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Residual Hypermethylation in Early Stage Non-Small Cell Lung Cancer (NSCLC) As Part of Adjuvant Therapy and Preventive Strategy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01209520
Recruitment Status : Completed
First Posted : September 27, 2010
Results First Posted : February 24, 2015
Last Update Posted : February 24, 2015
Sponsor:
Information provided by (Responsible Party):
Ikechukwu Akunyili, University of Miami

Brief Summary:
The trial investigates the feasibility and efficacy of targeting Non-Small Cell Lung Cancer (NSCLC) "driven" by epigenetic changes. The investigators study the impact of 5-azacitidine (Vidaza®, Celgene, Summit, NJ, USA) in combination with conventional cytotoxic chemotherapy in a sequential fashion. The study population consists of all NSCLC patients who undergo "curative" lung cancer resection and whose tumors harbor hypermethylation in any of the protocol-specific genes (samples will be banked for additional molecular testing including other 21 loci which have shown to be important in lung carcinogenesis.

Condition or disease Intervention/treatment Phase
Lung Cancer Non Small Cell Lung Carcinoma Hypermethylation Drug: Cisplatin Drug: Carboplatin Drug: Paclitaxel Drug: Vidaza Procedure: Tumor Specimen for Methylation Analysis Procedure: Blood Sample for Methylation Analysis Drug: Vinorelbine Drug: Docetaxel Drug: Pemetrexed Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pilot Study Targeting Residual Hypermethylation in Early Stage Non-Small Cell Lung Cancer As Part of Adjuvant Therapy and Preventive Strategy
Study Start Date : July 2009
Actual Primary Completion Date : December 2013

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Adjuvant Chemotherapy + Vidaza Drug: Cisplatin
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.
Other Names:
  • Platinol®,
  • cis-diamminedichloroplatinum

Drug: Carboplatin
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.
Other Name: Paraplatin®

Drug: Paclitaxel
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.
Other Name: Taxol

Drug: Vidaza
Patient will receive 5-azacitidine at a dose of 75 mg/m2 intravenously daily on day 1-5 every 28 days for 6 cycles
Other Name: 5-azacitidine

Procedure: Tumor Specimen for Methylation Analysis
Obtained from tissue of resected NSCLC tumor.

Procedure: Blood Sample for Methylation Analysis
Pre-Surgery, Post-Surgery, Post-Vidaza Therapy and during follow-up.

Drug: Vinorelbine
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.
Other Name: Navelbine®

Drug: Docetaxel
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.

Drug: Pemetrexed
Patients will receive a total of 4 cycles of adjuvant chemotherapy (each cycle given every 21 days). Conventional chemotherapy will be selected at discretion of the treating physicians except on those cases in which pathologic diagnosis indicates non squamous NSCLC.




Primary Outcome Measures :
  1. Percentage of Patients Showing a Presence of Methylated Tumor Suppressor Genes in Their Tumor Tissue and/or Serum Achieving Partial or Complete Response to Protocol Therapy. [ Time Frame: Up to 2 years ]
    To determine the feasibility and efficacy of incorporating a demethylating agent (5-azacitidine; Vidaza®, Celgene, Summit, NJ, USA) as part of adjuvant therapy in patients diagnosed with NSCLC who harbor methylated tumor supressor genes (TSGs) in their tumor tissue and/or serum. Response to be evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) v. 1.0.

  2. Degree of Demethylation in Patient Tumor Tissue and/or Serum Induced by 5-azacitidine on Specific Tumor Specific Genes (TSGs) [ Time Frame: Up to 2 years ]
    To measure the grade of demethylation induced by 5-azaciditine on specific TSGs by analyzing plasma DNA, and global demethylation by analyzing WBC DNA, and determine the duration of this effect.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have a pathologic diagnosis of NSCLC.
  • Patients must have surgical resection for NSCLC (stage I-IIIA) and tumor specimen (ideally) and/or blood sample available for biological correlative studies.
  • Patient's tumor specimen and/or blood sample must show hypermethylation in at least one (1) of the following genes: DAPK, RASSF1A, CDKN2A (p16INK4a), GATA-4, GATA-5, SPARC, MGMT, APC, and hMLH1.
  • Patient's age must be 18 years or greater.
  • Patients must have adequate organ and marrow function prior to be enrolled into the trial, as defined below:

    • Absolute neutrophil count (ANC) > 1500/mm3
    • Platelets > 100,000/mm3
    • Hemoglobin > 8.0 g/dL (with packed red blood cell transfusion or use of erythropoietin stimulating agents allowed)
    • Serum creatinine < 2.0 mg/dl.
    • Total bilirubin < 2.0 mg/dl.
    • AST/ALT < 2 x the upper limits of institutional normal.
  • ECOG performance status of 0, 1, or 2.
  • Estimated survival of > 12 months.
  • Patients must be able to understand and agree to sign an IRB-approved informed consent form, including permission to draw blood sample for correlative studies during active treatment and follow-up.
  • Women of child-bearing potential and men must agree to use adequate contraceptive method (hormonal or barrier method of birth control) prior to study entry for the duration of study.
  • Women of childbearing potential must have a negative serum pregnancy test prior to start targeted therapy with 5-azacitidine.
  • Patients with HIV infection (but not AIDS) are eligible for this trial. Therefore, no HIV testing will be required.

Exclusion Criteria:

  • Patients who are not candidates for surgical resection.
  • Patients who have received radiation therapy.
  • No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, breast DCIS adequately treated, or other cancer for which the subject has been disease-free ≥ 5 years.
  • Subjects should not have a significant history of cardiac disease (e.g., unstable angina, congestive heart failure, or uncontrolled arrhythmias).
  • Subjects must not have an uncontrolled seizure disorder, or active neurological disease.
  • Patients who have significant systemic infections including AIDS.
  • Pregnant and/or lactating women.
  • Known or suspected hypersensitivity to azacitidine or mannitol.
  • Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical illnesses.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01209520


Locations
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United States, Florida
University of Miami Sylvester Comprehensive Cancer Center
Miami, Florida, United States, 33136
Sponsors and Collaborators
University of Miami
Investigators
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Principal Investigator: Ikechukwu Akunyili, MD University of Miami
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Responsible Party: Ikechukwu Akunyili, Assistant Professor of Clinical, University of Miami
ClinicalTrials.gov Identifier: NCT01209520    
Other Study ID Numbers: 20080779
SCCC-2008045 ( Other Identifier: University of Miami Sylvester Comprehensive Cancer Center )
First Posted: September 27, 2010    Key Record Dates
Results First Posted: February 24, 2015
Last Update Posted: February 24, 2015
Last Verified: February 2015
Keywords provided by Ikechukwu Akunyili, University of Miami:
Lung Cancer
Non-Small Cell Lung Carcinoma
NSCLC
Methylation Analysis
Hypermethylation
Targeted Genes
Tumorigenesis
Tumor Supressor Genes
Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Paclitaxel
Vinorelbine
Docetaxel
Cisplatin
Carboplatin
Pemetrexed
Azacitidine
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors
Antimetabolites, Antineoplastic
Antimetabolites