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    Clinical Trial Results:
    Open-Label, Randomized Trial of Nivolumab (BMS-936558) plus Pemetrexed/Platinum or Nivolumab plus Ipilimumab (BMS-734016) vs Pemetrexed plus Platinum in Stage IV or Recurrent Non-Small Cell Lung Cancer (NSCLC) Subjects with Epidermal Growth Factor Receptor (EGFR) Mutation Who Failed 1L or 2L EGFR Tyrosine Kinase Inhibitor Therapy: CheckMate 722: CHECKpoint pathway and nivoluMAb clinical Trial Evaluation 722.

    Summary
    EudraCT number
    2017-002672-38
    Trial protocol
    ES  
    Global end of trial date
    17 Oct 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    22 Sep 2023
    First version publication date
    22 Sep 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CA209-722
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Bristol-Myers Squibb
    Sponsor organisation address
    Chaussee de la Hulpe 185, Brussels, Belgium, 1170
    Public contact
    EU Study Start-Up Unit, Bristol-Myers Squibb International Corporation, Clinical.Trials@bms.com
    Scientific contact
    Bristol-Myers Squibb Study Director, Bristol-Myers Squibb, Clinical.Trials@bms.com
    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
    06 Dec 2022
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    17 Oct 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To compare the PFS by BICR of nivolumab plus pemetrexed/platinum to pemetrexed plus platinum in EGFR mutation positive (ie, G719X, L861Q, Del 19, and L858R), metastatic or recurrent NSCLC that has progressed on 1L or 2L EGFR TKI.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization Good Clinical Practice Guidelines. All the local regulatory requirements pertinent to safety of trial participants were followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    17 Mar 2017
    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
    China: 54
    Country: Number of subjects enrolled
    France: 17
    Country: Number of subjects enrolled
    Hong Kong: 8
    Country: Number of subjects enrolled
    Japan: 100
    Country: Number of subjects enrolled
    Korea, Democratic People's Republic of: 91
    Country: Number of subjects enrolled
    Singapore: 13
    Country: Number of subjects enrolled
    Spain: 7
    Country: Number of subjects enrolled
    Taiwan: 74
    Country: Number of subjects enrolled
    United States: 3
    Worldwide total number of subjects
    367
    EEA total number of subjects
    24
    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)
    211
    From 65 to 84 years
    155
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    367 participants were randomized; 355 participants were treated.

    Period 1
    Period 1 title
    Pre-Treatment
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Arm description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    BMS-936558-01
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    360 mg IV every 3 weeks for a maximum of 4 cycles

    Investigational medicinal product name
    Pemetrexed
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate, Concentrate and solvent for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    500 mg/m2 on Day 1 of each Cycle

    Investigational medicinal product name
    Cisplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    75 mg/m2 administered on Day 1 of each cycle

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    AUC 5 or 6 administered on Day 1 of each cycle

    Arm title
    Arm B: Nivolumab plus Ipilimumab
    Arm description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.
    Arm type
    Experimental

    Investigational medicinal product name
    Ipilimumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    1 mg/kg IV every 6 weeks for a maximum of 24 months

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    BMS-936558-01
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    360 mg IV every 3 weeks for a maximum of 4 cycles

    Arm title
    Arm C: Platinum Doublet Chemotherapy
    Arm description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.
    Arm type
    Active comparator

    Investigational medicinal product name
    Pemetrexed
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate, Concentrate and solvent for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    500 mg/m2 on Day 1 of each Cycle

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    AUC 5 or 6 administered on Day 1 of each cycle

    Investigational medicinal product name
    Cisplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    75 mg/m2 administered on Day 1 of each cycle

    Number of subjects in period 1
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Started
    144
    73
    150
    Completed
    141
    71
    143
    Not completed
    3
    2
    7
         Withdrawal by Participant
    -
    -
    4
         Other Reasons
    -
    1
    1
         Adverse Event Unrelated to Study drug
    1
    -
    -
         Participant no Longer Meets Study Criteria
    2
    1
    2
    Period 2
    Period 2 title
    Treatment
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Arm description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    BMS-936558-01
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    360 mg IV every 3 weeks for a maximum of 4 cycles

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    AUC 5 or 6 administered on Day 1 of each cycle

