A Study of Pemetrexed and Carboplatin/Cisplatin or Gemcitabine and Carboplatin/Cisplatin With or Without IMC-1121B in Participants Previously Untreated With Recurrent or Advanced Non-Small Cell Lung Cancer (NSCLC)

Study Overview
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Brief Summary
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The purpose of this study is to determine if participants with Stage IV NSCLC have a better outcome when treated with IMC-1121B in combination with pemetrexed + carboplatin/cisplatin or gemcitabine + carboplatin/cisplatin than when treated with pemetrexed + carboplatin/cisplatin or gemcitabine + carboplatin/cisplatin alone.

Official Title
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An Open-label, Multicenter, Randomized, Phase 2 Study of a Recombinant Human Anti-VEGFR-2 Monoclonal Antibody, IMC-1121B in Combination With Platinum-based Chemotherapy Versus Platinum-based Chemotherapy Alone as First-line Treatment of Patients With Recurrent or Advanced Non-small Cell Lung Cancer (NSCLC)

Conditions
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Carcinoma, Non-Small-Cell Lung

Intervention / Treatment
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* Biological: IMC-1121B (ramucirumab)
* Drug: Pemetrexed
* Drug: Carboplatin (AUC 6)
* Drug: Cisplatin
* Drug: Gemcitabine
* Drug: Carboplatin (AUC 5)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmed NSCLC Stage IV disease at the time of study entry Measurable disease at the time of study entry Resolution to Grade ≤ 1 Adverse Events, of all clinically significant toxic effects of prior chemotherapy, surgery, radiotherapy, or hormonal therapy (except alopecia) Adequate hematologic function, hepatic function, renal function and coagulation function If sexually active, must be post-menopausal, surgically sterile, or using effective contraception; and agrees to use adequate contraception during the study period and for up to 6 months after the last dose of study medication Female participants of childbearing potential must have a negative serum pregnancy test Exclusion Criteria: Has cirrhosis at a level of Child-Pugh B (or worse), or cirrhosis and a history of hepatic encephalopathy, or ascites resulting from cirrhosis and requiring ongoing treatment with diuretics and/or paracentesis Tumor wholly or partially contains small cell lung cancer Untreated central nervous system (CNS) metastases, eligible if they are clinically stable with regard to neurologic function, off all steroids after cranial irradiation at least 2 weeks prior or after surgical resection performed at least 4 weeks prior to randomization Concurrent active malignancy other than adequately treated basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix. A participant with previous history of malignancy other than NSCLC is eligible, provided that he/she has been free of disease for ≥ 3 years Received prior therapy with monoclonal antibodies, signal transduction inhibitors, or any therapies targeting the vascular endothelial growth factor (VEGF) or vascular endothelial growth factor receptor (VEGFR) Receiving concurrent treatment with other anticancer therapy Has received previous chemotherapy for Stage IV NSCLC (participants who have received adjuvant chemotherapy are eligible if the last administration of the prior adjuvant regimen occurred at least 6 months prior to randomization) Has radiologically documented evidence of major blood vessel invasion or encasement by cancer Has undergone chest irradiation within 12 weeks prior to randomization (except palliative irradiation of bone lesions) Ongoing or active infection History of significant neurological or psychiatric disorders Experienced clinically relevant coronary artery disease, myocardial infarction within 6 months prior to randomization, uncontrolled congestive heart failure, or symptomatic poorly controlled arrhythmia Poorly-controlled hypertension Experienced any serious Grade 3-4 gastrointestinal bleeding within 3 months prior to study entry Receiving chronic daily treatment with aspirin (> 325 mg/day) or other known inhibitors of platelet function Serious nonhealing wound, ulcer, or bone fracture within 28 days prior to randomization Major surgery within 28 days prior the first dose of study medication, or subcutaneous venous access device placement within 7 days prior to randomization Elective or a planned major surgery Pregnant or lactating Any other serious uncontrolled medical disorders or psychological conditions Allergy / history of hypersensitivity reaction to any of the treatment components History of drug abuse

