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    Clinical Trial Results:
    A phase II study evaluating the efficacy and the safety of first-line chemotherapy combined with TG4010 and nivolumab in patients with advanced non-squamous Non-Small-Cell Lung Cancer (NSCLC)

    Summary
    EudraCT number
    2016-005115-41
    Trial protocol
    BE   HU   DK  
    Global end of trial date
    02 Nov 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Nov 2021
    First version publication date
    11 Nov 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    TG4010.24
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02823990
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Transgene S.A.
    Sponsor organisation address
    400 boulevard Gonthier d’Andernach - Parc d’innovation – CS80166, Illkirch-Graffenstaden, France, 67405
    Public contact
    Medical Affairs Secretariat, Transgene S.A., +33 388 27 91 55, clinical.trials@transgene.fr
    Scientific contact
    Medical Affairs Secretariat, Transgene S.A., +33 388 27 91 55, clinical.trials@transgene.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    26 Feb 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Nov 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Nov 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the anti-tumor activity in terms of objective response rate (ORR) by using RECIST 1.1 in chemotherapy-naïve and immunotherapy-naïve advanced, non-squamous NSCLC subjects with PD-L1 membrane staining on <50% of tumor cells receiving first-line chemotherapy (pemetrexed + carboplatin or cisplatin followed by pemetrexed maintenance therapy) plus TG4010 and nivolumab.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    05 Jan 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 6
    Country: Number of subjects enrolled
    Belgium: 6
    Country: Number of subjects enrolled
    France: 26
    Country: Number of subjects enrolled
    Hungary: 6
    Worldwide total number of subjects
    44
    EEA total number of subjects
    38
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    28
    From 65 to 84 years
    16
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Recruitment was initiated on 05 January 2018 and ended on 02 May 2019.

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    44
    Number of subjects completed
    44

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    TG4010,Nivo,Chemo
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    TG4010
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Suspension for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Patients received subcutaneous injections of TG4010 at the dose of 1 x 10E8 PFU weekly for 6 weeks and then once every 3 weeks until disease progression or death or premature discontinuation due to any reason

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Nivolumab was administered as an IV infusion over at least 30 minutes at a dose of 360 mg once every 3 weeks until disease progression or death or premature discontinuation due to any reason or for a maximum of 24 months whichever occurs first.

    Number of subjects in period 1
    TG4010,Nivo,Chemo
    Started
    44
    Completed
    40
    Not completed
    4
         Adverse event, serious fatal
    2
         Adverse event, non-fatal
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    44 44
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    28 28
        From 65-84 years
    16 16
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    17 17
        Male
    27 27
    ECOG
    Units: Subjects
        00
    21 21
        01
    23 23
    PD-L1 percentage of stained cells
    Method Dako PD-L1 IHC 22C3 pharmDx assay kit
    Units: Subjects
        <1
    22 22
        1 - <50
    22 22
        ≥50
    0 0
    Body Mass Index (BMI)
    Units: kg/m²
        median (full range (min-max))
    24.4 (15 to 37) -
    Subject analysis sets

    Subject analysis set title
    Full analysis set (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All subjects included and who received any component of the study treatment were included in the FAS. Any subject who was assigned a subject number but did not receive any study treatment was not included in the FAS. To be noted that in the study, all included subjects (N=44) received at least one administration of each treatment, thus the FAS is the same as the Safety Analysis Set.

    Subject analysis set title
    Evaluable Patients' Population (EPP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    Evaluable Patients’ Population for tumor response (EPP): consists of all subjects without major protocol deviation and have at least one baseline and one post-baseline evaluable CT-scan after study treatment start except early disease progression and death due to lung cancer. The evaluable patients’ population was the primary population for efficacy analyses.

