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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03043872
Other study ID # D419QC00001
Secondary ID 2016-001203-23
Status Active, not recruiting
Phase Phase 3
First received
Last updated
Start date March 27, 2017
Est. completion date December 31, 2024

Study information

Verified date May 2024
Source AstraZeneca
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This is a phase III, randomized, open-label, multicenter, global study to determine the efficacy and safety of combining durvalumab ± tremelimumab with platinum based chemotherapy (EP) followed by durvalumab ± tremelimumab maintenance therapy versus EP alone as first-line treatment in patients with extensive-stage small-cell lung cancer


Description:

Primary objective of this study is to assess the efficacy of durvalumab + tremelimumab + EP treatment compared with EP and the efficacy of durvalumab + EP treatment compared with EP in terms of OS. All patients will be randomized in a 1:1:1 ratio in a stratified manner according to the planned platinum-based therapy for Cycle 1 (cisplatin or carboplatin) to receive treatment with durvalumab + tremelimumab + EP (Arm 1), durvalumab + EP (Arm 2), or standard of care- EP (Arm 3). Arm 1 and Arm 2 patients receive the treatment until confirmed disease progression while Arm 3 patients receive up to 6 cycles of EP and prophylactic cranial irradiation if clinically indicated, at the Investigators' discretion.Patients who have discontinued treatment due to toxicity or symptomatic deterioration, clinical progression, or who have commenced subsequent anticancer therapy will be followed up until confirmed disease progression and for survival. Targeted population are adult patients (aged ≥18 years) with histologically or cytologically documented extensive disease (American Joint Committee on Cancer Stage (7th edition) IV SCLC [T any, N any,M1 a/b]), or T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan. Patients must have WHO/ECOG performance status of 0 or 1. Tumor assessments will be performed at Screening as baseline with follow-up at Week 6 ±1 week from the date of randomization, at Week 12 ±1 week from the date of randomization, and then every 8 weeks ±1 week until confirmed objective disease progression. An independent data monitoring committee (IDMC) comprised of independent experts will be convened to confirm the safety and tolerability of the proposed dose and schedule of durvalumab ± tremelimumab in combination with platinum based chemotherapy at two early stages of enrolment.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 987
Est. completion date December 31, 2024
Est. primary completion date January 27, 2020
Accepts healthy volunteers No
Gender All
Age group 18 Years to 130 Years
Eligibility Inclusion criteria: 1. Histologically or cytologically documented extensive disease. Brain metastases; must be asymptomatic or treated and stable off steroids and anti-convulsants for at least 1 month prior to study treatment. 2. Suitable to receive a platinum-based chemotherapy regimen as 1st line treatment. 3. Life expectancy =12 weeks at Day 1. 4. ECOG 0 or 1 at enrolment. 5. No prior exposure to immune-mediated therapy excluding therapeutic anticancer vaccines. Exclusion criteria: 1. Any history of radiotherapy to the chest prior to systemic therapy or planned consolidation chest radiation therapy (except paliative care outside of the chest). 2. Paraneoplastic syndrome of autoimmune nature, requiring systemic treatment or clinical symptomatology suggesting worsening of PNS 3. Active infection including tuberculosis, HIV, hepatitis B anc C 4. Active or prior documented autoimmune or inflammatory disorders 5. Uncontrolled intercurrent illness, including but not limited to interstitial lung disease.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Durvalumab
IV infusions every 3 weeks for 12 weeks (4 cycles) and every 4 weeks thereafter until PD or other discontinuation criteria.
Tremelimumab
IV infusions every 3 weeks for 12 weeks(4 cycles). An additional dose of tremelimumab will be administered in the week 16.
