Customizing First Line Chemotherapy in Advanced Non-Small Cell Lung Cancer - Full Text View

Purpose

The study aims at piloting the concept of customization of chemotherapy based on molecular markers in patients with stage IIIB (with pleural effusion) and IV with performance status ≤ 2 with pathologically proven non-small cell lung cancer (NSCLC). The study will not test or compare individual regimen but rather it will test the approach of customization concept as a whole.

The results of this pilot study will help in designing more definitive trials in our patient population.

Condition	Intervention	Phase
Non-Small Cell Lung Cancer	Drug: Cisplatin, Gemzar, Docetaxel, Alimta	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:	A Pilot Study of Customizing First Line Chemotherapy in Advanced Non-Small Cell Lung Cancer Based on Molecular Markers

Resource links provided by NLM:

Genetics Home Reference related topics: lung cancer

MedlinePlus related topics: Cancer Lung Cancer

Drug Information available for: Cisplatin Gemcitabine Docetaxel

U.S. FDA Resources

Further study details as provided by National Guard Health Affairs:

Primary Outcome Measures:

Efficacy and Safety [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
1. Efficacy is measured by:
  - overall response rate (partial response and complete response) using RECIST Criteria
  - time to disease progression (TTP)
  - progression free survival (PFS)
  - overall survival (OS)
2. To evaluate the Number of participants with Adverse Events and Serious Adverse Events.Safety will include 5 parameters to be collected for all patients who receive the study regimen which are:
  - Adverse Events
  - Laboratory Assessments
  - Vital Signs
  - Physical Examinations
  - ECG

Secondary Outcome Measures:

Tumor marker [ Time Frame: 3 years ] [ Designated as safety issue: No ]
1. The molecular characteristics of circulating tumor cells harvested from peripheral blood
2. Correlation between the markers of circulating tumor cells and primary tumor.


Enrollment:	3
Study Start Date:	May 2010
Study Completion Date:	May 2013
Primary Completion Date:	May 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Cisplatin,Docetaxel,Gemzar, Premetrexed Patients will receive treatment for up to six cycles of the assigned regimen unless there is disease progression or unacceptable toxicities. After treatment, the patients will be seen every 2 months for the first year, then every 3 months for the second year and every 6 months afterwards.	Drug: Cisplatin, Gemzar, Docetaxel, Alimta Patients will be assigned to treatment according to the molecular biological results which will analyze excision repair cross-complementing (ERCC1), ribonucleotide reductase subunit M1 (RRM1) and beta-tubulin genes in primary tumor cells which are present in tissues and peripheral blood.

Detailed Description:

The treatment of advanced NSCLC cancer includes various chemotherapies with equivalent regimens that have reached a therapeutic plateau. The selection of these regimens is completely empirical and physician dependent. Potential predictors of specific agent efficacy exist in the form of tumor molecular markers that are a reflection of the individual's genetic make up. Thus our study aims at utilizing these markers to more efficiently select the regimen in order to maximize the benefit to the patients rather than using empiric approaches. Fortunately, each of our selected regimens contains active and well-studied agents in the treatment of lung cancer (Table 1). This pilot study will help us determine the benefit, and safety of this approach (not individual regimen). The study is not to compare individual regimens but it aims at testing the whole concept of customization of chemotherapy based on molecular markers to help us in the future at selecting regimens based on these markers and not empirically. The results then will be used to determine more definitive future studies.

Furthermore, circulating tumor cells in the blood represent the future distant metastases that result in disease progression to incurable stages. The circulating tumor cells have the ability to cross into vessels, travel in circulation, and exit the vessels into tissues where they have the capability to grow. Therefore, these cells may express different biological and molecular features from the stationary cells in the primary tumors. Therefore, exploiting these circulating tumor cells for augmenting treatment approaches is of vital importance and utility.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Microscopic diagnosis of NSCLC stages IIIB (with malignant pleural effusion) and IV
Having adequate tissue sample to perform the markers testing
Age ≥ 18 years
No prior chemotherapy treatment for lung cancer (Surgery and radiotherapy are acceptable)
No other concurrent cancer treatment
Performance status of 0- 2 per ECOG scale (Appendix II)
Adequate laboratory values as follows as follows:

Absolute neutrophil count ≥ 1500/mm3 Platelet count ≥100, 000/ mm3 Total bilirubin ≤ 1.25X institutional upper normal level AST and ALT ≤ 3 X institutional upper normal level Serum creatinine ≤ 1.5 X institutional upper normal level
Presence of measurable disease

Exclusion Criteria:

Prior systemic treatment for lung cancer
History of hypersensitivity to drugs used
Diagnosis of other malignancy in the last 5 years excluding curatively treated non-melanoma skin cancer and in-situ cervical cancer
Medical illness that puts the patient at significant risk per investigator's discretion
Uncontrolled CNS disease. Patients with CNS metastatic disease treated with radiotherapy or surgery will be eligible if the CNS disease is stable 4 weeks after the treatment initiation without increase dose of steroids
Positive pregnancy test or refusal to use contraception during treatment. (Gynecology consultant for contraception)

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: NCT01356368

Locations


Saudi Arabia
King Abdul Aziz Medical City for National Guard Health Affairs
Riyadh, Saudi Arabia

Sponsors and Collaborators

National Guard Health Affairs

Investigators


Principal Investigator:	Abdulrahman Jazieh, MD/MPH	King Abdul Aziz Medical City for National Guard

More Information


Responsible Party:	National Guard Health Affairs
ClinicalTrials.gov Identifier:	NCT01356368 History of Changes
Other Study ID Numbers:	RC09/095
Study First Received:	March 19, 2011
Last Updated:	January 19, 2014
Health Authority:	Saudi Arabia: Ethics Committee

Keywords provided by National Guard Health Affairs:


Lung cancer

Additional relevant MeSH terms:


Lung Neoplasms Carcinoma, Non-Small-Cell Lung Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Neoplasms Lung Diseases Respiratory Tract Diseases Carcinoma, Bronchogenic Bronchial Neoplasms Docetaxel Gemcitabine Cisplatin	Antineoplastic Agents Tubulin Modulators Antimitotic Agents Mitosis Modulators Molecular Mechanisms of Pharmacological Action Antimetabolites, Antineoplastic Antimetabolites Antiviral Agents Anti-Infective Agents Enzyme Inhibitors Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 28, 2016

Customizing First Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (Customizing)