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: IMC-1121B + Pemetrexed + Carboplatin (AUC 6) or Cisplatin<br>IMC-1121B + Pemetrexed + Carboplatin [Area Under the Concentration Time Curve 6 (AUC 6)] or Cisplatin | Biological: IMC-1121B (ramucirumab)<br>* 10 milligrams/kilogram (mg/kg) once every 3 weeks beginning Day 1, Cycle 1<br>* Other names: LY3009806;Drug: Pemetrexed<br>* 500 milligrams/square meter (mg/m²) on Day 1 of every 21-day cycle<br>Drug: Carboplatin (AUC 6)<br>* Day 1 of every 21-day cycle<br>Drug: Cisplatin<br>* 75 mg/m² intravenous (IV) on Day 1 of each 21-day cycle<br>|
| Active Comparator: Pemetrexed + Carboplatin (AUC 6) or Cisplatin<br>Pemetrexed + Carboplatin (AUC 6) or Cisplatin | Drug: Pemetrexed<br>* 500 milligrams/square meter (mg/m²) on Day 1 of every 21-day cycle<br>Drug: Carboplatin (AUC 6)<br>* Day 1 of every 21-day cycle<br>Drug: Cisplatin<br>* 75 mg/m² intravenous (IV) on Day 1 of each 21-day cycle<br>|
| Experimental: IMC-1121B + Gemcitabine + Carboplatin (AUC 5) or Cisplatin<br>IMC-1121B + Gemcitabine + Carboplatin [Area Under the Concentration Time Curve 5 (AUC 5)] or Cisplatin | Biological: IMC-1121B (ramucirumab)<br>* 10 milligrams/kilogram (mg/kg) once every 3 weeks beginning Day 1, Cycle 1<br>* Other names: LY3009806;Drug: Cisplatin<br>* 75 mg/m² intravenous (IV) on Day 1 of each 21-day cycle<br>Drug: Gemcitabine<br>* 1000 mg/m² on Days 1 and 8 of every 21-day cycle<br>Drug: Carboplatin (AUC 5)<br>* Day 1 of every 21-day cycle<br>|
| Active Comparator: Gemcitabine + Carboplatin (AUC 5) or Cisplatin<br>Gemcitabine + Carboplatin (AUC 5) or Cisplatin | Drug: Cisplatin<br>* 75 mg/m² intravenous (IV) on Day 1 of each 21-day cycle<br>Drug: Gemcitabine<br>* 1000 mg/m² on Days 1 and 8 of every 21-day cycle<br>Drug: Carboplatin (AUC 5)<br>* Day 1 of every 21-day cycle<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-Free Survival (PFS) | PFS was the time from randomization to the first objective progression as defined by Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v 1.1) or death from any cause, whichever occurred first. Progressive disease (PD) was defined as ≥20% increase in sum of diameter (SOD) of target lesions and short axes of target lymph nodes, taking as reference the smallest sum of the longest diameters recorded since treatment started and an absolute increase in sum diameter of ≥5 millimeters (mm); appearance of ≥1 new lesions and/or unequivocal progression of existing non-target lesions. Participants alive and without disease progression were censored at the time of the last objective tumor assessment. Participants who did not progress and were lost to follow-up were censored at their last radiographic assessment. If no baseline or post baseline radiologic assessments were available, participants were censored at date of randomization. | Randomization to PD or death (up to 24 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants With Best Overall Response of Complete Response (CR) or Partial Response (PR) [Objective Response Rate (ORR)] | Best overall response of CR or PR was defined using RECIST v 1.1 criteria. CR was defined as the disappearance of all lesions, pathological lymph node reduction in short axis to <10 mm, and normalization of tumor marker levels of non-target lesions. PR was defined as ≥30% decrease in SOD of target lesions taking as reference the baseline sum diameter. PD was defined as ≥20% increase in SOD of target lesions and short axes of target lymph nodes, taking as reference the smallest sum of the longest diameters recorded since treatment started and an absolute increase in sum diameter of ≥5 mm; appearance of ≥1 new lesions and/or unequivocal progression of existing non-target lesions. Participants who had no post baseline tumor assessments were considered non-responders and included in the denominator when calculating response rate. Percentage of participants=(number of participants with CR+PR/total number of participants)*100. | Day 1, Cycle 1 (3-week cycles) and every 6 weeks thereafter to PD (up to 24 months) | 
| Overall Survival (OS) | OS was defined as the time from the date of randomization to the date of death from any cause. If the participant was alive at the end of the follow-up period or was lost to follow-up, OS was censored on the last date the participant was known to be alive. | Randomization to the date of death from any cause (up to 31.3 months) | 
| Duration of Response (DOR) | DOR was measured from the time criteria were met for the first objectively recorded CR or PR until the first date criteria for PD were met or death. Response was defined using RECIST v 1.1 criteria. CR was defined as the disappearance of all lesions, pathological lymph node reduction in short axis to <10 mm, and normalization of tumor marker level of non-target lesions. PR was defined as ≥30% decrease SOD of target lesions taking as reference the baseline sum diameter. PD was defined as ≥20% increase in SOD of target lesions and short axes of target lymph nodes, taking as reference the smallest sum of the longest diameters recorded since treatment started and an absolute increase in sum diameter of ≥5 mm; appearance of ≥1 new lesions and/or unequivocal progression of existing non-target lesions. Participants who did not relapse were censored at the day of their last objective tumor assessment. | Time of first response (CR or PR) until PD or death (up to 24 months) | 
| Number of Participants Reporting Treatment-Emergent Adverse Events (TEAEs) and Who Died | Data presented are the number of participants with at least 1 treatment-emergent adverse event (TEAE) and treatment-emergent serious adverse event (SAE), as well as, the number of participants who died during the study. TEAEs were defined as serious and other non-serious AEs that occurred or worsened after study treatment (regardless of causality). A summary of SAEs and other non-serious adverse events, regardless of causality, is located in the Reported Adverse Events module. | Day 1, Cycle 1 (3-week cycles) Up to 3 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lung neoplasms, Lung cancer, Non-small Cell Lung Cancer, pemetrexed, squamous, nonsquamous