Carboplatin
up to 4 cycles every 3 weeks in Arm 1 and 2, up to 6 cycles every 3 weeks in Arm 3
Cisplatin
up to 4 cycles every 3 weeks in Arm 1 and 2, up to 6 cycles every 3 weeks in Arm 3
Etoposide
up to 4 cycles every 3 weeks in Arm 1 and 2, up to 6 cycles every 3 weeks in Arm 3

Locations

Country Name City State
Argentina Research Site Buenos Aires
Argentina Research Site Ciudad de Buenos Aires
Argentina Research Site Mar del Plata
Argentina Research Site Rosario
Argentina Research Site San Miguel de Tucuman
Austria Research Site Linz
Austria Research Site Salzburg
Austria Research Site Wien
Austria Research Site Wien
Brazil Research Site Barretos
Brazil Research Site Curitiba
Brazil Research Site Passo Fundo
Brazil Research Site Porto Alegre
Brazil Research Site Ribeirão Preto
Brazil Research Site Rio de Janeiro
Brazil Research Site Salvador
Brazil Research Site Santo André
Brazil Research Site São José do Rio Preto
Brazil Research Site São Paulo
Bulgaria Research Site Panagyurishte
Bulgaria Research Site Plovdiv
Bulgaria Research Site Plovdiv
Bulgaria Research Site Sofia
Bulgaria Research Site Sofia
Bulgaria Research Site Sofia
Bulgaria Research Site Sofia
Bulgaria Research Site Varna
China Research Site Beijing
China Research Site Beijing
China Research Site Beijing
China Research Site Bengbu
China Research Site Changchun
China Research Site Changsha
China Research Site Chengdu
China Research Site ChongQing
China Research Site Hangzhou
China Research Site Hangzhou
China Research Site Hangzhou
China Research Site Hefei
China Research Site Nanchang
China Research Site Nanjing
China Research Site Nanjing
China Research Site Shanghai
China Research Site Shanghai
China Research Site Shenyang
China Research Site Ürümqi
China Research Site Wenzhou
China Research Site Wuhan
China Research Site Wuhan
China Research Site Xi'an
China Research Site Xi'an
China Research Site Zhanjiang
China Research Site Zhengzhou
China Research Site Zhuhai
Czechia Research Site Brno
Czechia Research Site Olomouc
Czechia Research Site Ostrava - Vitkovice
Czechia Research Site Praha
Czechia Research Site Praha 2
Czechia Research Site Praha 5
France Research Site Avignon Cedex 09
France Research Site Brest Cedex
France Research Site Creteil
France Research Site La Tronche
France Research Site Pierre Benite Cedex
France Research Site Rennes Cedex 09
Germany Research Site Aachen
Germany Research Site Berlin
Germany Research Site Gauting
Germany Research Site Gera
Germany Research Site Hamburg
Germany Research Site Heidelberg
Germany Research Site Mainz
Germany Research Site Regensburg
Hungary Research Site Budapest
Hungary Research Site Budapest
Hungary Research Site Budapest
Hungary Research Site Budapest
Hungary Research Site Deszk
Hungary Research Site Gyula
Hungary Research Site Kaposvár
Hungary Research Site Kecskemét
Hungary Research Site Miskolc
Hungary Research Site Pécs
Hungary Research Site Székesfehérvár
Israel Research Site Jerusalem
Israel Research Site Kfar Saba
Israel Research Site Petah Tikva
Israel Research Site Ramat Gan
Italy Research Site Bergamo
Italy Research Site Meldola
Italy Research Site Milano
Italy Research Site Palermo
Italy Research Site Roma
Italy Research Site Terni
Japan Research Site Chuo-ku
Japan Research Site Fukuoka-shi
Japan Research Site Fukushima-shi
Japan Research Site Himeji-shi
Japan Research Site Iwakuni-shi
Japan Research Site Kashiwa
Japan Research Site Koto-ku
Japan Research Site Kurume-shi
Japan Research Site Kyoto
Japan Research Site Matsuyama-shi
Japan Research Site Nagoya-shi
Japan Research Site Nagoya-shi
Japan Research Site Okayama-shi
Japan Research Site Osakasayama
Japan Research Site Sakai-shi
Japan Research Site Tokushima-shi
Japan Research Site Ube-shi
Japan Research Site Yokohama-shi
Japan Research Site Yokohama-shi
Korea, Republic of Research Site Changwon
Korea, Republic of Research Site Cheongju-si
Korea, Republic of Research Site Daegu
Korea, Republic of Research Site Incheon
Korea, Republic of Research Site Jinju-si
Korea, Republic of Research Site Seongnam-si
Korea, Republic of Research Site Seongnam-Si
Korea, Republic of Research Site Seoul
Korea, Republic of Research Site Seoul
Netherlands Research Site Amsterdam
Netherlands Research Site Arnhem
Netherlands Research Site Groningen
