Erlotinib With or Without Hydroxychloroquine in Chemo-Naive Advanced NSCLC and (EGFR) Mutations

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Stanford University
Yale University
University of Maryland
Genentech
Information provided by (Responsible Party):
Lecia V. Sequist, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT00977470
First received: September 11, 2009
Last updated: February 2, 2014
Last verified: February 2014
  Purpose

The purpose of this research study is to learn if adding hydroxychloroquine (HCQ) to erlotinib helps treat non-small cell lung cancer (NSCLC). Another goal of this research study is to learn more about NSCLC and how it may respond to study treatment. Erlotinib (Tarceva) is a type of drug called a tyrosine kinase inhibitor (TKI). TKIs block a protein called the epidermal growth factor receptor (EGFR). EGFR may control tumor growth and tumor cell survival. However, although TKI drugs can work for some lung cancer patients for a period of time, eventually the tumor finds a way to resist or counteract the TKI treatment and it begins to grow again. Hydroxychloroquine (HCQ) is a drug approved by the FDA for treating malaria, rheumatoid arthritis, and several other diseases. Laboratory research suggests that when HCQ is given with a TKI, it may help delay or prevent TKI resistance from developing.


Condition Intervention Phase
Non-small Cell Lung Cancer
Drug: Erlotinib
Drug: Hydroxychloroquine
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Study of Erlotinib With or Without Hydroxychloroquine in Patients With Previously Untreated Advanced NSCLC and EGFR Mutations

Resource links provided by NLM:


Further study details as provided by Massachusetts General Hospital:

Primary Outcome Measures:
  • To demonstrate a difference in progression-free survival in patients with advanced NSCLC and EGFR mutations treated with erlotinib as compared with patients treated with erlotinib plus HCQ. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • To evaluate the safety of treatment with erlotinib with and without HCQ. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • To describe the objective tumor response rate following treatment with erlotinib and with erlotinib/HCQ. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • To describe the median overall survival of patients treated with erlotinib and with erlotinib/HCQ [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • To collect serial circulating tumor cell (CTC) analyses from peripheral blood and associate tumor response via CTC quantification with outcome, and describe changing molecular genotypes from the isolated CTCs. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • To correlate genetic characteristics of tumors with response. Mutations in EGFR, KRAS, ALK and other genetic abnormalities will be analyzed. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 76
Study Start Date: October 2009
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: August 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Group A
Erlotinib
Drug: Erlotinib
Taken orally once daily
Other Name: Tarceva
Experimental: Group B
Erlotinib and Hydroxychloroquine
Drug: Erlotinib
Taken orally once daily
Other Name: Tarceva
Drug: Hydroxychloroquine
Taken orally once daily after erlotinib
Other Name: HCQ

Detailed Description:
  • Because no one knows which of the study options are best, participants will be randomized into of the study groups: Group A (erlotinib) or Group B (erlotinib and HCQ). Study treatment will be divided into time periods called cycles. Each study treatment cycle is 28 days.
  • Erlotinib (Group A and Group B) will be taken orally once a day. Hydroxychloroquine (Group B) will be taken orally once a day after taking erlotinib.
  • The following tests and procedures will be performed day 1 of each cycle: physical examination, performance status assessment, questions about any symptoms or side effects, blood for routine tests. The following procedures will be performed at certain study visits: Research blood tests (cycle 1, cycle 2, then every other even cycle); eye exam (cycle 4, cycle 7, and then every 3 months); assessment of the tumor with CT or MRI scan (done at the end of even cycles.
  Eligibility

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

Inclusion Criteria:

  • Pathologically confirmed diagnosis of non-small cell lung cancer
  • Stage IV disease by the American Joint Committee on Cancer/IASLC 7th edition proposed edition staging criteria
  • An EGFR sensitizing mutation must be detected in tumor tissue. Specifically, patients harboring the most common mutations, deletions in exon 19 or the L858R mutation in exon 21 are eligible. Presence of the known resistance mutation T790M as detected by direct tumor sequencing is not allowed. Other rare EGFR mutations may be eligible after discussion with the overall principal investigator
  • Age equal to or greater than 18 years
  • Measurable disease by RECIST criteria, defined as the presence of at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as 10mm or greater with spiral CT scan
  • ECOG Performance status of 0, 1 or 2
  • Since prior radiation or surgery, 14 days or more must have elapsed before starting protocol treatment
  • No prior treatment with erlotinib, gefitinib, or other small molecule EGFR-TKIs. Prior treatment in the adjuvant setting is allowed if at least 1 year has elapsed since TKI course.
  • Adequate organ function as outlined in the protocol
  • Patients must undergo a screening eye exam to obtain approval for HCQ treatment, which establishes the absence of baseline conditions include macular degeneration, visual field changes, other retinal disease, and cataracts that interfere with required funduscopic examinations
  • No G6PD deficiency, as HCQ may cause hemolysis in patients with G6DP

Exclusion Criteria:

  • Symptomatic CNS metastases or newly diagnosed CNS metastases that have not yet been definitively treated with radiation and/or surgery. Note that patients with a history of CNS metastases or cord compression are allowed if they have been definitively treated and are clinically stable. Maintenance steroids are allowed but maintenance seizure medication with an EIAED is not allowed
  • Prior radiation therapy inclusive of all identified target lesions. Note that prior palliative radiation to bony disease, CNS disease, or a limited thoracic area is allowed, provided that there is measurable disease outside the field and radiation is completed at least two weeks prior to starting treatment and the patient has fully recovered from all side effects
  • Current use of hydroxychloroquine for any reason
  • Known hypersensitivity to chloroquine, hydroxychloroquine, or any closely related drug: erlotinib, gefitinib, or any closely related drug
  • Patients who are pregnant or breastfeeding. Female subjects of childbearing potential and male subjects must practice acceptable methods of birth control
  • Any evidence of clinically active interstitial lung disease. Note that patients with chronic, stable radiographic changes who are asymptomatic are eligible
  • Invasive malignancies within the past 3 years except for adequately treated carcinoma of the cervix, basal or squamous cell carcinomas of the skin
  • Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the study, including a prior diagnosis of porphyria or non-light-sensitive psoriasis, as HCQ can significantly exacerbate both of these conditions
  • Use of any non-FDA approved or investigational agent in 30 days or less of enrolling onto the trial, or failure to recover from the side effects of any of these agents
  • Penicillamine use for Wilson's disease or any other indication, as concomitant use with HCQ can increase toxicity to penicillamine
  • Life expectancy of less than 12 weeks
  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: NCT00977470

Locations
United States, California
Stanford Cancer Institute
Stanford, California, United States, 94305
United States, Connecticut
Yale Cancer Center
New Haven, Connecticut, United States, 06519
United States, Maryland
University of Maryland
Baltimore, Maryland, United States, 21201
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
Stanford University
Yale University
University of Maryland
Genentech
Investigators
Principal Investigator: Lecia Sequist, MD Massachusetts General Hospital
  More Information

No publications provided

Responsible Party: Lecia V. Sequist, MD, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT00977470     History of Changes
Other Study ID Numbers: 09-097, OSI4620s
Study First Received: September 11, 2009
Last Updated: February 2, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Massachusetts General Hospital:
NSCLC
HCQ
erlotinib
Tarceva

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
Erlotinib
Hydroxychloroquine
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Therapeutic Uses
Antirheumatic Agents

ClinicalTrials.gov processed this record on September 22, 2014