Feasibility Study to Estimate Number of Patients With Precancerous Areas in Their Airways and the Response to Gefitinib (TIDAL1)
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We are going to use a special type of bronchoscopy test to examine patients who have had previous surgical treatment for lung cancer or head and neck cancer. The aim is to determine a) whether we can identify precancerous changes in their airways b) whether this type of testing is acceptable and c) get an initial idea of whether a new drug called gefitinib has any effect on precancerous areas in the airway.
Incidence of high grade dysplasia of the bronchial epithelium in patients at high risk of lung dysplasia [ Time Frame: during the screening broncoscopy - carried out within the first month post consent ]
Patients will have white/blue light bronchoscopy with biopsy of identified lesions. The incidence of high grade lung epithelial dysplasia will be recorded.
Secondary Outcome Measures
Acceptability of screening patients as measured by success of trial recruitment [ Time Frame: 12 months ]
Response of high grade dysplasia to treatment (complete / partial / stable / progression) [ Time Frame: 6 & 12 months ]
To be estimated by photography & biopsy of the lesions & comparison with previous findings:
Complete response: Complete resolution of a dysplastic lesion Partial response: Reduction of a dysplastic lesion by >=50% OR Reduction in grade of a high grade dysplastic lesion Progressive disease: Development of a new area of high grade dysplasia or invasive malignancy in an area of previous low grade dysplasia or normal epithelium OR Development of a higher grade lesion in an area of previous high grade dysplasia OR Increase in surface area of >=50%.
Stable disease: None of the above.
Toxicity and acceptability of treatment (proportion of patients refusing study entry). [ Time Frame: 2 weeks, 4 weeks, 3 & 6 months ]
Successful biobanking of samples [ Time Frame: 12 months ]
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Ages Eligible for Study:
18 Years to 80 Years (Adult, Senior)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Age 18 years or above
Resected NSCLC or Squamous cell Head & Neck cancer treated curatively
All treatment, including any adjuvant treatment with radiotherapy and/or chemotherapy completed at least 3 months prior to study entry
ECOG (Eastern Cooperative Oncology Group) performance status of 0 or 1
Suitable for flexible bronchoscopy
Able to give signed informed consent
Adequate haematological, kidney and liver function:
Serum alanine transaminase (ALT) ≤2.5 x upper limit of normal (ULN)
Total serum bilirubin ≤1.5 x ULN
Absolute neutrophil count (ANC) ≥1500/μL
Haemoglobin ≥9.0 g/dL
Sufficient renal function to allow administration of contrast medium (in line with Royal College of Radiologists guidelines).
In addition, the following inclusion criteria must be met during the screening period in order to confirm eligibility for the study treatment
No evidence of malignant disease activity on screening
High grade dysplasia on autofluorescence bronchoscopy analysis
No evidence of pulmonary fibrosis or interstitial lung disease on screening CT
Diagnosis of any second malignancy within the 5 years from date of enrolment, except basal cell carcinoma, squamous cell skin cancer, or in situ carcinoma of the cervix uteri that has been adequately treated with no evidence of recurrent disease for 12 months
Evidence of severe or uncontrolled systemic disease or psychiatric disorder that would interfere with the patient's safety
Known severe hypersensitivity to Gefitinib or any of the excipients of the product
Past medical history of interstitial lung disease, drug-induced interstitial disease, radiation pneumonitis which required steroid treatment or any evidence of clinically active interstitial lung disease
Pre-existing idiopathic pulmonary fibrosis
History of allergy to contrast medium
Insufficient lung function as determined by either clinical examination or an arterial oxygen tension (PaO2) of < 9.3kpa
Inability to swallow oral medications
Presence of active inflammatory bowel disease, partial or complete bowel obstruction or chronic diarrhoea or any condition which would interfere with absorption of an oral drug.
Past medical history of keratitis
Past medical history of Sjogren's syndrome
Pregnant or breast-feeding
Male and female patients (of childbearing age) not using, or not willing to use, protocol mandated contraception
Prior EGFR inhibitor use.
Concurrent medication with known potent CYP3A4 inhibitors and inducers and/or dosing within 7 days of date of enrolment (e.g.. ketoconazole, rifampin, phenytoin, carbamazepine, barbiturates or herbal preparations containing St John's wort/Hypericum perforatum etc.) or use of other concomitant medication incompatible with study drug (see SmPC)
Current treatment on another therapeutic clinical trial or previous investigational agent in the last 12 weeks (supportive care trials or non-treatment trials are allowed)
Previous enrolment or treatment in the present study.