Switch maintenance therapy with racotumomab or nimotuzumab vs docetaxel for NSCLC patients

Maintenance therapy is a common strategy in NSCLC treatment that improves PFS and OS. Racotumomab-alum is an anti-idiotypic vaccine that induces immunological response against N-glycolilated gangliosides in NSCLC patients. Nimotuzumab is a humanized anti-EGFR monoclonal antibody that has shown activity in NSCLC patients. The aim of this study is to evaluate safety and efficacy of racotumomab-alum or nimotuzumab versus docetaxel as second line or switch maintenance therapy for advanced NSCLC. This phase III, multicenter, open label, randomized trial is designed to enroll 743 stage IIIB-IV NSCLC patients, after first line therapy, with PS 0-2, with written informed consent. The primary endpoint is OS. Patients are been randomized (2:2:1) to 3 arms: racotumomab-alum, nimotuzumab or docetaxel, and stratified according to response to first line. Racotumomab-alum treatment consists in 5 bi-weekly intradermal doses and re-immunizations every 4 weeks. Nimotuzumab arm receives 6 weekly infusions followed by bi-weekly doses. Docetaxel is used at 75 mg/m2 for 6 cycles, if there are no evidences of progressive disease after 3 cycles. As switch maintenance therapy, both experimental drugs will be classified as non-inferior (NI) to docetaxel, if 1- year OS rate is 36% (HRC/T = 0.66) [ d0 (0,41), d0= - ln HR(C/T)] using a 15% NI margin. Here we report the final analysis in non-progressor patients (n = 237). 93 patients in each experimental arm and 51 in docetaxel arm with at least 1 year follow up were analyzed (ITT). The median OS and 1-year survival rate were 11.4 months (CI: 7.07-12.46) and 48.3 % with nimotuzumab, 9.67 months (CI: 6.52-12.82) and 45.5 % with racotumomab-alum and 9.76 months (CI: 7.07-12.46) and 33.5 % with docetaxel, respectively. Most frequent treatment-related adverse events were induration, local erythema and pain in injection site with racotumomab-alum; myalgia, nausea and fever with Nimotuzumab, and anemia, nausea and malaise after docetaxel. Racotumomab-alum [CI 90% NI (-∞;0.14)] and Nimotuzumab [CI 90% NI (- ∞; -0.002) are non-inferior to docetaxel as switch maintenance therapy. Both experimental treatments were safely administered at primary level of health assistance.