    Investigational medicinal product name
    Cisplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    75 mg/m2 administered on Day 1 of each cycle

    Investigational medicinal product name
    Pemetrexed
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate, Concentrate and solvent for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    500 mg/m2 on Day 1 of each Cycle

    Arm title
    Arm B: Nivolumab plus Ipilimumab
    Arm description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.
    Arm type
    Experimental

    Investigational medicinal product name
    Ipilimumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    1 mg/kg IV every 6 weeks for a maximum of 24 months

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    BMS-936558-01
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    360 mg IV every 3 weeks for a maximum of 4 cycles

    Arm title
    Arm C: Platinum Doublet Chemotherapy
    Arm description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Pemetrexed
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate, Concentrate and solvent for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    500 mg/m2 on Day 1 of each Cycle

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    AUC 5 or 6 administered on Day 1 of each cycle

    Investigational medicinal product name
    Cisplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    75 mg/m2 administered on Day 1 of each cycle

    Number of subjects in period 2
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Started
    141
    71
    143
    Completed
    3
    5
    0
    Not completed
    138
    66
    143
         Adverse event, serious fatal
    -
    2
    3
         Withdrawal by Participant
    8
    5
    13
         Other Reasons
    1
    1
    4
         Participant Req to Discontinue Study Treatment
    8
    -
    5
         Maximum Clinical Benefit
    1
    -
    1
         Study Drug Toxicity
    9
    4
    10
         Adverse Event Unrelated to Study drug
    1
    1
    6
         Participant no Longer Meets Study Criteria
    -
    1
    -
         Disease Progression
    109
    52
    101
         Administrative Reason by Sponsor
    1
    -
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Reporting group description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.

    Reporting group title
    Arm B: Nivolumab plus Ipilimumab
    Reporting group description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.

    Reporting group title
    Arm C: Platinum Doublet Chemotherapy
    Reporting group description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.

    Reporting group values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy Total
    Number of subjects
    144 73 150 367
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    75 44 92 211
        From 65-84 years
    69 29 57 155
        85 years and over
    0 0 1 1
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    62.3 ( 10.6 ) 61.9 ( 10.6 ) 60.7 ( 10.1 ) -
    Sex: Female, Male
    Units: Participants
        Female
    83 37 94 214
        Male
    61 36 56 153
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 0 0 0
        Asian
    136 68 139 343
        Native Hawaiian or Other Pacific Islander
    0 0 0 0
        Black or African American
    0 0 0 0
        White
    7 3 11 21
        More than one race
    0 0 0 0
        Unknown or Not Reported
    1 2 0 3
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    0 0 0 0
        Not Hispanic or Latino
    59 39 73 171
        Unknown or Not Reported
    85 34 77 196

    End points

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    End points reporting groups
    Reporting group title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Reporting group description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.

    Reporting group title
    Arm B: Nivolumab plus Ipilimumab
    Reporting group description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.

    Reporting group title
    Arm C: Platinum Doublet Chemotherapy
    Reporting group description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.
    Reporting group title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Reporting group description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.

    Reporting group title
    Arm B: Nivolumab plus Ipilimumab
    Reporting group description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.

    Reporting group title
    Arm C: Platinum Doublet Chemotherapy
    Reporting group description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.

    Primary: Progression Free Survival (PFS) by Blinded Independent Centralized Review (BICR)

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    End point title
    Progression Free Survival (PFS) by Blinded Independent Centralized Review (BICR)
    End point description
    PFS is defined as the time between the date of randomization and the date of first documented tumor progression, as determined by BICR (per RECIST v1.1 criteria), or death due to any cause, whichever occurs first. Participants who died without reported progression will be considered to have progressed on the date of their death. Subsequent therapy was accounted for by censoring at the last evaluable tumor assessment on or prior to the date of subsequent therapy. Progression is the appearance of one or more new lesions. RECIST - "response evaluation criteria in solid tumors" is a standard system to measure tumor response to treatment. Based on Kaplan-Meier estimates
    End point type
    Primary
    End point timeframe
    From randomization to the date of first documented tumor progression or death (approximately 58 months)
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    144
    73
    150
    Units: Months
        median (confidence interval 95%)
    5.59 (4.47 to 6.80)
    1.54 (1.41 to 2.63)
    5.45 (4.40 to 5.65)
    Statistical analysis title
    Hazard Ratio
    Comparison groups
    Arm B: Nivolumab plus Ipilimumab v Arm C: Platinum Doublet Chemotherapy
    Number of subjects included in analysis
    223
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    2.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.43
         upper limit
    2.99
    Statistical analysis title
    Hazard Ratio
    Comparison groups
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy v Arm C: Platinum Doublet Chemotherapy
    Number of subjects included in analysis
    294
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.0528 [1]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.75
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.56
         upper limit
    1
    Notes
    [1] - Log-rank test stratified by PD-L1 expression (>= 1% vs <1%/indeterminate/not evaluable), brain metastases (presence vs absence), smoking history (current/former vs never smoker), and prior osimertinib use (yes vs no) from IRT.