    Subject analysis sets values
    Full analysis set (FAS) Evaluable Patients' Population (EPP)
    Number of subjects
    44
    40
    Age categorical
    Units: Subjects
        In utero
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
        Newborns (0-27 days)
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
        Children (2-11 years)
    0
    0
        Adolescents (12-17 years)
    0
    0
        Adults (18-64 years)
    28
    26
        From 65-84 years
    16
    14
        85 years and over
    0
    0
    Age continuous
    Units:
        
    ( )
    ( )
    Gender categorical
    Units: Subjects
        Female
    17
    14
        Male
    27
    26
    ECOG
    Units: Subjects
        00
    21
    19
        01
    23
    21
    PD-L1 percentage of stained cells
    Method Dako PD-L1 IHC 22C3 pharmDx assay kit
    Units: Subjects
        <1
    22
    20
        1 - <50
    22
    20
        ≥50
    0
    0
    Body Mass Index (BMI)
    Units: kg/m²
        median (full range (min-max))
    24.4 (15 to 37)
    24.6 (15 to 37)

    End points

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    End points reporting groups
    Reporting group title
    TG4010,Nivo,Chemo
    Reporting group description
    -

    Subject analysis set title
    Full analysis set (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All subjects included and who received any component of the study treatment were included in the FAS. Any subject who was assigned a subject number but did not receive any study treatment was not included in the FAS. To be noted that in the study, all included subjects (N=44) received at least one administration of each treatment, thus the FAS is the same as the Safety Analysis Set.

    Subject analysis set title
    Evaluable Patients' Population (EPP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    Evaluable Patients’ Population for tumor response (EPP): consists of all subjects without major protocol deviation and have at least one baseline and one post-baseline evaluable CT-scan after study treatment start except early disease progression and death due to lung cancer. The evaluable patients’ population was the primary population for efficacy analyses.

    Primary: Overall Response rate

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    End point title
    Overall Response rate [1]
    End point description
    Percentage of subjects whose best overall response is complete response or partial response using RECIST 1.1. confirmed by a second scan no less than 4 weeks after the criteria for response are first met. Complete response: disappearance of all lesions and no new lesions. Partial response: decrease of at least 30% in the sum of the diameters of measurable lesions taking as reference the baseline sum of diameters, no progression of non-measurable lesions and no new lesions.
    End point type
    Primary
    End point timeframe
    15 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Single arm study: no comparative test was performed.
    End point values
    TG4010,Nivo,Chemo Evaluable Patients' Population (EPP)
    Number of subjects analysed
    40
    40
    Units: Percentage
    number (confidence interval 90%)
        Responders
    32.5 (20.4 to 46.6)
    32.5 (20.4 to 46.6)
    No statistical analyses for this end point

    Secondary: Duration of Response

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    End point title
    Duration of Response
    End point description
    Duration of Response (DoR): applies only to subjects with complete response or partial response. The start date was the date of first documented response (complete response or partial response) and the end date was the date of first documented disease progression. If no progression has been observed at the cut-off date of analysis or at the date when a subsequent cancer therapy was started, duration of response was censored at the date of the last evaluable tumor assessment.
    End point type
    Secondary
    End point timeframe
    28 months
    End point values
    TG4010,Nivo,Chemo Evaluable Patients' Population (EPP)
    Number of subjects analysed
    13
    13
    Units: weeks
        median (inter-quartile range (Q1-Q3))
    74.9 (19.4 to 92.6)
    74.9 (19.4 to 92.6)
    No statistical analyses for this end point

    Secondary: Progression Free Survival (PFS)

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    End point title
    Progression Free Survival (PFS)
    End point description
    Progression Free Survival (PFS): time from the date of first study treatment administration to the date of first documented tumor progression or death due to any cause, whichever occurs first. If a subject has not had a PFS event at the cut-off date for analysis or at the date when a subsequent cancer therapy (other than those planned as study treatment in the protocol) is started, PFS will be censored at the date of last evaluable tumor assessment before the cut-off date or start of subsequent therapy.
    End point type
    Secondary
    End point timeframe
    28 months
    End point values
    TG4010,Nivo,Chemo Evaluable Patients' Population (EPP)
    Number of subjects analysed
    40
    40
    Units: months
        median (inter-quartile range (Q1-Q3))
    5.7 (1.5 to 11.1)
    5.7 (1.5 to 11.1)
    No statistical analyses for this end point

