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Phase I Study of the Combination of Anlotinib With Pemetrexed or Docetaxel

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: NCT03566576
Recruitment Status : Unknown
Verified May 2018 by Fujian Cancer Hospital.
Recruitment status was:  Not yet recruiting
First Posted : June 25, 2018
Last Update Posted : June 25, 2018
Sponsor:
Information provided by (Responsible Party):
Fujian Cancer Hospital

Brief Summary:
The purpose of this clinical study is to evaluate the tolerability and toxicity of different dose of Anlotinib puls Pemetrexed/Docetaxel in Second-line Treatment of Advanced Gene Negative Non-squamous Non-small Cell Lung Cancer , to provide a reference of dosage for Phase II clinical trials

Condition or disease Intervention/treatment Phase
Non-squamous Non-small Cell Lung Cancer Drug: Anlotinib Drug: Pemetrexed Drug: Docetaxel Not Applicable

Detailed Description:

This is a randomized, single -center study conducted in China to compare the tolerability and toxicity of different dose of Anlotinib Plus Pemetrexed / Docetaxel in patients of Advanced Gene Negative Non-squamous Non-small Cell Lung Cancer.From low dose group up to high dose group, each one had 3 patients at least.Primary group received anlotinib 8mg. The dose of Anlotinib would increase gradually until MTD.

Eligible patients will be randomized to arm A and arm B:

Arm A: Patients were instructed to take folic acid 400ug orally daily beginning 1 week before the first dose of pemetrexed and continuing daily until 3 weeks after the last dose of pemetrexed. A 1000ug B12 injection was administered intramuscularly approximately 1 week before the first dose of pemetrexed and was repeated approximately every 9 weeks until after discontinuation. All target volumes were instructed to take dexamethasone (4 mg orally twice daily the day before, the day of, and the day after pemetrexed) as a prophylactic measure against skin rash. Patients on the pemetrexed arm received 500mg/m2 pemetrexed as a 10-minute intravenous infusion on day 1 of a 21-day cycle and 8mg/10mg/12mg Anlotinib orally daily on day 1 to 14 of a 21-day cycle.

Arm B: Patients on the docetaxel arm received 60mg/m2 docetaxel as a 10-minute intravenous infusion on day 1 of a 21-day cycle and 8mg/10mg/12mg anlotinib orally daily on day 1to 14 of a 21-day cycle.

Approximately 18 patients will be enrolled to ensure that roughly 9 patients per arm complete treatments for primary endpoint analysis.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 18 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Dose Climbing Trial of Anlotinib Plus Pemetrexed/Docetaxel in the Second-line Treatment of Advanced Gene Negative Non-squamous Non-small Cell Lung Cancer
Estimated Study Start Date : July 1, 2018
Estimated Primary Completion Date : September 1, 2018
Estimated Study Completion Date : October 1, 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Anlotinib Plus Pemetrexed

This study will include a sequential evaluation of 3 subjects per cohort. Cohort 1: Anlotinib 8mg per day and Pemetrexed. Cohort 2: Anlotinib 10mg per day and Pemetrexed. Cohort 3: Anlotinib 12mg per day and Pemetrexed.

A dose limiting toxicity (DLT) event is defined as any of the following events:

  1. CTCAE Grade 4 event (ANC<1000/ul, body temperature≥38.5°C);
  2. Grade 3 non-hematologic toxicity (except for nausea and vomiting that could be improved with optimal supportive care, escalation of alkaline phosphatase) If a DLT is experienced in any cohort, the cohort will be expanded to 6 subjects. If 2 DLTs are experienced in any cohort, the dose escalation ceased. The MTD was defined as the dose having at most two out of six patients experience DLT.
Drug: Anlotinib
Anlotinib 8mg p.o. qd in first cohort (3 subjects). 10mg p.o. qd in second cohort (3 subjects). 12mg p.o. qd in third cohort (3 subjects).

