• Safety - Adverse Events [ Time Frame: Enrollment in the trial (date of first signature of informed consent, Dec 2009) until End of Treatment visit. ] [ Designated as safety issue: No ]
• Time to Symptom Progression (TTSP) [ Time Frame: Time from randomization to symptomatic progression reported between the day of first patient randomised, Dec 2009, until the cut-off date expected Sept 2015 ] [ Designated as safety issue: No ]
  Time from randomization to symptomatic progression. Symptomatic progression is defined as an increase (worsening) of the ASBI (The Average Symptomatic Burden Index i.e., the mean of the six major lung cancer specific symptom scores of the LCSS subject scale). Worsening is defined as a 10% increase in the scale breadth from the baseline score.
• Time to Progression (TTP) [ Time Frame: Time from randomization to radiological confirmation of progressive disease (PD) reported between the day of first patient randomised, Dec 2009, until the cut-off date expected Sept 2015 ] [ Designated as safety issue: No ]
  Time from randomization to the radiological confirmation of progression performed according to Response Evaluation Criteria In Solid Tumors (RECIST). If radiological confirmation cannot be obtained but a subject is withdrawn from trial treatment due to PD, TTP will be measured from the date of randomization to the date of discontinuation of trial treatment. TTP of subjects without PD at the time of analysis will be censored at the time of last contact.
• Progression Free Survival (PFS) Time [ Time Frame: Time from randomization to objective tumor progression or death (whichever occurs earlier)] reported between the day of first patient randomised, Dec 2009, until the cut-off date expected Sept 2015 ] [ Designated as safety issue: No ]
  Time from randomization to PD as determined by the investigator or death. PFS time for subjects without an event will be censored as of the date of last contact.
• Time to Treatment Failure [ Time Frame: Time from randomization to the date of discontinuation of trial treatment], reported between the day of first patient randomised, Dec 2009, until the cut-off date expected Sept 2015 ] [ Designated as safety issue: No ]
  Time from randomization to discontinuation of trial treatment for any reason as reported by the investigator. For subjects still receiving treatment at the time of analysis, the time between the date of randomization and the last date of treatment will be used as a censored observation in the analysis. Subjects who have missed two consecutive scheduled doses will be considered as treatment failures and the TTF will be calculated from the date of randomization to the date of their first missed treatment.

Darmstadt, Germany, June 17 2010 - Merck Serono, a division of Merck KGaA, and its U.S. affiliate, EMD Serono, Inc. today announced that they are resuming their Stimuvax® (BLP25 liposome vaccine)* clinical program in patients with non-small cell lung cancer (NSCLC) which includes the Phase III studies, START and INSPIRE. The treatment and enrollment in these studies will restart after approval by the local regulatory authorities and ethics committees.

More information can be accessed here: http://www.merck.de/en/media/extNewsDetail.html?newsId=0BDEF079C946D24FC1257744005B84C0&newsType=1

The purpose of this study is to determine whether the cancer vaccine Stimuvax in addition to best supportive care is effective in prolonging the lives of Asian patients with unresectable stage III non-small cell lung cancer in comparison to a placebo plus best supportive care (a so-called Placebo controlled study).

• Biological: L-BLP25 or BLP25 liposome vaccine (Stimuvax)
  All subjects randomized to the investigational arm will begin the following treatment regimen within three days of randomization: A single I.V. infusion of 300 mg/m2 of cyclophosphamide administered exactly three days prior to the first L-BLP25 (Stimuvax) vaccination. Subjects will then receive eight consecutive weekly subcutaneous vaccinations with 918 μg BLP25 lipopeptide (Stimuvax) at weeks 1, 2, 3, 4, 5, 6, 7, and 8 (primary treatment phase) and then at six-week intervals, beginning at week 14 (maintenance phase) and continuing until disease progression is documented or the subject discontinues for any other reason.
• Biological: Placebo
  A single I.V. infusion of 0.9% sodium chloride will be administered to subjects randomized to the control arm exactly 3 days prior to treatment with placebo. Subjects will then receive eight consecutive weekly subcutaneous treatments with placebo at weeks 1, 2, 3, 4, 5, 6, 7, and 8 followed by maintenance treatment at 6 week intervals, beginning at week 14 and continuing until disease progression is documented.