Netherlands Research Site Hengelo
Netherlands Research Site Maastricht
Netherlands Research Site Rotterdam
Poland Research Site Bialystok
Poland Research Site Bialystok
Poland Research Site Lublin
Poland Research Site Olsztyn
Poland Research Site Warszawa
Romania Research Site Cluj Napoca
Romania Research Site Floresti
Romania Research Site Suceava
Russian Federation Research Site Moscow
Russian Federation Research Site Omsk
Russian Federation Research Site Rostov-on-Don
Russian Federation Research Site Saint Petersburg
Russian Federation Research Site Saint-Petersburg
Russian Federation Research Site Sankt-Peterburg
Russian Federation Research Site St. Petersburg
Russian Federation Research Site Ufa
Slovakia Research Site Banska Bystrica
Slovakia Research Site Bardejov
Slovakia Research Site Bratislava
Slovakia Research Site Bratislava
Slovakia Research Site Kosice
Slovakia Research Site Nove Zamky
Slovakia Research Site Trnava
Spain Research Site A Coruña
Spain Research Site Badajoz
Spain Research Site Badalona
Spain Research Site Barcelona
Spain Research Site Madrid
Spain Research Site Madrid
Spain Research Site Madrid
Spain Research Site Santander
Spain Research Site Valencia
Spain Research Site Zaragoza
Taiwan Research Site Changhua
Taiwan Research Site Kaohsiung
Taiwan Research Site Kaohsiung City
Taiwan Research Site Taichung
Taiwan Research Site Taichung
Taiwan Research Site Tainan
Taiwan Research Site Tainan
Taiwan Research Site Taipei
Taiwan Research Site Taipei
Turkey Research Site Ankara
Turkey Research Site Ankara
Turkey Research Site Edirne
Turkey Research Site Istanbul
Turkey Research Site Izmir
Turkey Research Site Izmir
Ukraine Research Site Dnipro
Ukraine Research Site Ivano-Frankivsk
Ukraine Research Site Kirovohrad
Ukraine Research Site Kryvyi Rih
Ukraine Research Site Kyiv
Ukraine Research Site Kyiv
Ukraine Research Site Lviv
Ukraine Research Site Odesa
Ukraine Research Site Sumy
Ukraine Research Site Vinnytsia
Ukraine Research Site Zaporizhzhia
United States Research Site Athens Georgia
United States Research Site Birmingham Alabama
United States Research Site Cleveland Ohio
United States Research Site Columbus Ohio
United States Research Site Fort Wayne Indiana
United States Research Site Grand Rapids Michigan
United States Research Site Harrisburg Pennsylvania
United States Research Site Kennewick Washington
United States Research Site Leawood Kansas
United States Research Site Mineola New York
United States Research Site Muncie Indiana
United States Research Site Nashville Tennessee
United States Research Site New Haven Connecticut
United States Research Site Paducah Kentucky
United States Research Site Rogers Arkansas
United States Research Site Santa Monica California
United States Research Site Scottsdale Arizona
United States Research Site Sioux Falls South Dakota
United States Research Site Wichita Kansas

Sponsors (1)

Lead Sponsor Collaborator
AstraZeneca

Countries where clinical trial is conducted

United States,  Argentina,  Austria,  Brazil,  Bulgaria,  China,  Czechia,  France,  Germany,  Hungary,  Israel,  Italy,  Japan,  Korea, Republic of,  Netherlands,  Poland,  Romania,  Russian Federation,  Slovakia,  Spain,  Taiwan,  Turkey,  Ukraine, 

Outcome

Type Measure Description Time frame Safety issue
Primary Overall Survival (OS) in the Global Cohort; Assessed at Global Cohort Interim Analysis; D + EP Compared With EP OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An interim analysis of OS in the global cohort was pre-specified after approximately 318 OS events occurred each between the D + EP and EP groups (60% maturity), and between the D + T + EP and EP groups (60% maturity). At the global cohort interim analysis DCO (11 March 2019), comparison of OS in the D + EP versus (vs) EP groups had crossed the pre-specified boundary. Since these results were considered final in terms of formal statistical testing, they are presented here as a primary outcome measure. Analysis of OS for D + EP vs EP and for D + T + EP vs EP at the time of the global cohort final analysis is presented separately in the subsequent primary outcome measure. From baseline until death due to any cause. Assessed until global cohort interim analysis DCO (maximum of approximately 23 months).