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    Overall Survival (OS) is defined as the time between the date of randomization and the date of death due to any cause. OS will be censored on the last date a participant was known to be alive. Median based on Kaplan-Meier Estimates
    End point type
    Secondary
    End point timeframe
    From randomization to the date of death due to any cause (up to approximately 67 months)
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    144
    73
    150
    Units: Months
        median (confidence interval 95%)
    19.35 (16.13 to 20.99)
    17.12 (13.67 to 23.59)
    15.90 (14.00 to 18.79)
    Statistical analysis title
    Hazard Ratio
    Comparison groups
    Arm B: Nivolumab plus Ipilimumab v Arm C: Platinum Doublet Chemotherapy
    Number of subjects included in analysis
    223
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.06
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.75
         upper limit
    1.52
    Statistical analysis title
    Hazard Ratio
    Comparison groups
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy v Arm C: Platinum Doublet Chemotherapy
    Number of subjects included in analysis
    294
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.218
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.62
         upper limit
    1.12

    Secondary: Objective Response Rate (ORR) by Blinded Independent Centralized Review (BICR)

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    End point title
    Objective Response Rate (ORR) by Blinded Independent Centralized Review (BICR)
    End point description
    ORR is number of randomized participants who have confirmed best overall response (BOR) of complete response (CR) or partial response (PR) using RECIST v1.1 criteria by BICR assessment. BOR is the best response designation, between randomization and objectively documented progression per RECIST v1.1 criteria by BICR or the date of subsequent anti-cancer therapy, whichever occurs first. PR is at least a 30% decrease in the sum of diameters of target lesions, using the baseline sum diameters as reference. CR is disappearance of all target lesions and a reduction in the short axis of pathological lymph nodes to <10 mm (whether target or non-target). Radiographic tumor response assessments from Week 7 (± 7 days), then every 6 weeks (± 7 days) until Week 49 and every 12 weeks (± 7 days) thereafter, until disease progression, treatment discontinued, or the start of subsequent anti-cancer therapy. CR+PR, confidence interval based on the Clopper and Pearson method.
    End point type
    Secondary
    End point timeframe
    From randomization to the date of objectively documented progression, date of death, or the date of subsequent therapy (up to approximately 67 months)
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    144
    73
    150
    Units: Percent of Participants
        number (confidence interval 95%)
    30.6 (23.2 to 38.8)
    13.7 (6.8 to 23.8)
    26.7 (19.8 to 34.5)
    Statistical analysis title
    Hazard Ratio
    Comparison groups
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy v Arm C: Platinum Doublet Chemotherapy
    Number of subjects included in analysis
    294
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.27
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.75
         upper limit
    2.16

    Secondary: 12 Month Progression Free Survival Rates (PFSR) by Blinded Independent Centralized Review (BICR)

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    End point title
    12 Month Progression Free Survival Rates (PFSR) by Blinded Independent Centralized Review (BICR)
    End point description
    The PFSR at 12 months is defined as the percent of treated participants remaining progression free and surviving at 12 months since the first dosing date. Progression is the appearance of one or more new lesions. Point estimates are derived from Kaplan-Meier analyses.
    End point type
    Secondary
    End point timeframe
    12 Months after first treatment dose
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    144
    73
    150
    Units: Percent of Participants
        number (confidence interval 95%)
    21.2 (14.3 to 29.1)
    12.2 (5.5 to 21.7)
    15.9 (9.3 to 24.0)
    No statistical analyses for this end point

