A placebo-controlled, double-blind trial of infliximab for cancer-associated weight loss in elderly and/or poor performance non-small cell lung cancer patients (N01C9)

Abstract

Purpose: This study tested whether infliximab, a chimeric IgG1kappa monoclonal antibody that blocks tumor necrosis factor (TNF) alpha, improves/stabilizes weight loss in elderly and/or poor performance status patients with metastatic non-small cell lung cancer (NSCLC).

Methods: This double-blind trial randomly assigned patients to infliximab/docetaxel (n=32) versus placebo/docetaxel (n=29). The primary endpoint was > or = 10% weight gain.

Results: Groups were balanced with respect to age, number of prior chemotherapy regimens, baseline weight loss, and performance status. No patient gained > or = 10% baseline weight, and early evidence of the lack of efficacy prompted early trial closure. Appetite improvement was negligible in both arms. However, infliximab-/docetaxel-treated patients developed greater fatigue and worse global quality of life scores. Other outcomes, such as tumor response rate (<10% in both groups) and overall survival, were not statistically different between groups. There were no statistically significant differences in adverse events, although one death was attributed to infliximab. Genotyping for the TNF alpha -238 and -308 polymorphisms revealed no clinical significance of these genotypes, as relevant to the loss of weight or appetite.

Conclusions: This trial closed early because infliximab did not prevent or palliate cancer-associated weight loss. Infliximab was associated with increased fatigue and inferior global quality of life.

Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

This “bug plot” shows the percent change in weight from baseline.

Figure 2

Patients in the infliximab/docetaxel group had higher levels of fatigue, as suggested by average patient-reported scores from the Brief Fatigue Inventory. The dark line represents scores from the infliximab/docetaxel group, the interrupted line represents scores from the placebo/docetaxel group, and bars show 95% confidence intervals.

Figure 3

Patients who received infliximab/docetaxel had worse global quality of life scores, as suggested by worse total FACT-G scores. The dark line represents scores from the infliximab/docetaxel group, the interrupted line represents scores from the placebo/docetaxel group, and bars show 95% confidence intervals.

Figure 4

Kaplan Meir curves did not reveal statistically significant differences in survival between groups.