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    Clinical Trial Results:
    A Phase III, Randomized, Multicenter, Double-blind, Placebo-controlled Study of Durvalumab for the Treatment of Stage II-III NSCLC Patients with Minimal Residual Disease Following Surgery and Curative Intent Therapy (MERMAID-2)

    Summary
    EudraCT number
    2020-000612-30
    Trial protocol
    DE   PL   NL   GB   BG   BE   FR   GR   HU   CZ   DK   IT  
    Global end of trial date
    15 Jan 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    17 Oct 2024
    First version publication date
    17 Oct 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    D910MC00001
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04642469
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    AstraZeneca AB
    Sponsor organisation address
    Forskargatan 18, Södertälje, Sweden, 151 85
    Public contact
    Global Clinical Lead, AstraZeneca AB, +1 877-240-9479, information.center@astrazeneca.com
    Scientific contact
    Global Clinical Lead, AstraZeneca AB, +1 877-240-9479, information.center@astrazeneca.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
    15 Jan 2024
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Jan 2024
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To assess the efficacy of durvalumab compared to placebo as measured by disease-free survival (DFS) in all randomized participants.
    Protection of trial subjects
    This study was performed in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with International Council for Harmonisation/Good Clinical Practice, applicable regulatory requirements, and the AstraZeneca policy on Bioethics.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Nov 2020
    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
    France: 7
    Country: Number of subjects enrolled
    Hungary: 3
    Country: Number of subjects enrolled
    Türkiye: 3
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    Australia: 1
    Country: Number of subjects enrolled
    Czechia: 1
    Country: Number of subjects enrolled
    Greece: 1
    Country: Number of subjects enrolled
    Israel: 1
    Country: Number of subjects enrolled
    Italy: 1
    Country: Number of subjects enrolled
    Japan: 5
    Country: Number of subjects enrolled
    Taiwan: 3
    Country: Number of subjects enrolled
    United States: 1
    Country: Number of subjects enrolled
    Brazil: 1
    Worldwide total number of subjects
    30
    EEA total number of subjects
    15
    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)
    16
    From 65 to 84 years
    14
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This Phase III multicenter, double-blind, placebo-controlled study was conducted in participants with Stage II to III non-small cell lung cancer (NSCLC) at 21 sites in 13 countries.

    Pre-assignment
    Screening details
    30 participants were randomized in a 1:1 ratio to receive durvalumab monotherapy or placebo in the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Carer

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Durvalumab
    Arm description
    Participants received durvalumab 1500 milligram (mg) via intravenous (IV) infusion over 60 minutes, once every 4 weeks (q4w) for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.
    Arm type
    Experimental

    Investigational medicinal product name
    Durvalumab
    Investigational medicinal product code
    MEDI4736
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Durvalumab was provided in 500 mg vials. Participants received durvalumab 1500 mg via IV infusion over 60 minutes, q4w for a maximum of 26 cycles, unless protocol-specified discontinuation criterion was met.

    Arm title
    Placebo
    Arm description
    Participants received matching placebo via IV infusion over 60 minutes, once q4w for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Matching placebo was provided in vials. Participants received matching placebo via IV infusion over 60 minutes, once q4w for a maximum of 26 cycles, unless protocol-specified discontinuation criterion was met.

    Number of subjects in period 1
    Durvalumab Placebo
    Started
    15
    15
    Completed
    0
    1
    Not completed
    15
    14
         Adverse event, serious fatal
    1
    2
         Consent withdrawn by subject
    1
    -
         Failure to meet inclusion/exclusion criteria
    1
    -
         Unspecified
    1
    1
         Study/site closed following amendment 1
    11
    11

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Durvalumab
    Reporting group description
    Participants received durvalumab 1500 milligram (mg) via intravenous (IV) infusion over 60 minutes, once every 4 weeks (q4w) for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Reporting group title
    Placebo
    Reporting group description
    Participants received matching placebo via IV infusion over 60 minutes, once q4w for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Reporting group values
    Durvalumab Placebo Total
    Number of subjects
    15 15 30
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    11 5 16
        From 65-84 years
    4 10 14
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    59.3 ( 8.6 ) 66.7 ( 10.3 ) -
    Sex: Female, Male
    Units: Participants
        Female
    7 4 11
        Male
    8 11 19
    Race/Ethnicity, Customized
    Units: Subjects
        Hispanic or Latino
    0 0 0
        Not Hispanic or Latino
    15 15 30
    Race/Ethnicity, Customized
    Units: Subjects
        Asian
    3 5 8
        White
    7 7 14
        Other
    1 0 1
        Missing
    4 3 7

    End points

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    End points reporting groups
    Reporting group title
    Durvalumab
    Reporting group description
    Participants received durvalumab 1500 milligram (mg) via intravenous (IV) infusion over 60 minutes, once every 4 weeks (q4w) for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Reporting group title
    Placebo
    Reporting group description
    Participants received matching placebo via IV infusion over 60 minutes, once q4w for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Primary: Disease-free survival (DFS)