    Secondary: Duration of Response (DOR) by Blinded Independent Centralized Review (BICR)

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    End point title
    Duration of Response (DOR) by Blinded Independent Centralized Review (BICR)
    End point description
    DOR is the time between first response (CR or PR) and first documented disease progression as determined by Response Evaluation Criteria In Solid Tumors (RECIST 1.1) or death due to any cause (death occurring after re-treatment or randomization to new combination treatment not included), whichever occurred first. PR is at least a 30% decrease in the sum of diameters of target lesions, using baseline sum diameters as reference. CR is disappearance of all target lesions and a reduction in the short axis of pathological lymph nodes to <10 mm (target or non-target). Radiographic tumor response assessments from Week 7 (± 7 days), then every 6 weeks (± 7 days) until Week 49 and every 12 weeks (± 7 days) thereafter, until disease progression, treatment discontinued, or the start of subsequent anti-cancer therapy. Participants who neither progress nor die were censored on the date of their last assessment. 99999 = Not Available/ Not Applicable Median computed using Kaplan-Meier method
    End point type
    Secondary
    End point timeframe
    From randomization to the date of first documented disease progression or death due to any cause (approximately 67 months)
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    44
    10
    40
    Units: Months
        median (confidence interval 95%)
    6.67 (4.17 to 12.45)
    50.04 (2.86 to 99999)
    5.55 (4.07 to 9.92)
    No statistical analyses for this end point

    Secondary: 9 Month Progression Free Survival Rates (PFSR) by Blinded Independent Centralized Review (BICR)

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    End point title
    9 Month Progression Free Survival Rates (PFSR) by Blinded Independent Centralized Review (BICR)
    End point description
    The PFSR at 9 months is defined as the percent of treated participants remaining progression free and surviving at 9 months since the first dosing date. Progression is the appearance of one or more new lesions. Point estimates are derived from Kaplan-Meier analyses.
    End point type
    Secondary
    End point timeframe
    9 months after first treatment dose
    End point values
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab Arm C: Platinum Doublet Chemotherapy
    Number of subjects analysed
    144
    73
    150
    Units: Percent of Participants
        number (confidence interval 95%)
    25.9 (18.4 to 34.0)
    12.2 (5.5 to 21.7)
    19.8 (12.6 to 28.1)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Serious Adverse Events (SAEs) and Non-Serious Adverse Events (NSAEs) was assessed from first dose to 100 days post the last dose of study therapy (up to approximately an average of 11 months and a maximum of 51 months).
    Adverse event reporting additional description
    The number at risk for SAEs and NSAEs represents all participants that received at least 1 dose of study therapy or similar.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.1
    Reporting groups
    Reporting group title
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy
    Reporting group description
    Nivolumab was administered IV every 3 weeks with platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) IV for a maximum of 4 cycles. Treatment administered was either Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Nivolumab 360 mg IV, followed by pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Following completion of the fourth cycle of nivolumab/chemotherapy, all participants who did not experience disease progression should have continued nivolumab 360 mg IV and pemetrexed (500 mg/m2) every 3 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, or study closure, whichever comes first. Nivolumab should only be administered for a maximum of 24 months (96 weeks) from the first study treatment.

    Reporting group title
    Arm C: Platinum Doublet Chemotherapy
    Reporting group description
    Platinum-doublet chemotherapy (investigator’s choice of cisplatin or carboplatin) was administered IV in 3-week cycles for up to a maximum of 4 cycles. Participants received either Pemetrexed (500 mg/m2) with cisplatin (75 mg/m2) administered on Day 1 of each cycle OR Pemetrexed (500 mg/m2) with carboplatin (AUC 5 or 6) administered on Day 1 of each cycle. Platinum-doublet chemotherapy continued until disease progression, unacceptable toxicity, or completion of the 4 cycles, whichever came first. Participants who had stable disease or response after 4 cycles of pemetrexed with cisplatin or carboplatin should have continued pemetrexed alone as maintenance therapy until disease progression, or unacceptable toxicity.