Primary OS in the Global Cohort; Assessed at Global Cohort Final Analysis; D + EP Compared With EP and D + T + EP Compared With EP OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. This primary outcome measure presents OS for the analysis of D + EP vs EP and D + T + EP vs EP at the time of the global cohort final analysis DCO (27 January 2020). Analysis of D + EP vs EP at the global cohort interim analysis DCO is presented in the previous primary outcome measure. Analysis of D + T + EP vs D + EP (global cohort final analysis) is presented as a secondary outcome measure. From baseline until death due to any cause. Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Primary OS in the China Cohort; Assessed at China Cohort First Analysis; D + EP Compared With EP OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An analysis of OS for D + EP vs EP in the China cohort was pre-specified at approximately 60% maturity (to ensure a similar maturity to the interim analysis of the Global cohort). This primary outcome measure presents OS for analysis of D + EP vs EP at the China cohort first analysis DCO (06 January 2020), and is comparable in terms of maturity with the interim analysis of OS for D + EP vs EP in the Global cohort. Analysis of OS for D + EP vs EP and for D + T + EP vs EP at the time of the China cohort second analysis is presented separately in the subsequent primary outcome measure. From baseline until death due to any cause. Assessed until China cohort first analysis DCO (maximum of approximately 19 months).
Primary OS in the China Cohort; Assessed at China Cohort Second Analysis; D + EP Compared With EP and D + T + EP Compared With EP OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An analysis of OS for D + T + EP vs EP in the China cohort was pre-specified at approximately 80% maturity (to ensure a similar maturity to the final analysis of the Global cohort). This primary outcome measure presents OS for analysis of D + EP vs EP and D + T + EP vs EP at the time of the China cohort second analysis DCO (02 November 2020), and is comparable in terms of maturity with the final analysis of OS for D + EP vs EP and D + T + EP vs EP in the Global cohort. Analysis of D + EP vs EP at the China cohort first analysis DCO is presented in the previous primary outcome measure. Analysis of D + T + EP vs D + EP (China cohort second analysis) is presented as a secondary outcome measure. From baseline until death due to any cause. Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary OS in the Global Cohort; D + T + EP Compared With D + EP OS was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. This secondary outcome measure presents OS for the analysis of D + T + EP vs D + EP in the global cohort. The alternative treatment comparisons in the global cohort were performed as primary outcome measures. From baseline until death due to any cause. Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Secondary Progression-Free Survival (PFS) in the Global Cohort PFS (per Response Evaluation Criteria in Solid Tumors, version 1.1 [RECIST 1.1] using Investigator assessments) was defined as time from date of randomization until date of objective disease progression or death (by any cause in the absence of progression), regardless of whether the patient withdrew from randomized therapy or received another anticancer therapy prior to progression. Progression (ie, PD) was defined as at least a 20% increase in the sum of diameters of target lesions (TLs), taking as reference the smallest previous sum of diameters (nadir) and an absolute increase of =5 millimeters (mm) for the sum from nadir. For evaluation of non-target lesions (NTLs), PD was defined as unequivocal progression of existing NTLs. Median PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Secondary Objective Response Rate (ORR) in the Global Cohort ORR (per RECIST 1.1 using Investigator assessments) was defined as the percentage of patients with at least 1 visit response of Complete Response (CR) or Partial Response (PR). CR was defined as disappearance of all TLs since baseline (any pathological lymph nodes selected as TLs must have a reduction in short axis diameter to <10 mm) or disappearance of all NTLs since baseline (all lymph nodes must be non-pathological in size [<10 mm short axis]). PR was defined as at least a 30% decrease in the sum of diameters of TLs (taking as reference the baseline sum of diameters). Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Secondary Percentage of Patients Alive and Progression Free at 6 Months (APF6) in the Global Cohort The APF6 was defined as the percentage of patients who were alive and progression free at 6 months from randomization (ie, PFS rate at 6 months). PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until 6 months post-randomization.
Secondary Percentage of Patients Alive and Progression Free at 12 Months (APF12) in the Global Cohort The APF12 was defined as the percentage of patients who were alive and progression free at 12 months from randomization (ie, PFS rate at 12 months). PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until 12 months post-randomization.
