Induction Chemotherapy Using Paclitaxel, Carboplatin, CPT-11 With Pegfilgrastim

This study has been completed.
Sponsor:
Collaborators:
AstraZeneca
Amgen
Information provided by (Responsible Party):
UNC Lineberger Comprehensive Cancer Center
ClinicalTrials.gov Identifier:
NCT00280787
First received: January 19, 2006
Last updated: February 1, 2013
Last verified: February 2013
  Purpose

Patients enrolled on this study will have been diagnosed with non-small cell lung cancer which cannot be removed by an operation. The standard treatment for this disease is a combination of chemotherapy and radiation therapy; however, the best way to combine these treatments is not known. This study will examine if the combination of chemotherapy and radiotherapy has an increased effect on slowing tumor growth with the addition of a drug called ZD1839.

In this study, chemotherapy will be given initially (induction therapy) to try to control the spread of the cancer. Then radiation and chemotherapy will be given together. Receiving chemotherapy at the same time as radiation treatments can enhance the effect of the radiation. In this study, patients will receive a drug called ZD1839. In laboratory tests on cancer cells, ZD1839 has shown an additive effect when used in combination with radiation. ZD1839 has also been shown to slow or stop growth in tumors.

The purpose of this study is to determine the side effects and effectiveness of using ZD1839 when used with radiation in this treatment regimen (induction chemotherapy followed by combination chemotherapy, ZD1839, and radiation therapy).


Condition Intervention Phase
Non Small Cell Lung Cancer
Drug: Paclitaxel
Drug: Carboplatin
Drug: CPT-11
Drug: Pegfilgrastim
Radiation: Conformal radiotherapy
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: LCCC 0215: Induction Chemotherapy Using Paclitaxel, Carboplatin, CPT-11 With Pegfilgrastim Support Followed by Conformal Radiotherapy and Paclitaxel/Carboplatin/ZD1839 in Locally Advanced Unresectable Stage IIIA/B Non-Small Cell Carcinoma of the Lung

Resource links provided by NLM:


Further study details as provided by UNC Lineberger Comprehensive Cancer Center:

Primary Outcome Measures:
  • Number of subjects experiencing toxicity [ Time Frame: 60 days ] [ Designated as safety issue: Yes ]
    Toxicity of the combination of induction carboplatin/paclitaxel/irinotecan, followed by concurrent carboplatin/paclitaxel/ZD1839 and high-dose TCRT, will be assessed by CTCAE criteria

  • Efficacy of 2 cycles of induction paclitaxel/carboplatin/irinotecan [ Time Frame: 42 days ] [ Designated as safety issue: No ]
    To estimate the efficacy of 2 cycles (42 days) of induction paclitaxel/carboplatin/irinotecan, followed by concurrent carboplatin/paclitaxel/ZD1839 using RECIST criteria to evualate tumor response.


Secondary Outcome Measures:
  • Progression Free Survival [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    Radigraphic response measured by RECIST critera.


Enrollment: 24
Study Start Date: November 2003
Study Completion Date: October 2010
Primary Completion Date: January 2006 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Paclitaxel
    175 mg/m2 administered on Day 1, of a 21 day cycle. Subjects will receive 2 cycles
    Other Name: Taxol
    Drug: Carboplatin
    Area Under the Curve(AUC)=5 administered on Day 1 of a 21 day cycle. Subjects will receive 2 cycles.
    Other Name: Paraplatin
    Drug: CPT-11
    100 mg/m2 administered on Day 1 of each 21 day cycle. Subjects will receive 2 cycles.
    Other Name: Irinotecan
    Drug: Pegfilgrastim
    6 mg administered on Day 2 each each 21 day cylce. Subjects will receive 2 cycles of treatment.
    Other Name: Neulasta
    Radiation: Conformal radiotherapy
    Radiation therapy will be administered with standard daily fractionation of 2.0 Gy per fraction, 5 days per week.The total dose of radiotherapy will be 74 Gy
Detailed Description:

Lung cancer remains the leading cause of cancer-related mortality in the United States. In 2002, approximately 170,000 new cases of lung cancer will be diagnosed, and approximately 160,000 deaths will occur. Eighty percent of cases of lung cancer are of the non-small cell type, and 30 to 35% will be Stage IIIA/B and are considered potentially curable. The standard of care in the United States for those patients with unresectable Stage IIIA/B and a good performance status (PS) is a combination of systemic chemotherapy and thoracic radiation therapy (TRT). What is not clear in the management of these patients is the optimal strategy to employ in the combined-modality approach, as well as the optimal chemotherapy and radiation therapy dose and schedule.

Induction and Concurrent Chemoradiation Therapy for Stage IIIA/B NSCLC The use of combined modality has become the standard of care in unresectable Stage IIIA/B non-small cell lung cancer (NSCLC). In the curative approach to this disease, both local control and eradication of occult micrometastatic disease must be achieved. Combined-modality trials employing induction chemotherapy have suggested a reduction in the rate of metastatic disease, suggesting that effectively delivered chemotherapy can eradicate occult micrometastatic disease. All of the trials cited have shown improved survival for the combined-modality arm. Combined-modality trials employing concurrent chemoradiation have suggested improved loco-regional control resulting in improved survival. These data suggest that both induction and concurrent treatment may be important and may exert their benefit in different manners: induction therapy with effective chemotherapy reduces the rate of overt metastatic disease, while concurrent treatment improves local control by enhancing the local effect of TRT. Four trials to date have been published addressing sequential versus concurrent therapy. In these trials, concurrent treatment yielded improved survival over the sequential approach. The value of either induction or consolidation therapy in addition to concurrent chemotherapy is currently being addressed in randomized Phase III trials.