    Reporting group title
    Arm B: Nivolumab plus Ipilimumab
    Reporting group description
    Nivolumab 3 mg/kg IV was administered every 2 weeks and ipilimumab 1 mg/kg IV was administered every 6 weeks until the progression of disease, discontinuation due to toxicity, withdrawal of consent, a maximum of 24 months (96 weeks) from the first study treatment, or study closure.

    Serious adverse events
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm C: Platinum Doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    77 / 141 (54.61%)
    55 / 143 (38.46%)
    46 / 71 (64.79%)
         number of deaths (all causes)
    91
    104
    55
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Lymphangiosis carcinomatosa
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lung neoplasm malignant
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Cancer pain
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Brain cancer metastatic
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Plasma cell myeloma
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Non-small cell lung cancer
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Neoplasm progression
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Metastases to peritoneum
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metastases to meninges
         subjects affected / exposed
    0 / 141 (0.00%)
    2 / 143 (1.40%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal cancer
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metastases to bone
         subjects affected / exposed
    0 / 141 (0.00%)
    2 / 143 (1.40%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malignant pleural effusion
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malignant neoplasm progression
         subjects affected / exposed
    25 / 141 (17.73%)
    22 / 143 (15.38%)
    20 / 71 (28.17%)
         occurrences causally related to treatment / all
    0 / 27
    0 / 29
    0 / 22
         deaths causally related to treatment / all
    0 / 12
    0 / 12
    0 / 10
    Malignant ascites
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Metastases to central nervous system
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Tumour pain
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Tumour associated fever
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Transitional cell carcinoma
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    3 / 141 (2.13%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
    Peripheral venous disease
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    General disorders and administration site conditions
    Catheter site oedema
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pain
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    3 / 141 (2.13%)
    1 / 143 (0.70%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 1
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Sudden death
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Swelling
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Postmenopausal haemorrhage
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary haemorrhage
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
    Dyspnoea
         subjects affected / exposed
    0 / 141 (0.00%)
    2 / 143 (1.40%)
    5 / 71 (7.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
    Interstitial lung disease
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 141 (0.71%)
    3 / 143 (2.10%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    5 / 141 (3.55%)
    1 / 143 (0.70%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    6 / 6
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Depression
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Delirium
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood alkaline phosphatase increased
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood bilirubin increased
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood creatine increased
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood creatinine increased
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Liver function test increased
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    0 / 141 (0.00%)
    2 / 143 (1.40%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Subdural haemorrhage
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femoral neck fracture
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Post procedural discharge
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal fracture
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fall
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Wrist fracture
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac tamponade
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardio-respiratory arrest
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Pericarditis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Prinzmetal angina
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    Sinus bradycardia
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune-mediated myocarditis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebral infarction