Secondary Percentage of Patients Alive at 18 Months (OS18) in the Global Cohort OS18 was defined as the percentage of patients who were alive at 18 months after randomization per the Kaplan-Meier estimate of OS at 18 months. At 18 months post-randomization. Assessed at the global cohort final analysis DCO (27 January 2020).
Secondary Pharmacokinetics (PK) of Durvalumab; Peak and Trough Serum Concentrations in the Global Cohort To evaluate PK, blood samples were collected at pre-specified timepoints and peak and trough serum concentrations of durvalumab were determined. Peak concentration on Week 0 is the post-infusion concentration of Week 0 (collected within 10 minutes of the end of infusion). Trough concentrations on Weeks 3 and 12 are the pre-infusion concentrations of Weeks 3 and 12, respectively. Samples were collected post-dose on Day 1 (Week 0), and pre-dose on Weeks 3 and 12. Assessed at the global cohort final analysis DCO (27 January 2020).
Secondary PK of Tremelimumab; Peak and Trough Serum Concentrations in the Global Cohort To evaluate PK, blood samples were collected at pre-specified timepoints and peak and trough serum concentrations of tremelimumab were determined. Peak concentration on Week 0 is the post-infusion concentration of Week 0 (collected within 10 minutes of the end of infusion). Trough concentrations on Weeks 3 and 12 are the pre-infusion concentrations of Weeks 3 and 12, respectively. Samples were collected post-dose on Day 1 (Week 0), and pre-dose on Weeks 3 and 12. Assessed at the global cohort final analysis DCO (27 January 2020).
Secondary Number of Patients With Anti-Drug Antibody (ADA) Response to Durvalumab in the Global Cohort Serum sampling for ADA assessment was conducted utilizing a tiered approach (screen, confirm, titer). ADA positive post-baseline only was also referred to as treatment-induced ADA. Treatment-emergent ADA was defined as the sum of treatment-induced ADA and treatment-boosted ADA (defined as baseline positive ADA titer that was boosted to =4-fold during the study period). Persistently positive was defined as having =2 post-baseline ADA positive measurements with =16 weeks between first and last positive, or an ADA positive result at the last available assessment. Transiently positive was defined as having =1 post-baseline ADA positive measurement and not fulfilling the conditions for persistently positive. Presence of neutralizing antibody (nAb) was tested for all ADA positive samples. Results are reported as number of patients with ADA responses to durvalumab for each indicated category. Samples were collected on Day 1 (Week 0), Week 12 and at 3 months after the last dose of IP (ie, durvalumab). Assessed at the global cohort final analysis DCO (27 January 2020).
Secondary Number of Patients With ADA Response to Tremelimumab in the Global Cohort Serum sampling for ADA assessment was conducted utilizing a tiered approach (screen, confirm, titer). ADA positive post-baseline only was also referred to as treatment-induced ADA. Treatment-emergent ADA (or ADA incidence) was defined as the sum of treatment-induced ADA and treatment-boosted ADA (defined as baseline positive ADA titer that was boosted to =4-fold during the study period). Persistently positive was defined as having =2 post-baseline ADA positive measurements with =16 weeks between first and last positive, or an ADA positive result at the last available assessment. Transiently positive was defined as having =1 post-baseline ADA positive measurement and not fulfilling the conditions for persistently positive. The presence of nAb was tested for all ADA positive samples. Results are reported as number of patients with ADA responses to tremelimumab for each indicated category. Samples were collected on Day 1 (Week 0), Week 12 and at 3 months after the last dose of IP (ie, tremelimumab). Assessed at the global cohort final analysis DCO (27 January 2020).