    Secondary: Disease Control Rate (DCR)

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    End point title
    Disease Control Rate (DCR)
    End point description
    Percentage of subjects whose best overall response is either complete response, partial response or stable disease.
    End point type
    Secondary
    End point timeframe
    15 months
    End point values
    TG4010,Nivo,Chemo Evaluable Patients' Population (EPP)
    Number of subjects analysed
    40
    40
    Units: Percentage of subjects
        number (confidence interval 90%)
    75.0 (61.3 to 85.8)
    75.0 (61.3 to 85.8)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS) at 1 year

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    End point title
    Overall Survival (OS) at 1 year
    End point description
    Percentage of participants alive 1 year after treatment start. Analyzed with standard Kaplan-Meier methodology. A 12-month survival rate is calculated since the upper limit of 95% confidence interval for overall survival was not reached by the end of the study period.
    End point type
    Secondary
    End point timeframe
    12 months
    End point values
    Evaluable Patients' Population (EPP)
    Number of subjects analysed
    40
    Units: Percentage of subjects
        number (confidence interval 95%)
    57.5 (40.8 to 71.0)
    No statistical analyses for this end point

    Secondary: Assessment of Safety

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    End point title
    Assessment of Safety
    End point description
    The assessment of safety of the combination was based mainly on the frequency of adverse events, serious adverse events, adverse events of special interest (Injection site reaction, fatigue, pyrexia, infusion-related reactions and diarrhea), immune-mediated adverse events and laboratories abnormalities.
    End point type
    Secondary
    End point timeframe
    28 months
    End point values
    TG4010,Nivo,Chemo Full analysis set (FAS)
    Number of subjects analysed
    44
    44
    Units: Percentage of subjects
        Adverse events
    100
    100
        Serious adverse events
    64
    64
        Adverse events of special interest
    84
    84
        Immune-mediated adverse events
    32
    32
        Grade 3/4 laboratories abnormalities
    70
    70
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Collection of AEs / serious AEs starts from the date of signature of the informed consent form up to the safety follow-up visits (100 days after the last administration of any study treatment administration). Timeframe was approximately 28 months.
    Adverse event reporting additional description
    Any new untoward medical occurrence or worsening of a preexisting medical condition in a clinical investigation patient administered study treatment and that does not necessarily have a causal relationship with this treatment.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.0
    Reporting groups
    Reporting group title
    TG4010, Nivo, Chemo
    Reporting group description
    -