Drug: Pemetrexed
Pemetrexed 500mg/m2 as a 10-minute intravenous infusion on day 1 of a 21-day cycle.

Experimental: Anlotinib Plus Docetaxel

This study will include a sequential evaluation of 3 subjects per cohort. Cohort 1: Anlotinib 8mg per day and Pemetrexed. Cohort 2: Anlotinib 10mg per day and Pemetrexed. Cohort 3: Anlotinib 12mg per day and Pemetrexed.

A dose limiting toxicity (DLT) event is defined as any of the following events:

  1. CTCAE Grade 4 event (ANC<1000/ul, body temperature≥38.5°C);
  2. Grade 3 non-hematologic toxicity (except for nausea and vomiting that could be improved with optimal supportive care, escalation of alkaline phosphatase) If a DLT is experienced in any cohort, the cohort will be expanded to 6 subjects. If 2 DLTs are experienced in any cohort, the dose escalation ceased. The MTD was defined as the dose having at most two out of six patients experience DLT.
Drug: Anlotinib
Anlotinib 8mg p.o. qd in first cohort (3 subjects). 10mg p.o. qd in second cohort (3 subjects). 12mg p.o. qd in third cohort (3 subjects).

Drug: Docetaxel
Docetaxel 60mg/m2 as a 10-minute intravenous infusion on day 1 of a 21-day cycle.
Other Name: Taxotere




Primary Outcome Measures :
  1. Dose limiting toxicity [ Time Frame: From enrollment to completion of study. Estimated about 6 months. ]
    Dose Limiting Toxicity (DLT) is referred to grade 3 non-hematological toxicity or grade 4 hematological toxicity according to NCI CTCAE 4.03 criteria

  2. Maximum tolerance dose [ Time Frame: From enrollment to completion of study. Estimated about 6 months ]
    Maximum Tolerance Dose (MTD) is the dose of treatment in the cohort where there are 2 cases of DTL reported.


Secondary Outcome Measures :
  1. disease control rate [ Time Frame: From enrollment to 2 months after treatment ]
    Clinical response of treatment according to RESIST v1.1 criteria (DCR, disease control rate)

  2. time to progression [ Time Frame: From enrollment to progression of disease. Estimated about 6 months. ]
    The length of time from enrollment until the time of progression of disease (TTP, time to progression).



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Be≥18 years of age on the day of signing informed consent.
  • Patients with histologic or cytologic confirmation of advanced or metastatic NSCLC with stage III or IV disease amenable to platinum-based chemotherapy were assessed for eligibility.
  • Patients with EGFR、ALK、ROS1 Mutation-negative were eligible.
  • Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Status.
  • Life expectancy ≥3 months.
  • Without serious system dysfunction and could tolerate chemotherapy.
  • With normal marrow, liver ,renal and coagulation function:

a leucopenia count of ≥3.0×109/L; a platelet count of ≥1.5×109/L; hemoglobin≥ 90 g/L; a platelet count of ≥100×109/L; a alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) of ≤2.5 UNL in case of liver metastasis; a total bilirubin (TBil) of ≤1.5 upper normal limitation (UNL); a creatinine (Cr) of ≤ 1.5 UNL; a creatinine clearance rate ≥ 50ml/min (Cockcroft-Gault);

  • With normal coagulation function: activated partial thromboplastin time (APTT), prothrombin time (PT) and INR, each ≤ 1.5 x UNL.
  • Female subjects of child-bearing potential must agree to use contraceptive measures starting 1 week before the administration of the first dose of apatinib until 8 weeks after discontinuing study drug. Male subjects must agree to use contraceptive measures during the study and 8 weeks after last dose of study drug.
  • With written informed consent signed voluntarily by patients themselves or their supervisors witted by doctors.
  • With good compliance and agree to accept follow-up of disease progression and adverse events.