The study will evaluate the incorporation of ZD1839 with concurrent CP and TCRT to a dose of 74 Gy following 2 cycles of induction CIP. The primary objective will be to define the toxicity profile of this approach. With amendment 2, patients will no longer receive maintenance ZD1839. Given the data generated on LCCC 9603 and 2001, this "hybrid" platform of induction CIP followed by concurrent TCRT (74 Gy) and CP seems appropriate for incorporation of ZD1839 because of the general tolerance of this therapy in good PS, unresectable, Stage III NSCLC subjects. Given that esophagitis is the primary toxicity seen with this approach, stopping rules will be in place for excessive esophageal toxicity.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Subjects 18 years of age or older.
  2. Subjects with histologically or cytologically confirmed NSCLC that is considered generally unresectable or inoperable. No prior chemotherapy for NSCLC or thoracic radiotherapy is allowed.
  3. Subjects with Stage IIIA or IIIB disease (clinically or surgically staged).
  4. Subject with disease designated T3, N0-N1 based on mediastinal invasion or proximity to the carina.

    Subjects with contralateral mediastinal disease (N3) are eligible if all gross disease can be encompassed within the radiation port.

  5. Subjects with pleural fluid that is a transudate and is cytologically negative.
  6. Subjects with pleural effusions that are seen only on CT scan and are too small to tap.
  7. Subjects with measurable or evaluable disease.
  8. Subjects with PS of 0 or 1 by the ECOG scale (see Appendix 2).
  9. Subjects with laboratory values as follows:

    Absolute granulocyte count: ≥1,500/µL Platelets: ≥100,000/µL Total bilirubin: ≤1.5 x institutional upper normal limit Serum creatinine: <1.6 mg/dL or Creatinine clearance:>40 mL/min

    AST and ALT: ≤2.5 x institutional upper normal limit FEV 1 >800 cc

  10. Subjects must be nonpregnant and non-lactating. Subjects of childbearing potential must implement an effective method of contraception during the study. All female subjects, except those who are postmenopausal or surgically sterilized, must have a negative pre-study serum or urine pregnancy test.
  11. Subjects must have a life expectancy > 2 months.
  12. Subjects must be seen by both a medical oncologist and a radiation oncologist before registration.
  13. Subjects must be informed of the investigational nature of the study and must sign an informed consent form.

Exclusion Criteria:

  1. Subjects with disease designated T3, N0-N1 based on chest wall invasion, subjects with N3 supraclavicular disease, or subjects with superior sulcus tumors.
  2. Subjects with cytologically positive pleural effusions.
  3. Subjects who have received prior chemotherapy or radiochemotherapy for lung cancer or prior chest radiotherapy.
  4. Subjects who are < 3 weeks since formal exploratory thoracotomy.
  5. Subjects with a history of other cancers except in situ carcinoma of the cervix or breast, inactive nonmelanomatous skin cancer, or other cancer, unless the subject has been free of disease for > 5 years.

    Also, exceptions can be made by the PI for a subject with a malignancy for which the prognosis is substantially better than the subject's prognosis for NSCLC.

  6. Subjects with an active serious infection or other serious underlying medical condition that would otherwise impair their ability to receive protocol treatment. Subjects with post-obstructive pneumonia remain eligible.
  7. Subjects with dementia or significantly altered mental status that would prohibit the understanding and/or giving of informed consent.
  8. Pregnant or breast-feeding females or subjects not using adequate methods of birth control.
  9. Subjects receiving other investigational therapy or non-approved therapy within 30 days before Day 1 of protocol treatment.
  10. Subjects with known hypersensitivity to E coli-derived proteins, pegfilgrastim, or any component of the product will be excluded.
  11. Subjects with metastatic disease are excluded.
  12. Subjects taking phenytoin, rifampicin, barbiturates, carbamazepine, or St. John's Wort.
  13. Any evidence of clinically active ILD (subjects with chronic stable radiographic changes who are asymptomatic need not be excluded).
  14. Subjects with evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the subject to participate in the trial.
  15. As judged by the investigator, subjects with any evidence of severe or uncontrolled systemic disease (eg, unstable or uncompensated respiratory, cardiac, hepatic, or renal disease).
  16. Subjects with known severe hypersensitivity to ZD1839 or any of the excipients of this product.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00280787

Locations
United States, North Carolina
University of North Carolina Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, United States, 27599
Sponsors and Collaborators
UNC Lineberger Comprehensive Cancer Center
AstraZeneca
Amgen
Investigators
Principal Investigator: David Morris, MD University of North Carolina, Chapel Hill
  More Information

No publications provided

Responsible Party: UNC Lineberger Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT00280787     History of Changes
Obsolete Identifiers: NCT00522366
Other Study ID Numbers: LCCC 0215
Study First Received: January 19, 2006
Last Updated: February 1, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by UNC Lineberger Comprehensive Cancer Center:
unresectable
induction
radiotherapy
ZD1839

Additional relevant MeSH terms:
Carcinoma, Non-Small-Cell Lung
Carcinoma, Bronchogenic
Bronchial Neoplasms
Lung Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Paclitaxel
Carboplatin
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on October 01, 2014