    Serious adverse events
    TG4010, Nivo, Chemo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    28 / 44 (63.64%)
         number of deaths (all causes)
    28
         number of deaths resulting from adverse events
    15
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Cancer pain
    Additional description: Cancer pain
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Deep vein thrombosis
    Additional description: Deep vein thrombosis
         subjects affected / exposed
    2 / 44 (4.55%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Condition aggravated
    Additional description: Condition aggravated
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fatigue
    Additional description: Fatigue
         subjects affected / exposed
    2 / 44 (4.55%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
    Additional description: General physical health deterioration
         subjects affected / exposed
    9 / 44 (20.45%)
         occurrences causally related to treatment / all
    0 / 9
         deaths causally related to treatment / all
    0 / 8
    Immune system disorders
    Anaphylactic reaction
    Additional description: Anaphylactic reaction
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Prostatitis
    Additional description: Prostatitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory failure
    Additional description: Acute respiratory failure
         subjects affected / exposed
    2 / 44 (4.55%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Dyspnoea
    Additional description: Dyspnoea
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary embolism
    Additional description: Pulmonary embolism
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary haemorrhage
    Additional description: Pulmonary haemorrhage
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory distress
    Additional description: Respiratory distress
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Investigations
    Blood creatinine increased
    Additional description: Blood creatinine increased
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebral infarction
    Additional description: Cerebral infarction
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral ischaemia
    Additional description: Cerebral ischaemia
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Headache
    Additional description: Headache
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ischaemic stroke
    Additional description: Ischaemic stroke
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Loss of consciousness
    Additional description: Loss of consciousness
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Neuropathy peripheral
    Additional description: Neuropathy peripheral
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
    Additional description: Transient ischaemic attack
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
    Additional description: Febrile neutropenia
         subjects affected / exposed
    2 / 44 (4.55%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
    Additional description: Thrombocytopenia
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
    Additional description: Abdominal pain
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Autoimmune colitis
    Additional description: Autoimmune colitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Colitis ulcerative
    Additional description: Colitis ulcerative
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
    Additional description: Diarrhoea
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Duodenitis
    Additional description: Duodenitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
    Additional description: Pancreatitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
    Additional description: Vomiting
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholangitis acute
    Additional description: Cholangitis acute
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash
    Additional description: Rash
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
    Additional description: Acute kidney injury
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bartholinitis
    Additional description: Bartholinitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Brain abscess
    Additional description: Brain abscess
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cellulitis
    Additional description: Cellulitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diverticulitis
    Additional description: Diverticulitis
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile infection
    Additional description: Febrile infection
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
    Additional description: Pneumonia
         subjects affected / exposed
    2 / 44 (4.55%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Septic shock
    Additional description: Septic shock
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Metabolism and nutrition disorders
    Dehydration
    Additional description: Dehydration
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypercalcaemia
    Additional description: Hypercalcaemia
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperglycaemia
    Additional description: Hyperglycaemia
         subjects affected / exposed
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    TG4010, Nivo, Chemo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    43 / 44 (97.73%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Cancer pain
    Additional description: Cancer pain
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    4
    Vascular disorders
    Flushing
    Additional description: Flushing
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    4
    General disorders and administration site conditions
    Asthenia
    Additional description: Asthenia
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Fatigue
    Additional description: Fatigue
         subjects affected / exposed
    29 / 44 (65.91%)
         occurrences all number
    39
    Injection site erythema
    Additional description: Injection site erythema
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    6
    Injection site pain
    Additional description: Injection site pain
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    5
    Injection site reaction
    Additional description: Injection site reaction
         subjects affected / exposed
    6 / 44 (13.64%)
         occurrences all number
    6
    Oedema peripheral
    Additional description: Oedema peripheral
         subjects affected / exposed
    9 / 44 (20.45%)
         occurrences all number
    11
    Pyrexia
    Additional description: Pyrexia
