in activity, assistance required; medical intervention, hospitalization or hospice care probable; Grade 5 = death.	From the date of the first dose of IP until 28 days after the last dose of IP; up to a later data cut-off date of 14 July 2017; maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively.
Secondary	Percentage of Participants With at Least 1 Treatment Emergent Adverse Event With Action Taken as Study Drug Withdrawn	The percentage of participants with at least 1 TEAE with action taken as studydrug withdrawn during the treatment period of the trial was assessed throughout the conduct of the study. Study drug withdrawn (treatment permanently discontinued) was attributed to the part in which the onset of the adverse event took place.	From the date of the first dose of IP until 28 days after the last dose of IP; up to a later data cut-off date of 14 July 2017 the maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively
Secondary	Dose Intensity Per Week of Nab-Paclitaxel During the Entire Study	Dose intensity was the cumulative dose divided by the dosing period in weeks.	From day 1 of study treatment to the end date of study treatment; up to data cut off date of 20 November 2016; the maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively
Secondary	Dose Intensity Per Week of Carboplatin During the Entire Study	Dose intensity for carboplatin was the cumulative dose divided by the dosing period in weeks."	From day 1 of study treatment to the end date of study treatment; up to data cut off date of 20 November 2016; the maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively
Secondary	Percentage of Participants With Dose Reductions During the Entire Study	A dose reduction occurred when the dose assigned at a visit was lower than the dose assigned at the previous visit. Dose reductions were typically caused by clinically significant laboratory abnormalities and/or TEAEs or toxicities.	From the first dose of study treatment to discontinuation date of study treatment; up to date cut off date of 20 November 2016; the maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively
Secondary	Percentage of Participants With a Dose Delay During the Entire Study	A dose delay occurred when the dose assigned at a visit was held compared to the previous visit. Dose delays were typically caused by clinically significant laboratory abnormalities and/or TEAEs or toxicities.	From the first dose of study treatment to discontinuation date of study treatment; up to date cut off date of 16 November 2016; the maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively
Secondary	Kaplan Meier Estimate of Progression-Free Survival (PFS)	Progression-free survival was defined as the time in months from day 1 of treatment to the date of disease progression based on the investigator's assessment according to Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 criteria (documented by radiological assessment) or death (any cause) on or prior to the clinical cut-off date, which ever occurred earlier. RECIST V1.1 criteria includes: - Complete Response (CR) is the disappearance of all target lesions; - Partial Response (PR) is at least a 30% decrease in the sum of diameters of target lesions from baseline; - Stable Disease (SD) is neither sufficient shrinkage to qualify for PR nor sufficient increase of lesions to qualify for progressive disease (PD); - Progressive Disease is at least a 20% increase in the sum of diameters of target lesions from nadir	From first dose of IP to the date of disease progression; up to a later clinical cut-off date of 14 July 2017; for Arms A and B participants were followed for PFS for 31 months and 20 months respectively
Secondary	Kaplan Meier Estimate of Overall Survival (OS)	Overall survival was defined as the time in months between day 1 of treatment and death from any cause). Participants who were still alive as of the clinical cut-off date had their OS censored at the date of last contact or clinical cut-off, whichever was earlier. Participants who were lost to follow-up prior to the end of the study or who were withdrawn from the study were censored at the time of last contact.	From first dose of IP to the date of death due to any cause; up to a later clinical cut-off date of 14 July 2017; for Arms A and B participants were followed for OS for 31 months and 33 months respectively
Secondary	Percentage of Participants Who Achieved a Best Overall Response of Complete Response (CR) or Partial Response (PR) According to RECIST 1.1 Criteria	Overall response rate (ORR) was defined as the percentage of participants who had radiologic CR or PR compared to baseline (radiographic evaluation on the day of or within 28 days prior to randomization) according to RECIST Version 1.1 criteria as determined by the investigator, which was confirmed by repeated radiologic assessment performed no less than 28 days after the criteria for response were first met and occurred between Day 1 of treatment and the start of subsequent anticancer therapy, death or study discontinuation. A complete response and partial response per RECIST V 1.0 criteria was defined as the disappearance of all target lesions; a partial response was defined as at least a 30% decrease in the sum of diameters of target lesions from baseline.	From the first dose of IP to the date of documented first response; up to the data cut-off date of 14 July 2017; maximum treatment duration for Arms A and B was 16.6 months and 20.1 months respectively.