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Cervical cord compression
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Optic neuritis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Intracranial pressure increased
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Hydrocephalus
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 141 (0.71%)
    3 / 143 (2.10%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    1 / 1
    3 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 1
    Febrile neutropenia
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myelosuppression
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Leukocytosis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Cataract
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Colitis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    Diarrhoea
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Enteritis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    3 / 141 (2.13%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancreatitis acute
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    4 / 141 (2.84%)
    1 / 143 (0.70%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    4 / 5
    1 / 1
    1 / 2
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 1
    Immune-mediated enterocolitis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatic function abnormal
         subjects affected / exposed
    3 / 141 (2.13%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune-mediated hepatitis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Drug eruption
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash maculo-papular
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Stevens-Johnson syndrome
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urticarial vasculitis
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 141 (1.42%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nephrolithiasis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelocaliectasis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Endocrine disorders
    Inappropriate antidiuretic hormone secretion
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Hypopituitarism
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thyroiditis subacute
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tenosynovitis stenosans
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myositis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune-mediated myositis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Flank pain
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Carbuncle
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Atypical pneumonia
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Breast cellulitis
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Cellulitis
         subjects affected / exposed
    3 / 141 (2.13%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 5
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Device related infection
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis viral
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia influenzal
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    2 / 71 (2.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Meningitis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Pneumocystis jirovecii pneumonia
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    10 / 141 (7.09%)
    7 / 143 (4.90%)
    4 / 71 (5.63%)
         occurrences causally related to treatment / all
    3 / 10
    1 / 7
    1 / 4
         deaths causally related to treatment / all
    1 / 4
    1 / 3
    0 / 1
    Pneumonia aspiration
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Pneumonia klebsiella
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Post procedural infection
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tuberculosis
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 143 (0.70%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vestibular neuronitis
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Decreased appetite
         subjects affected / exposed
    4 / 141 (2.84%)
    0 / 143 (0.00%)
    0 / 71 (0.00%)
         occurrences causally related to treatment / all
    3 / 4
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Diabetes mellitus
         subjects affected / exposed
    0 / 141 (0.00%)
    0 / 143 (0.00%)
    1 / 71 (1.41%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Arm A: Nivolumab plus Platinum-doublet Chemotherapy Arm C: Platinum Doublet Chemotherapy Arm B: Nivolumab plus Ipilimumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    136 / 141 (96.45%)
    140 / 143 (97.90%)
    62 / 71 (87.32%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour pain
         subjects affected / exposed
    4 / 141 (2.84%)
    3 / 143 (2.10%)
    7 / 71 (9.86%)
         occurrences all number
    4
    3
    7
    Malignant neoplasm progression
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 143 (0.70%)
    4 / 71 (5.63%)
         occurrences all number
    2
    1
    4
    Cancer pain
         subjects affected / exposed