Secondary Time to Deterioration of Health-Related Quality of Life (HRQoL) and Patient Reported Outcome (PRO) Symptoms, Assessed Using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) in the Global Cohort The EORTC QLQ-Core 30 version 3 (QLQ-C30 v3) was included for assessing HRQoL. It assesses HRQoL/health status through 9 multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social), 3 symptom scales (fatigue, pain, and nausea and vomiting), and a global health and QoL scale. 6 single-item symptom measures are also included: dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties. Scores from 0 to 100 were derived for each of the 15 domains, with higher scores representing greater functioning, greater HRQoL, or greater level of symptoms. Time to deterioration (calculated using the Kaplan-Meier technique) was defined as time from randomization until the date of first clinically meaningful deterioration (a decrease in score from baseline of =10) that is confirmed at a subsequent visit or death (by any cause) in the absence of a clinically meaningful deterioration. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Secondary Time to Deterioration of PRO Symptoms, Assessed Using EORTC QLQ-Lung Cancer Module 13 (QLQ-LC13) in the Global Cohort The EORTC QLQ-LC13 is a disease-specific 13-item self-administered questionnaire for lung cancer, to be used in conjunction with the EORTC QLQ-C30. It comprises both multi-item and single-item measures of lung cancer-associated symptoms (ie, coughing, hemoptysis, dyspnea, and pain) and side effects from conventional chemotherapy and radiotherapy (ie, hair loss, neuropathy, sore mouth, and dysphagia). Scores from 0 to 100 were derived for each symptom item, with higher scores representing greater level of symptoms. Time to deterioration (calculated using the Kaplan-Meier technique) was defined as time from randomization until the date of first clinically meaningful deterioration (an increase in score from baseline of =10) that is confirmed at a subsequent visit or death (by any cause) in the absence of a clinically meaningful deterioration. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed until global cohort final analysis DCO (maximum of approximately 33 months).
Secondary Change From Baseline in Primary PRO Symptoms as Assessed by EORTC QLQ in the Global Cohort; D + T + EP Compared With EP A mixed model repeated measures (MMRM) analysis of EORTC QLQ-C30 and EORTC QLQ-LC13 was performed for 5 primary PRO symptoms (cough, dyspnea, chest pain, fatigue and appetite loss), and considered all data from baseline to PD or 12 months, excluding visits with excessive missing data (defined as >75% missing data). An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales/symptom items, with higher scores representing greater symptom severity. An improvement in symptoms was indicated by a negative change from baseline. A positive change from baseline indicated a deterioration of symptoms. A minimum clinically meaningful change was defined as an absolute change from baseline of =10. This outcome measure presents change from baseline for primary PRO symptoms (reported as adjusted means) for analysis of D + T + EP vs P. Analysis of D + EP vs EP is presented in a separate outcome measure. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed up to 12 months.
Secondary Change From Baseline in Primary Symptoms, Assessed Using EORTC QLQ-C30 and EORTC QLQ-LC13 in the Global Cohort; D + EP Compared With EP A MMRM analysis of EORTC QLQ-C30 and EORTC QLQ-LC13 was performed for 5 primary PRO symptoms (cough, dyspnea, chest pain, fatigue and appetite loss), and considered all data from baseline to PD or 12 months, excluding visits with excessive missing data (defined as >75% missing data). An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales/symptom items, with higher scores representing greater symptom severity. An improvement in symptoms was indicated by a negative change from baseline. A positive change from baseline indicated a deterioration of symptoms. A minimum clinically meaningful change was defined as an absolute change from baseline of =10. This outcome measure presents change from baseline for primary PRO symptoms (reported as adjusted means) for analysis of D + EP vs EP. Analysis of D + T + EP vs EP is presented in a separate outcome measure. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed up to 12 months.
Secondary OS in the China Cohort; D + T + EP Compared With D + EP OS was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. This secondary outcome measure presents OS for the analysis of D + T + EP vs D + EP at the China cohort second analysis DCO (02 November 2020). The alternative treatment comparisons were performed as primary outcome measures. From baseline until death due to any cause. Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary PFS in the China Cohort PFS (per RECIST 1.1 using Investigator assessments) was defined as time from date of randomization until date of objective disease progression or death (by any cause in the absence of progression), regardless of whether the patient withdrew from randomized therapy or received another anticancer therapy prior to progression. Progression (ie, PD) was defined as at least a 20% increase in the sum of diameters of TLs, taking as reference the smallest previous sum of diameters (nadir) and an absolute increase of =5 mm for the sum from nadir. For evaluation of NTLs, PD was defined as unequivocal progression of existing NTLs. Median PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary ORR in the China Cohort ORR (per RECIST 1.1 using Investigator assessments) was defined as the percentage of patients with at least 1 visit response of CR or PR. CR was defined as disappearance of all TLs since baseline (any pathological lymph nodes selected as TLs must have a reduction in short axis diameter to <10 mm) or disappearance of all NTLs since baseline (all lymph nodes must be non-pathological in size [<10 mm short axis]). PR was defined as at least a 30% decrease in the sum of diameters of TLs (taking as reference the baseline sum of diameters). Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary APF6 in the China Cohort The APF6 was defined as the percentage of patients who were alive and progression free at 6 months from randomization (ie, PFS rate at 6 months). PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until 6 months post-randomization.
