A Study of the Effect of R1507 in Combination With Tarceva (Erlotinib) on Progression-Free Survival in Patients With Stage IIIb/IV Non-Small Cell Lung Cancer (NSCLC) Having Received Tarceva Monotherapy.

• RG1507 (Drug): iv 9mg/kg weekly
• erlotinib [Tarceva] (Drug): 150mg oral daily

Primary outcomes

• Percentage of Participants With Progression Free Survival (PFS) [12 weeks]: The primary efficacy endpoint is progression-free survival at 12 weeks after start of therapy. A progression-free survival rate at 12 weeks will be calculated, with patients categorized in a dichotomous manner as alive and progression-free or in progression or dead at 12 weeks.

Secondary outcomes

• Duration of Overall Survival [From start of treatment to death; up to the time that all participants ended treatment]: The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Participants Achieving Objective Response [Patients were followed from start of therapy until date of first response]: Objective response is defined as a complete response (CR) or partial response (PR) that has been confirmed by a second tumor assessment no earlier than 4 weeks after the initial documentation. Response is assessed using Response Evaluation Criteria in Solid Tumors (RECIST)criteria. The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Time to Best Response [Patients were followed from start of therapy until date of first response]: This is defined as time from the start of therapy to the date of first CR or PR. The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Time to Progressive Disease (PD) [From start of therapy to the date of first documentation of PD. Pts who never progress prior to final analysis or are withdrawn from the study without documented progression will be censored at the date of the last valid tumor assessment.]: The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Duration of Objective Response [from the date the complete or partial response was first recorded to the date which progressive disease is first noted or date of death. If a patient does not progress or die while being followed, the date of the last valid tumor assessment will be taken]: This is defined similarly for complete and partial responders. Complete response or partial response lasts from the date the complete response or partial response was first recorded to the date on which progressive disease is first noted or date of death. If a patient does not progress or die while being followed, the date of the last valid tumor assessment will be taken. The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Baseline Electrocardiogram (ECG) [baseline within 28 days of starting treatment (screening visit).]: Standard safety monitoring includes baseline Electrocardiogram (ECG). The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed. The study was prematurely terminated due to discontinuation of R1507 development (not for safety reasons). As a result, data not provided for outcome measures listed.
• Fasting Glucose, Highest Post-Baseline Value [Baseline, Highest Post-Baseline value within the timeframe of post-baseline collection up to when patient discontinued (up to 59 weeks)]: A fasting glucose was required at baseline, and random non-fasting glucose testing was performed weekly for the first 6 weeks followed by day 1 of each 3 week treatment phase. The number of participants with the highest post-baseline fasting glucose level at any time point post baseline relative to the participant's baseline glucose level is reported.
• Hemoglobin A1c (HbA1c) [screening]: Standard safety monitoring includes baseline Electrocardiogram (ECG), Fasting glucose and HbA1c, monthly urine pregnancy test in female patients of childbearing potential and Human anti-human antibody (HAHA) testing. Data will be represented in the Serious Adverse Event (SAE) Adverse Event (AE) section of Protocol Registration System (PRS).
• Monthly Urine Pregnancy Test in Female Patients of Childbearing Potential [Within 7 days of starting treatment (baseline visit)]: Standard safety monitoring includes baseline Electrocardiogram (ECG), Fasting glucose and HbA1c, monthly urine pregnancy test in female patients of childbearing potential and Human anti-human antibody (HAHA) testing. Not posted; it will be represented in the Serious Adverse Event (SAE) Adverse Event (AE) section of Protocol Registration System (PRS).
• Number of Participants With Positive Results for Human Anti-human Antibody (HAHA) Testing [prior to dosing on week 1 (day 1), week 4 (day 22), week 10 (day 64), final visit, follow up visit and 12 weeks post last dose (up to 71 weeks)]: Number of participants who tested positive for Human anti-human antibody (HAHA) testing for immunogenicity. To determine HAHA specificity, screened positive samples were tested in a confirmatory assay in the presence of 10 ug/mL R1507. Samples with > 19.7% inhibition were considered true positives, whereas those with < 19.7% inhibition were considered to be false positives.
• Electrocardiogram (ECG) [baseline and thereafter as clinically indicated at the discretion of the investigator up to the time that the patient discontinued (up to 59 weeks)]: 12 lead ECG is required at baseline and will be measured during the trial as clinically indicated at the discretion of the investigators. For each reading, QTcF value will be calculated as the QT value (seconds) divided by the cube root of the RR interval in seconds (Fridericia correction). A listing will be generated showing, for each patient, the visits at which ECGs were taken and the results (normal or abnormal, as well as any comments provided).
• Population Pharmacokinetics of R1507 and Tarceva [Throughout study]: Population PK of R1507 and erlotinib were planned but not analyzed due to the termination of the trial.
• Assessment of Potential Predictive and Prognostic Biomarkers. [Throughout study]: Total IGF-I, free IGF I/II and other potential biomarkers present in serum. Further putative biomarker analyses in blood and tumor samples were planned in the protocol for exploratory assessment of correlation with clinical outcome. None of these were analyzed due to the termination of the trial.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* male or female patients >=18 years with histologically documented inoperable, locally advanced or metastatic (stage IIIB or IV) NSCLC;
* currently receiving Tarceva monotherapy and having failed at least one standard chemotherapy regimens;
* prior response or stable disease 12 weeks from start of Tarceva;
* documented progressive disease at enrollment;
* measurable disease according to the RECIST criteria;
* ECOG performance status 0-2;
* life expectancy >12 weeks.

Exclusion Criteria:

* patients with active CNS lesions;
* prior treatment with agents acting via IGF-1R inhibition or EGFR targeting;
* administration with high doses of systemic corticosteroids;
* radiotherapy in the 4 weeks prior to study start;
* surgery or significant traumatic injury with in the last 2 weeks prior to study start.

Participant flow

Outcome results

• Percentage of Participants With Progression Free Survival (PFS) (Primary), Number, Percentage of participants: R1507 32.4 (17.4 to 50.5)
• Duration of Overall Survival (Secondary)
• Participants Achieving Objective Response (Secondary)
• Time to Best Response (Secondary)
• Time to Progressive Disease (PD) (Secondary)
• Duration of Objective Response (Secondary)
• Baseline Electrocardiogram (ECG) (Secondary)
• Fasting Glucose, Highest Post-Baseline Value (Secondary), Number, participants: R1507_Baseline Glucose Normal 21; R1507_Baseline Impaired Fasting Glucose 3; R1507_Baseline Diabetes Mellitus 1; R1507_Baseline Missing 0
• Hemoglobin A1c (HbA1c) (Secondary)
• Monthly Urine Pregnancy Test in Female Patients of Childbearing Potential (Secondary)
• Number of Participants With Positive Results for Human Anti-human Antibody (HAHA) Testing (Secondary), Number, participants: R1507 1
• Electrocardiogram (ECG) (Secondary), Mean, ms (millisecond): R1507 421.5 +/- 3.54
• Population Pharmacokinetics of R1507 and Tarceva (Secondary)
• Assessment of Potential Predictive and Prognostic Biomarkers. (Secondary)

Adverse events

Time frame: From start of treatment until 30 days after last dose (up to 64 weeks) or if the AE was related to study drug, up until the AE resolved

Serious adverse events by term

Other adverse events by term

• Clinical Trials, Study director, Hoffmann-La Roche

NIH grants: 2008