    9 / 141 (6.38%)
    9 / 143 (6.29%)
    5 / 71 (7.04%)
         occurrences all number
    9
    9
    5
    Vascular disorders
    Hypertension
         subjects affected / exposed
    9 / 141 (6.38%)
    4 / 143 (2.80%)
    5 / 71 (7.04%)
         occurrences all number
    13
    4
    5
    General disorders and administration site conditions
    Face oedema
         subjects affected / exposed
    8 / 141 (5.67%)
    9 / 143 (6.29%)
    0 / 71 (0.00%)
         occurrences all number
    10
    9
    0
    Malaise
         subjects affected / exposed
    18 / 141 (12.77%)
    21 / 143 (14.69%)
    5 / 71 (7.04%)
         occurrences all number
    24
    25
    6
    Fatigue
         subjects affected / exposed
    30 / 141 (21.28%)
    19 / 143 (13.29%)
    15 / 71 (21.13%)
         occurrences all number
    69
    26
    17
    Asthenia
         subjects affected / exposed
    12 / 141 (8.51%)
    10 / 143 (6.99%)
    3 / 71 (4.23%)
         occurrences all number
    20
    11
    3
    Pyrexia
         subjects affected / exposed
    29 / 141 (20.57%)
    17 / 143 (11.89%)
    14 / 71 (19.72%)
         occurrences all number
    38
    18
    19
    Oedema peripheral
         subjects affected / exposed
    26 / 141 (18.44%)
    18 / 143 (12.59%)
    8 / 71 (11.27%)
         occurrences all number
    30
    20
    8
    Non-cardiac chest pain
         subjects affected / exposed
    10 / 141 (7.09%)
    8 / 143 (5.59%)
    7 / 71 (9.86%)
         occurrences all number
    10
    8
    8
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    16 / 141 (11.35%)
    18 / 143 (12.59%)
    16 / 71 (22.54%)
         occurrences all number
    17
    18
    17
    Productive cough
         subjects affected / exposed
    9 / 141 (6.38%)
    11 / 143 (7.69%)
    8 / 71 (11.27%)
         occurrences all number
    15
    12
    8
    Hiccups
         subjects affected / exposed
    12 / 141 (8.51%)
    8 / 143 (5.59%)
    2 / 71 (2.82%)
         occurrences all number
    16
    13
    3
    Haemoptysis
         subjects affected / exposed
    9 / 141 (6.38%)
    9 / 143 (6.29%)
    4 / 71 (5.63%)
         occurrences all number
    9
    10
    4
    Dyspnoea
         subjects affected / exposed
    15 / 141 (10.64%)
    12 / 143 (8.39%)
    14 / 71 (19.72%)
         occurrences all number
    18
    13
    16
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    17 / 141 (12.06%)
    22 / 143 (15.38%)
    6 / 71 (8.45%)
         occurrences all number
    18
    25
    6
    Anxiety
         subjects affected / exposed
    6 / 141 (4.26%)
    3 / 143 (2.10%)
    4 / 71 (5.63%)
         occurrences all number
    7
    3
    4
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    42 / 141 (29.79%)
    45 / 143 (31.47%)
    4 / 71 (5.63%)
         occurrences all number
    118
    117
    6
    Blood creatinine increased
         subjects affected / exposed
    19 / 141 (13.48%)
    15 / 143 (10.49%)
    1 / 71 (1.41%)
         occurrences all number
    27
    23
    2
    Aspartate aminotransferase increased
         subjects affected / exposed
    35 / 141 (24.82%)
    27 / 143 (18.88%)
    11 / 71 (15.49%)
         occurrences all number
    87
    39
    12
    Amylase increased
         subjects affected / exposed
    13 / 141 (9.22%)
    9 / 143 (6.29%)
    3 / 71 (4.23%)
         occurrences all number
    23
    13
    3
    Alanine aminotransferase increased
         subjects affected / exposed
    35 / 141 (24.82%)
    26 / 143 (18.18%)
    12 / 71 (16.90%)
         occurrences all number
    83
    41
    16
    Platelet count decreased
         subjects affected / exposed
    19 / 141 (13.48%)
    28 / 143 (19.58%)
    6 / 71 (8.45%)
         occurrences all number
    45
    50
    7
    Weight decreased
         subjects affected / exposed
    9 / 141 (6.38%)
    6 / 143 (4.20%)
    7 / 71 (9.86%)
         occurrences all number
    10
    6
    7
    White blood cell count decreased
         subjects affected / exposed
    38 / 141 (26.95%)
    35 / 143 (24.48%)
    3 / 71 (4.23%)
         occurrences all number
    129
    95
    6
    Nervous system disorders
    Headache
         subjects affected / exposed
    22 / 141 (15.60%)
    19 / 143 (13.29%)
    5 / 71 (7.04%)
         occurrences all number
    25
    23
    5
    Dysgeusia
         subjects affected / exposed
    9 / 141 (6.38%)
    10 / 143 (6.99%)
    1 / 71 (1.41%)
         occurrences all number
    13
    11
    1
    Dizziness
         subjects affected / exposed
    15 / 141 (10.64%)
    14 / 143 (9.79%)
    7 / 71 (9.86%)
         occurrences all number
    21
    14
    7
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    10 / 141 (7.09%)
    6 / 143 (4.20%)
    1 / 71 (1.41%)
         occurrences all number
    32
    9
    1
    Neutropenia
         subjects affected / exposed
    22 / 141 (15.60%)
    6 / 143 (4.20%)
    3 / 71 (4.23%)
         occurrences all number
    110
    7
    5
    Anaemia
         subjects affected / exposed
    66 / 141 (46.81%)
    58 / 143 (40.56%)
    7 / 71 (9.86%)
         occurrences all number
    115
    77
    8