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    End point title
    Disease-free survival (DFS) [1]
    End point description
    DFS was defined as the time from the date of randomization until any one of the following events, whichever occurred first: Date of disease recurrence using Investigator assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 OR Date of death from any cause. The full analysis set (FAS) included all randomized participants. Here, '99999' indicates that upper limit of confidence interval was not estimable due to insufficient number of participants with events at study closure and due to limited duration of follow-up.
    End point type
    Primary
    End point timeframe
    Every 8 weeks (q8w) ± 1 week until Week 48, then every 12 weeks (q12w) ± 1 week until appearance of RECIST 1.1-defined disease recurrence or follow-up, up to 16.6 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: As the analysis was descriptive in nature, no statistical analysis was reported.
    End point values
    Durvalumab Placebo
    Number of subjects analysed
    15
    15
    Units: Months
        median (confidence interval 95%)
    3.9 (3.515 to 99999)
    2.0 (1.643 to 3.910)
    No statistical analyses for this end point

    Secondary: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)

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    End point title
    Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
    End point description
    An AE was any untoward medical occurrence (other than progression of the malignancy under evaluation) in a participant or clinical study participant administered a medicinal product and which did not necessarily have causal relationship with this treatment. An SAE was an AE that occurred during any study phase and fulfilled one or more of following criteria: Resulted in death, was immediately life-threatening, required in-participant hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability or incapacity, was a congenital abnormality or birth defect, was an important medical event that might jeopardize the participant or might require medical treatment to prevent one of the outcomes listed above, AEs for malignant tumors reported during a study, malignant tumors that – as part of normal, if rare, progression–underwent transformation. Safety Analysis Set included all randomized participants who received any amount of study treatment.
    End point type
    Secondary
    End point timeframe
    From start of study treatment (Day 1) up to 90 days after last dose of study treatment, approximately 21.4 months
    End point values
    Durvalumab Placebo
    Number of subjects analysed
    14
    15
    Units: Participants
        Any AEs
    13
    10
        Any SAEs
    1
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs were collected from start of study treatment (Day 1) up to 90 days after last dose of study treatment, approximately 21.4 months. All-cause mortality=start of randomization (Day 0) up to completion of study, approximately 30 months.
    Adverse event reporting additional description
    The Safety Analysis Set included all randomized participants who received any amount of study treatment. All-cause mortality was reported in FAS.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.0
    Reporting groups
    Reporting group title
    Durvalumab
    Reporting group description
    Participants received durvalumab 1500 milligram (mg) via intravenous (IV) infusion over 60 minutes, once every 4 weeks (q4w) for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Reporting group title
    Placebo
    Reporting group description
    Participants received matching placebo via IV infusion over 60 minutes, once q4w for a maximum of 26 cycles, unless there was unacceptable toxicity, withdrawal of consent, or another discontinuation criterion was met.

    Serious adverse events
    Durvalumab Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 15 (6.67%)
         number of deaths (all causes)
    1
    2
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Autoimmune hepatitis
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Durvalumab Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    13 / 14 (92.86%)
    10 / 15 (66.67%)
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 15 (6.67%)
         occurrences all number
    1
    1
    Chest discomfort
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Asthenia
         subjects affected / exposed
    3 / 14 (21.43%)
    0 / 15 (0.00%)
         occurrences all number
    3
    0
    Xerosis
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Pyrexia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Malaise
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Anxiety
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Tachyphrenia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Investigations
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    2
    0
    Amylase increased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Platelet count decreased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Radiation pneumonitis
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 15 (13.33%)
         occurrences all number
    0
    2
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Headache
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Hypoaesthesia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Intercostal neuralgia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Memory impairment
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Peripheral sensory neuropathy
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Presyncope
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Iron deficiency anaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Stomatitis
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Constipation
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Diarrhoea
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 15 (6.67%)
         occurrences all number
    2
    1
    Periodontal disease
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Toothache
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Hepatobiliary disorders
    Liver disorder
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Skin exfoliation
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Rash
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 15 (6.67%)
         occurrences all number
    2
    1
    Pruritus
         subjects affected / exposed
    3 / 14 (21.43%)
    0 / 15 (0.00%)
         occurrences all number
    3
    0
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Endocrine disorders
    Hyperthyroidism
         subjects affected / exposed
    2 / 14 (14.29%)
    0 / 15 (0.00%)
         occurrences all number
    2
    0
    Hypothyroidism
         subjects affected / exposed
    4 / 14 (28.57%)
    0 / 15 (0.00%)
         occurrences all number
    4
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    2 / 14 (14.29%)
    0 / 15 (0.00%)
         occurrences all number
    2
    0
    Back pain
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal pain
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Pain in extremity
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Respiratory tract infection
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Nasopharyngitis
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Bronchitis
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    COVID-19
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Hepatitis C
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Diabetes mellitus
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Hyperglycaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Hyperkalaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 15 (6.67%)
         occurrences all number
    0
    1
    Hyperlipidaemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0
    Hypermagnesaemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 15 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Aug 2022
    The primary reason for this amendment was to close enrollment early, following the approval of neoadjuvant and adjuvant immunotherapy options for participants with resectable Stage II-III NSCLC. The amendment also provided procedures required for all participants who had signed informed consent for the study and ensured that eligible participants had access to open-label durvalumab where appropriate.

    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.
    The Sponsor closed enrollment to the study early due to treatment landscape changes. Interpretation of study outcomes were limited by the resulting small sample size and limited duration of follow-up.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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