Secondary APF12 in the China Cohort The APF12 was defined as the percentage of patients who were alive and progression free at 12 months from randomization (ie, PFS rate at 12 months). PFS was calculated using the Kaplan-Meier technique. Tumour scans performed at baseline, Week 6, Week 12 then every 8 weeks relative to the date of randomization until RECIST 1.1-defined progression. Assessed until 12 months post-randomization.
Secondary OS18 in the China Cohort OS18 was defined as the percentage of patients who were alive at 18 months after randomization per the Kaplan-Meier estimate of OS at 18 months. At 18 months post-randomization. Assessed at the China cohort second analysis DCO (02 November 2020).
Secondary PK of Durvalumab; Peak and Trough Serum Concentrations in the China Cohort To evaluate PK, blood samples were collected at pre-specified timepoints and peak and trough serum concentrations of durvalumab were determined. Peak concentration on Week 0 is the post-infusion concentration of Week 0 (collected within 10 minutes of the end of infusion). Trough concentrations on Weeks 3 and 12 are the pre-infusion concentrations of Weeks 3 and 12, respectively. Samples were collected post-dose on Day 1 (Week 0), and pre-dose on Weeks 3 and 12. Assessed at the China cohort second analysis DCO (02 November 2020).
Secondary PK of Tremelimumab; Peak and Trough Serum Concentrations in the China Cohort To evaluate PK, blood samples were collected at pre-specified timepoints and peak and trough serum concentrations of tremelimumab were determined. Peak concentration on Week 0 is the post-infusion concentration of Week 0 (collected within 10 minutes of the end of infusion). Trough concentrations on Weeks 3 and 12 are the pre-infusion concentrations of Weeks 3 and 12, respectively. Samples were collected post-dose on Day 1 (Week 0), and pre-dose on Weeks 3 and 12. Assessed at the China cohort second analysis DCO (02 November 2020).
Secondary Number of Patients With ADA Response to Durvalumab in the China Cohort Serum sampling for ADA assessment was conducted utilizing a tiered approach (screen, confirm, titer). ADA positive post-baseline only was also referred to as treatment-induced ADA. Treatment-emergent ADA was defined as the sum of treatment-induced ADA and treatment-boosted ADA (defined as baseline positive ADA titer that was boosted to =4-fold during the study period). Persistently positive was defined as having =2 post-baseline ADA positive measurements with =16 weeks between first and last positive, or an ADA positive result at the last available assessment. Transiently positive was defined as having =1 post-baseline ADA positive measurement and not fulfilling the conditions for persistently positive. Presence of nAb was tested for all ADA positive samples. Results are reported as number of patients with ADA responses to durvalumab for each indicated category. Samples were collected on Day 1 (Week 0), Week 12 and at 3 months after the last dose of IP (ie, durvalumab). Assessed at the China cohort second analysis DCO (02 November 2020).
Secondary Number of Patients With ADA Response to Tremelimumab in the China Cohort Serum sampling for ADA assessment was conducted utilizing a tiered approach (screen, confirm, titer). ADA positive post-baseline only was also referred to as treatment-induced ADA. Treatment-emergent ADA (or ADA incidence) was defined as the sum of treatment-induced ADA and treatment-boosted ADA (defined as baseline positive ADA titer that was boosted to =4-fold during the study period). Persistently positive was defined as having =2 post-baseline ADA positive measurements with =16 weeks between first and last positive, or an ADA positive result at the last available assessment. Transiently positive was defined as having =1 post-baseline ADA positive measurement and not fulfilling the conditions for persistently positive. The presence of nAb was tested for all ADA positive samples. Results are reported as number of patients with ADA responses to tremelimumab for each indicated category. Samples were collected on Day 1 (Week 0), Week 12 and at 3 months after the last dose of IP (ie, tremelimumab). Assessed at the China cohort second analysis DCO (02 November 2020).