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    35 / 141 (24.82%)
    21 / 143 (14.69%)
    7 / 71 (9.86%)
         occurrences all number
    51
    35
    10
    Stomatitis
         subjects affected / exposed
    12 / 141 (8.51%)
    10 / 143 (6.99%)
    4 / 71 (5.63%)
         occurrences all number
    14
    12
    4
    Nausea
         subjects affected / exposed
    63 / 141 (44.68%)
    60 / 143 (41.96%)
    12 / 71 (16.90%)
         occurrences all number
    104
    98
    15
    Diarrhoea
         subjects affected / exposed
    18 / 141 (12.77%)
    17 / 143 (11.89%)
    17 / 71 (23.94%)
         occurrences all number
    23
    19
    25
    Constipation
         subjects affected / exposed
    52 / 141 (36.88%)
    57 / 143 (39.86%)
    21 / 71 (29.58%)
         occurrences all number
    66
    82
    32
    Abdominal pain upper
         subjects affected / exposed
    3 / 141 (2.13%)
    4 / 143 (2.80%)
    4 / 71 (5.63%)
         occurrences all number
    3
    5
    4
    Abdominal pain
         subjects affected / exposed
    3 / 141 (2.13%)
    11 / 143 (7.69%)
    5 / 71 (7.04%)
         occurrences all number
    3
    11
    8
    Skin and subcutaneous tissue disorders
    Rash pruritic
         subjects affected / exposed
    12 / 141 (8.51%)
    1 / 143 (0.70%)
    9 / 71 (12.68%)
         occurrences all number
    12
    2
    15
    Rash
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 143 (0.00%)
    9 / 71 (12.68%)
         occurrences all number
    3
    0
    10
    Pruritus
         subjects affected / exposed
    17 / 141 (12.06%)
    8 / 143 (5.59%)
    18 / 71 (25.35%)
         occurrences all number
    22
    9
    25
    Eczema
         subjects affected / exposed
    2 / 141 (1.42%)
    1 / 143 (0.70%)
    5 / 71 (7.04%)
         occurrences all number
    2
    1
    5
    Alopecia
         subjects affected / exposed
    6 / 141 (4.26%)
    8 / 143 (5.59%)
    4 / 71 (5.63%)
         occurrences all number
    6
    8
    4
    Rash maculo-papular
         subjects affected / exposed
    9 / 141 (6.38%)
    4 / 143 (2.80%)
    2 / 71 (2.82%)
         occurrences all number
    9
    4
    2
    Endocrine disorders
    Hypothyroidism
         subjects affected / exposed
    15 / 141 (10.64%)
    0 / 143 (0.00%)
    12 / 71 (16.90%)
         occurrences all number
    16
    0
    12
    Hyperthyroidism
         subjects affected / exposed
    7 / 141 (4.96%)
    0 / 143 (0.00%)
    8 / 71 (11.27%)
         occurrences all number
    8
    0
    8
    Musculoskeletal and connective tissue disorders
    Pain in extremity
         subjects affected / exposed
    6 / 141 (4.26%)
    3 / 143 (2.10%)
    5 / 71 (7.04%)
         occurrences all number
    7
    3
    6
    Arthralgia
         subjects affected / exposed
    15 / 141 (10.64%)
    10 / 143 (6.99%)
    9 / 71 (12.68%)
         occurrences all number
    17
    10
    11
    Back pain
         subjects affected / exposed
    21 / 141 (14.89%)
    12 / 143 (8.39%)
    5 / 71 (7.04%)
         occurrences all number
    26
    12
    5
    Muscular weakness
         subjects affected / exposed
    7 / 141 (4.96%)
    3 / 143 (2.10%)
    4 / 71 (5.63%)
         occurrences all number
    8
    3
    4
    Myalgia
         subjects affected / exposed
    6 / 141 (4.26%)
    4 / 143 (2.80%)
    6 / 71 (8.45%)
         occurrences all number
    9
    5
    7
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    5 / 141 (3.55%)
    3 / 143 (2.10%)
    4 / 71 (5.63%)
         occurrences all number
    5
    5
    4
    Upper respiratory tract infection
         subjects affected / exposed
    9 / 141 (6.38%)
    9 / 143 (6.29%)
    6 / 71 (8.45%)
         occurrences all number
    11
    10
    8
    Pneumonia
         subjects affected / exposed
    7 / 141 (4.96%)
    7 / 143 (4.90%)
    5 / 71 (7.04%)
         occurrences all number
    8
    7
    5
    Paronychia
         subjects affected / exposed
    6 / 141 (4.26%)
    1 / 143 (0.70%)
    4 / 71 (5.63%)
         occurrences all number
    7
    1
    4
    Nasopharyngitis
         subjects affected / exposed
    8 / 141 (5.67%)
    1 / 143 (0.70%)
    1 / 71 (1.41%)
         occurrences all number
    9
    1
    2
    Conjunctivitis
         subjects affected / exposed
    10 / 141 (7.09%)
    2 / 143 (1.40%)
    2 / 71 (2.82%)
         occurrences all number
    10
    2
    6
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    42 / 141 (29.79%)
    52 / 143 (36.36%)
    16 / 71 (22.54%)
         occurrences all number
    83
    68
    23
    Hypoalbuminaemia
         subjects affected / exposed
    9 / 141 (6.38%)
    6 / 143 (4.20%)
    2 / 71 (2.82%)
         occurrences all number
    18
    6
    4
    Hypokalaemia
         subjects affected / exposed
    11 / 141 (7.80%)
    6 / 143 (4.20%)
    6 / 71 (8.45%)
         occurrences all number
    14
    6
    9

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Nov 2018
    Stopped enrollment to Arm B (nivolumab + ipilimumab)

    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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