Carboplatin and Gemcitabine Combined With Celecoxib and/or Zileuton in Treating Patients With Advanced Non-Small Cell Lung Cancer

RATIONALE: Drugs used in chemotherapy, such as carboplatin and gemcitabine, work in different ways to stop tumor cells from dividing so they stop growing or die. Celecoxib and zileuton may stop the growth of tumor cells by stopping blood flow to the tumor and may block the enzymes necessary for tumor cell growth. Combining chemotherapy with celecoxib and/or zileuton may kill more tumor cells.

PURPOSE: Randomized phase II trial to study the effectiveness of combining celecoxib and/or zileuton with carboplatin and gemcitabine in treating patients who have advanced non-small cell lung cancer.

OBJECTIVES:

Primary

• Compare the efficacy of carboplatin and gemcitabine with celecoxib and/or zileuton, in terms of 7-month progression-free survival, in patients with advanced non-small cell lung cancer.

Secondary

• Compare the response rate, distribution of survival, and failure-free survival time of patients treated with these regimens.
• Correlate CYFRA and serum vascular endothelial growth factor levels with response and survival of patients treated with these regimens.
• Correlate cyclo-oxygenase-2 and 5-lipoxygenase expression with survival of patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 3 treatment arms.

• Arm I: Patients receive gemcitabine IV over 30 minutes on days 1 and 8, carboplatin IV over 30 minutes on day 1, and oral zileuton 4 times daily on days 1-21.
• Arm II: Patients receive gemcitabine and carboplatin as in arm I and oral celecoxib twice daily on days 1-21.
• Arm III: Patients receive gemcitabine and carboplatin as in arm I, oral celecoxib as in arm II, and oral zileuton as in arm I.

In all arms, treatment repeats every 21 days for 6 courses. Patients with responding or stable disease continue courses of zileuton and/or celecoxib in the absence of disease progression or unacceptable toxicity.

Patients are followed monthly for 1 year, every 2 months for 2 years, and then every 4 months for 3 years or until disease progression.

PROJECTED ACCRUAL: A total of 117 patients (39 per treatment arm) will be accrued for this study within 11-12 months.

• Drug: carboplatin
  given IV
• Drug: celecoxib
  given PO
• Drug: gemcitabine hydrochloride
  given IV
• Drug: zileuton
  given PO

• Experimental: Gem + Carboplatin + Zileuton
  Interventions:

  • Drug: carboplatin
  • Drug: gemcitabine hydrochloride
  • Drug: zileuton
• Experimental: Gem + Carboplatin + celecoxib
  Interventions:

  • Drug: carboplatin
  • Drug: celecoxib
  • Drug: gemcitabine hydrochloride
• Experimental: Gem + carboplatin + zilueton + celecoxib
  Interventions:

  • Drug: carboplatin
  • Drug: celecoxib
  • Drug: gemcitabine hydrochloride
  • Drug: zileuton

• Edelman MJ, Watson D, Wang X, Morrison C, Kratzke RA, Jewell S, Hodgson L, Mauer AM, Gajra A, Masters GA, Bedor M, Vokes EE, Green MJ. Eicosanoid modulation in advanced lung cancer: cyclooxygenase-2 expression is a positive predictive factor for celecoxib + chemotherapy--cancer and leukemia group B trial 30203. J Clin Oncol. 2008 Feb 20;26(6):848-55.
• Edelman, MJ, Watson DM, Wang X, et al.: Eicosanoid modulation in advanced non-small cell lung cancer (NSCLC): CALGB 30203. [Abstract] J Clin Oncol 24 (Suppl 18): A-7025, 370s, 2006.

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC) of 1 of the following cellular types:

  • Adenocarcinoma
  • Large cell
  • Squamous cell
  • Mixed

• Meets 1 of the following staging criteria:

  • Stage IIIB disease with malignant pleural effusion, supraclavicular node involvement, or contralateral hilar nodes

    • Stage IIIB patients eligible for Cancer and Leukemia Group B protocols of combined chemotherapy and chest irradiation are not allowed
  • Stage IV disease

• Measurable or nonmeasurable disease

  • Unidimensionally measurable lesions at least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan

  • The following are considered nonmeasurable disease:

    • Bone lesions
    • Ascites
    • Pleural/pericardial effusion
    • Lymphangitis cutis/pulmonis
    • Abdominal masses that are not confirmed and followed by imaging techniques
    • Cystic lesions
    • Small lesions
• No leptomeningeal disease
• Symptomatic CNS metastases must be treated (e.g., surgery, radiotherapy, or gamma knife), neurologically stable, and off steroids

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Granulocyte count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic

• Bilirubin no greater than 1.5 mg/dL
• AST no greater than 2.0 times upper limit of normal

Renal

• Creatinine no greater than 1.5 mg/dL

Cardiovascular

• None of the following within the past 6 months:

  • Myocardial infarction
  • Unstable angina
  • Symptomatic congestive heart failure
  • Serious uncontrolled cardiac arrhythmia
  • Cerebrovascular accident
  • Transient ischemic attack
  • Symptomatic carotid artery or peripheral vascular disease
  • Deep vein thrombosis
  • Significant thromboembolic event

Pulmonary

• No pulmonary embolism within the past 6 months

Gastrointestinal

• No history of gastrointestinal (GI) bleeding
• No history of peptic ulcer disease
• No active GI bleeding

Other

• Not pregnant or nursing
• No known hypersensitivity to aspirin, NSAIDs, or sulfonamides

• No currently active second malignancy other than nonmelanoma skin cancer

  • Patients are not considered to have a currently active malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No prior immunotherapy for NSCLC

Chemotherapy

• No prior chemotherapy for NSCLC
• No other concurrent chemotherapy

Endocrine therapy

• See Disease Characteristics

• No concurrent chronic oral steroids

  • Concurrent episodic steroids for antiemetic purposes allowed
• No concurrent hormonal therapy
• Concurrent inhaled steroids allowed when medically indicated
• Concurrent megestrol for appetite stimulation is allowed

Radiotherapy

• See Disease Characteristics
• At least 2 weeks since prior radiotherapy and recovered

Surgery

• See Disease Characteristics
• At least 2 weeks since prior surgery and recovered

Other

• No prior systemic treatments for NSCLC
• No other concurrent investigational therapy

• At least 1 week since prior nonsteroidal anti-inflammatory drugs (NSAIDs), including any of the following:

  • Rofecoxib
  • Choline magnesium trisalicylate
  • Ibuprofen
  • Naproxen
  • Etodolac
  • Oxaprozin
  • Diflunisal
  • Nabumetone
  • Tolmetin
  • Valdecoxib
• No concurrent NSAIDs

• No concurrent chronic aspirin

  • Concurrent aspirin no greater than 325 mg/day is allowed
• No concurrent fluconazole
• No concurrent leukotriene antagonists (e.g., zafirlukast, montelukast, or pranlukast)