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    7
    Respiratory, thoracic and mediastinal disorders
    Cough
    Additional description: Cough
         subjects affected / exposed
    12 / 44 (27.27%)
         occurrences all number
    13
    Dyspnoea
    Additional description: Dyspnoea
         subjects affected / exposed
    13 / 44 (29.55%)
         occurrences all number
    14
    Epistaxis
    Additional description: Epistaxis
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    5
    Productive cough
    Additional description: Productive cough
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Investigations
    Alanine aminotransferase increased
    Additional description: Alanine aminotransferase increased
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    4
    Aspartate aminotransferase increased
    Additional description: Aspartate aminotransferase increased
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    5
    Blood creatinine increased
    Additional description: Blood creatinine increased
         subjects affected / exposed
    7 / 44 (15.91%)
         occurrences all number
    7
    Lipase increased
    Additional description: Lipase increased
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Weight decreased
    Additional description: Weight decreased
         subjects affected / exposed
    8 / 44 (18.18%)
         occurrences all number
    8
    Injury, poisoning and procedural complications
    Infusion related reaction
    Additional description: Infusion related reaction
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Nervous system disorders
    Dizziness
    Additional description: Dizziness
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    4
    Dysgeusia
    Additional description: Dysgeusia
         subjects affected / exposed
    8 / 44 (18.18%)
         occurrences all number
    8
    Headache
    Additional description: Headache
         subjects affected / exposed
    9 / 44 (20.45%)
         occurrences all number
    9
    Paraesthesia
    Additional description: Paraesthesia
         subjects affected / exposed
    8 / 44 (18.18%)
         occurrences all number
    8
    Blood and lymphatic system disorders
    Anaemia
    Additional description: Anaemia
         subjects affected / exposed
    24 / 44 (54.55%)
         occurrences all number
    43
    Leukopenia
    Additional description: Leukopenia
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    5
    Neutropenia
    Additional description: Neutropenia
         subjects affected / exposed
    14 / 44 (31.82%)
         occurrences all number
    21
    Thrombocytopenia
    Additional description: Thrombocytopenia
         subjects affected / exposed
    13 / 44 (29.55%)
         occurrences all number
    20
    Eye disorders
    Lacrimation increased
    Additional description: Lacrimation increased
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Gastrointestinal disorders
    Abdominal pain
    Additional description: Abdominal pain
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    5
    Constipation
    Additional description: Constipation
         subjects affected / exposed
    16 / 44 (36.36%)
         occurrences all number
    17
    Diarrhoea
    Additional description: Diarrhoea
         subjects affected / exposed
    17 / 44 (38.64%)
         occurrences all number
    23
    Dry mouth
    Additional description: Dry mouth
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Gastrooesophageal reflux disease
    Additional description: Gastrooesophageal reflux disease
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Nausea
    Additional description: Nausea
         subjects affected / exposed
    26 / 44 (59.09%)
         occurrences all number
    31
    Stomatitis
    Additional description: Stomatitis
         subjects affected / exposed
    7 / 44 (15.91%)
         occurrences all number
    8
    Vomiting
    Additional description: Vomiting
         subjects affected / exposed
    8 / 44 (18.18%)
         occurrences all number
    10
    Skin and subcutaneous tissue disorders
    Alopecia
    Additional description: Alopecia
         subjects affected / exposed
    3 / 44 (6.82%)
         occurrences all number
    3
    Dry skin
    Additional description: Dry skin
         subjects affected / exposed
    7 / 44 (15.91%)
         occurrences all number
    7
    Pruritus
    Additional description: Pruritus
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    4
    Rash
    Additional description: Rash
         subjects affected / exposed
    7 / 44 (15.91%)
         occurrences all number
    9
    Endocrine disorders
    Hypothyroidism
    Additional description: Hypothyroidism
         subjects affected / exposed
    4 / 44 (9.09%)
         occurrences all number
    4
    Musculoskeletal and connective tissue disorders
    Myalgia
    Additional description: Myalgia
         subjects affected / exposed
    6 / 44 (13.64%)
         occurrences all number
    6
    Pain in extremity
    Additional description: Pain in extremity
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    5
    Infections and infestations
    Conjunctivitis
    Additional description: Conjunctivitis
         subjects affected / exposed
    5 / 44 (11.36%)
         occurrences all number
    5
    Metabolism and nutrition disorders
    Decreased appetite
    Additional description: Decreased appetite
         subjects affected / exposed
    13 / 44 (29.55%)
         occurrences all number
    15
    Hypokalaemia
    Additional description: Hypokalaemia
         subjects affected / exposed
    9 / 44 (20.45%)
         occurrences all number
    13

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    25 Apr 2018
    The amendment objective was to i) implement changes demanded by the French and Danish Health Authorities : modification of an inclusion criterion to specify that patients with stage IIIB must not be eligible to radiotherapy and of an exclusion criterion to exclude patients with stage IIIB eligible to radiotherapy, strengthen the monitoring of pulmonary and cardiac toxicity possibly associated with nivolumab and/or pemetrexed, align the protocol with SmPC for dose reduction in case of haematologic or non-haematologic toxicity with pemetrexed + cisplatin and treatment modifications of nivolumab, addition of uric acid measurement as part of biochemistry analyses for surveillance of tumor lysis syndrome, implement the highly effective contraceptive methods in accordance with CTFG recommendation, ii) implement new data available from the nivolumab investigator brochure.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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