Secondary Time to Deterioration of HRQoL and PRO Symptoms, Assessed Using EORTC QLQ in the China Cohort The EORTC QLQ-C30 v3 was included for assessing HRQoL. It assesses HRQoL/health status through 9 multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social), 3 symptom scales (fatigue, pain, and nausea and vomiting), and a global health and QoL scale. 6 single-item symptom measures are also included: dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties. Scores from 0 to 100 were derived for each of the 15 domains, with higher scores representing greater functioning, greater HRQoL, or greater level of symptoms. Time to deterioration (calculated using the Kaplan-Meier technique) was defined as time from randomization until the date of first clinically meaningful deterioration (a decrease in score from baseline of =10) that is confirmed at a subsequent visit or death (by any cause) in the absence of a clinically meaningful deterioration. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary Time to Deterioration of PRO Symptoms, Assessed Using EORTC QLQ-LC13 in the China Cohort The EORTC QLQ-LC13 is a disease-specific 13-item self-administered questionnaire for lung cancer, to be used in conjunction with the EORTC QLQ-C30. It comprises both multi-item and single-item measures of lung cancer-associated symptoms (ie, coughing, hemoptysis, dyspnea, and pain) and side effects from conventional chemotherapy and radiotherapy (ie, hair loss, neuropathy, sore mouth, and dysphagia). Scores from 0 to 100 were derived for each symptom item, with higher scores representing greater level of symptoms. Time to deterioration (calculated using the Kaplan-Meier technique) was defined as time from randomization until the date of first clinically meaningful deterioration (an increase in score from baseline of =10) that is confirmed at a subsequent visit or death (by any cause) in the absence of a clinically meaningful deterioration. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed until China cohort second analysis DCO (maximum of approximately 29 months).
Secondary Change From Baseline in Primary PRO Symptoms, Assessed Using EORTC QLQ-C30 and EORTC QLQ-LC13 in the China Cohort; D + T + EP Compared With EP A MMRM analysis of EORTC QLQ-C30 and EORTC QLQ-LC13 was performed for 5 primary PRO symptoms (cough, dyspnea, chest pain, fatigue and appetite loss), and considered all data from baseline to PD or 12 months, excluding visits with excessive missing data (defined as >75% missing data). An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales/symptom items, with higher scores representing greater symptom severity. An improvement in symptoms was indicated by a negative change from baseline. A positive change from baseline indicated a deterioration of symptoms. A minimum clinically meaningful change was defined as an absolute change from baseline of =10. This outcome measure presents change from baseline for primary PRO symptoms (reported as adjusted means) for analysis of D + T + EP vs EP. Analysis of D + EP vs EP is presented in a separate outcome measure. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed up to 12 months.
Secondary Change From Baseline in Primary Symptoms as Assessed by EORTC QLQ in the China Cohort; D + EP Compared With EP A MMRM analysis of EORTC QLQ-C30 and EORTC QLQ-LC13 was performed for 5 primary PRO symptoms (cough, dyspnea, chest pain, fatigue and appetite loss), and considered all data from baseline to PD or 12 months, excluding visits with excessive missing data (defined as >75% missing data). An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales/symptom items, with higher scores representing greater symptom severity. An improvement in symptoms was indicated by a negative change from baseline. A positive change from baseline indicated a deterioration of symptoms. A minimum clinically meaningful change was defined as an absolute change from baseline of =10. This outcome measure presents change from baseline for primary PRO symptoms (reported as adjusted means) for analysis of D + EP vs EP. Analysis of D + T + EP vs EP is presented in a separate outcome measure. At baseline, Weeks 3, 6, 9, 12, 16 and 20, then Q4W until PD, on Day 28 and 2 months post-PD, then every 8 weeks until second progression/death (whichever comes first). Assessed up to 12 months.
See also
  Status Clinical Trial Phase
Completed NCT04449861 - Durvalumab Plus Chemotherapy in ES-SCLC (Oriental) Phase 3
Completed NCT04712903 - Durvalumab Plus Chemotherapy in Untreated Patients With Extensive-Stage Small Cell Lung Cancer Phase 3

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