• Experimental: Investigational Arm
  Pretreatment (Single Dose): 300 mg/m2 of IV cyclophosphamide L-BLP25 plus Best Supportive Care (BSC)
  Intervention: Biological: L-BLP25 or BLP25 liposome vaccine (Stimuvax)
• Placebo Comparator: Control Arm
  Pretreatment (Single Dose): 0.9% sodium chloride infusion Placebo plus BSC
  Intervention: Biological: Placebo

Inclusion Criteria:

• Histologically or cytologically documented unresectable stage III NSCLC.
• Documented stable disease or objective response, according to RECIST after primary chemo-radiotherapy (either sequential or concomitant) for unresectable stage III disease, within four weeks (28 days) prior to randomization.
• Receipt of concomitant or sequential chemo-radiotherapy, consisting of a minimum of two cycles of platinum-based chemotherapy and a minimum radiation dose of ≥ 50 Gy. Subjects must have completed the primary thoracic chemo-radiotherapy at least four weeks (28 days) and no later than 12 weeks (84 days) prior to randomization. Subjects who received prophylactic brain irradiation as part of primary chemo-radiotherapy are eligible.
• Geographically accessible for ongoing follow-up, and committed to comply with the designated visits
• An Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
• A platelet count ≥ the lower limit of normal for the site or ≥ 100 x 10⁹/L (whichever is greater); WBC ≥ 2.5 x 10⁹/L and hemoglobin ≥ 90 g/L
• ≥18 years of age (or minimum age of legal consent consistent with local regulations, if minimum is > 18 years of age)

Exclusion Criteria:

Pre-Therapies*:

• Lung-cancer-specific therapy (including surgery) other than primary chemoradiotherapy.
• Immunotherapy (e.g., interferons, tumor necrosis factor [TNF], interleukins, or biological response modifiers [granulocyte macrophage colony stimulating factor {GMCSF}, granulocyte colony stimulating factor {G-CSF}, macrophage-colony stimulating factor {M-CSF}], monoclonal antibodies) within four weeks (28 days) prior to randomization.
• Investigational systemic drugs (including off-label use of approved products) within four weeks (28 days) prior to randomization.

Disease Status:

• Metastatic disease
• Malignant pleural effusion at initial diagnosis and/or at trial entry
• Past or current history of neoplasm other than lung carcinoma, except for curatively treated non-melanoma skin cancer, in situ carcinoma of the cervix, or other cancer curatively treated and with no evidence of disease for at least 5 years
• Autoimmune disease that in the opinion of the investigator could compromise the safety of the subject in this trial
• A recognized immunodeficiency disease including cellular immunodeficiencies, hypogammaglobulinemia or dysgammaglobulinemia; subjects who have hereditary or congenital immunodeficiencies
• Any preexisting medical condition requiring chronic steroid or immunosuppressive therapy (steroids for the treatment of radiation pneumonitis are allowed)
• Known active Hepatitis B infection and/or Hepatitis C infection
• Signs and symptoms suggestive of transmissible spongiform encephalopathy, or of family members who suffer(ed) from such

Physiological Functions:

• Clinically significant hepatic dysfunction
• Clinically significant renal dysfunction
• Clinically significant cardiac disease
• Splenectomy
• Infectious process that in the opinion of the investigator could compromise the subject's ability to mount an immune response

Standard Safety:

• Pregnant or breastfeeding women, women of childbearing potential, unless using effective contraception as determined by the investigator.
• Known drug abuse or alcohol abuse
• Participation in another clinical trial within the past 28 days
• Requires concurrent treatment with a non-permitted drug
• Known hypersensitivity to any of the trial treatment ingredients
• Legal incapacity or limited legal capacity