Exclusion Criteria:

  • Small cell lung cancer (include Small cell lung cancer mixture of NSCLC).
  • Patients with brain or central nervous system metastases, including leptomeningeal disease, or CT/MRI examination revealed brain or leptomeningeal disease) (14 days before the random treatment has been completed and the symptoms of patients with brain metastases from stable can into the group, but need to the cerebral MRI, CT or vein angiography confirmed as without symptoms of cerebral hemorrhage).
  • Iconography (CT or MRI) shows that the tumor vessels have 5 mm or less, or Cardiovascular involvement by Central tumor ; Or obvious lung empty or necrotic tumor.
  • Uncontrollable hypertensive (systolic blood pressure or greater 140 mmHg or diastolic blood pressure or greater 90 mmHg, despite the best drug treatment).
  • Significant cardiac disease as defined as: grade II or greater myocardial infarction, unstable arrhythmia(Including corrected QT interval (QTc )period between male or greater 450 ms, female or greater 470 ms); New York Heart Association (NYHA) grade II or greater heart dysfunction , or Echocardiography reveal left ventricular ejection fraction (LVEF)Less than 50%.
  • Abnormal coagulation (INR > 1.5 or prothrombin time (PT) > ULN + 4 seconds or APTT ULN > 1.5), with bleeding tendency or be treated with thrombolysis and anticoagulation.

Note: under the premise of International Normalized ratio (INR) of prothrombin time (PT) Less than or equal to 1.5, allow to administrate low-dose heparin (adult daily dose is 06000 ~ 12000 U) or low-dose aspirin (100 mg daily dosage or less) , for prophylactic purposes.

  • Urine routines show urine protein≥ ++, or urine protein quantity≥ 1.0 g during 24 hours.
  • Patients with NCI-CTCAE grade II or greater peripheral neuropathy, except due to trauma.
  • Clinically significant serous effusion (including pleural effusion, ascites, pericardial effusion).
  • Serious, non-healing wound, ulcer, or bone fracture.
  • Patients with severe infections , and need to receive Systemic antibiotic treatment.
  • Decompensated diabetes or high dose glucocorticoid treatment of other contraindication.
  • Active or chronic hepatitis c and/or Hepatitis B virus (HBV) infection.
  • Has an obvious factor influencing oral drug absorption, such as unable to swallow, chronic diarrhea and intestinal obstruction, etc.
  • Has received major surgery or severe traumatic injury, fractures or ulcer Within 4weeks before Random.
  • Severe weight loss (> 10%) Within 6 weeks before Random.
  • Has Clinically significant hemoptysis Within 3 months before Random (daily hemoptysis than 50 ml;Or significant clinical significance of bleeding symptoms or have definite bleeding tendency, such as gastrointestinal bleeding, bleeding ulcers, baseline period + + and above of fecal occult blood, or vasculitis, etc.
  • Has venous thromboembolism events Within 12 months before Random, such as cerebrovascular accident (including transient ischemic attack, cerebral hemorrhage, cerebral infarction), deep vein thrombosis and pulmonary embolism, etc.
  • There are any contraindications with receiving pemetrexed or docetaxel treatment; has a history of severe allergic reactions of docetaxel or other containing Polysorbate 80 (twain 80)
  • There are allergic reaction to contrast media, anlotinib, and/or excipient of experimental drug.
  • Patients with any other medical condition or reason, in that investigator's opinion, makes the patient unstable to participate in a clinical trial.

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): NCT03566576


Contacts
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Contact: Lin Gen 13313786157 lingen197505@163.com

Sponsors and Collaborators
Fujian Cancer Hospital
Investigators
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Principal Investigator: Lin Gen Fujian Cancer Hospital
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Responsible Party: Fujian Cancer Hospital
ClinicalTrials.gov Identifier: NCT03566576    
Other Study ID Numbers: FujianCH110
First Posted: June 25, 2018    Key Record Dates
Last Update Posted: June 25, 2018
Last Verified: May 2018

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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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
Pemetrexed
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors