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Stereotactic Radiosurgery or Other Local Ablation Then Erlotinib in Epidermal Growth Factor Receptor (EGFR)

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: NCT01573702
Recruitment Status : Completed
First Posted : April 9, 2012
Results First Posted : January 12, 2021
Last Update Posted : January 12, 2021
Sponsor:
Collaborator:
Astellas Pharma Global Development, Inc.
Information provided by (Responsible Party):
UNC Lineberger Comprehensive Cancer Center

Study Type Interventional
Study Design Allocation: N/A;   Intervention Model: Single Group Assignment;   Masking: None (Open Label);   Primary Purpose: Treatment
Condition Non Small Cell Lung Cancer
Interventions Procedure: Stereotactic Radiosurgery
Drug: Erlotinib
Enrollment 32
Recruitment Details 32 participants were accrued from six institutions between 12/2012 and 6/2016
Pre-assignment Details Of the 32 participants who consented to the study, 5 were determined to be not eligible and 2 withdrew consent prior to starting study treatment
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Period Title: Overall Study
Started 25
Completed 25
Not Completed 0
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Baseline Participants 25
Hide Baseline Analysis Population Description
[Not Specified]
Age, Continuous  
Median (Full Range)
Unit of measure:  Years
Number Analyzed 25 participants
64
(44 to 82)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
Female
16
  64.0%
Male
9
  36.0%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
Hispanic or Latino
0
   0.0%
Not Hispanic or Latino
25
 100.0%
Unknown or Not Reported
0
   0.0%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
American Indian or Alaska Native
0
   0.0%
Asian
0
   0.0%
Native Hawaiian or Other Pacific Islander
0
   0.0%
Black or African American
0
   0.0%
White
25
 100.0%
More than one race
0
   0.0%
Unknown or Not Reported
0
   0.0%
Region of Enrollment  
Measure Type: Number
Unit of measure:  Participants
United States Number Analyzed 25 participants
25
Smoking status  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
Never smoker
16
  64.0%
Former smoker
7
  28.0%
Unknown
2
   8.0%
Performance status   [1] 
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
0, Fully active
16
  64.0%
1, Restricted in strenuous activity but ambulatory
9
  36.0%
[1]
Measure Description: Eastern Cooperative Oncology Group (ECOG) Performance Status is a scale from 0-5 to describe a patient's level of functioning in terms of self care ability and activity level. Higher on the scale is worse functioning
Mutation type   [1] 
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 25 participants
Exon 19
14
  56.0%
Exon 21
7
  28.0%
Exon 19+ ALK rearrangement
1
   4.0%
Exon 18 and Exon 20
1
   4.0%
None proven; met clinical criteria
2
   8.0%
[1]
Measure Description: The mutation type is the location (Exon) of the mutation in the Epidermal Growth Factor Receptor (EGFR) gene. Subjects who did have proof of a mutation through testing (due to inadequate tissue, for example) were still eligible for the study if they met the clinical criteria of a clinical response overwhelmingly consistent with EGFR mutation (PR plus at least 6 months free of progressive disease as a consequence of EGFR-TKI therapy).
Charlson Co-morbidity Index   [1] 
Median (Full Range)
Unit of measure:  Units on a scale
Number Analyzed 25 participants
6
(0 to 10)
[1]
Measure Description: The Charlson Comorbidity Index is a method of categorizing comorbidities of patients in which each category has an associated weight (from 1 to 6), based on the adjusted risk of mortality or resource use, and the sum of all the weights results in a single comorbidity score for a patient ranging from 0 (no comorbidities) to 24. The higher the score, the more likely the predicted outcome will result in mortality or higher resource use.
1.Primary Outcome
Title Percentage of Participants With Progression Free Survival
Hide Description Progression free survival (PFS) after locally ablative therapy and erlotinib in EGFR-mutant NSCLC patients who progressed on prior EGFR-tyrosine kinase inhibitor (TKI) therapy reported as percentage of participants who are alive and without progressive disease at 3 months. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or the appearance of new lesions.
Time Frame 3 months after Initiation of Stereostatic Radiotherapy
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description:

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Participants Analyzed 25
Measure Type: Number
Number (95% Confidence Interval)
Unit of Measure: percentage of participants
64
(42.5 to 82)
2.Secondary Outcome
Title Percentage of Participants With Local Control of Sites on Erlotinib Following Stereotactic Radiosurgery (SRS)
Hide Description Count of subjects who had local control of sites previously progressive on erlotinib following SRS followed by erlotinib. Using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), local control is defined as Complete Response (CR), Disappearance of all target lesions; or Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; in sites ablated by SRS.
Time Frame Initiation of Stereotactic Radiotherapy every 6 to 12 weeks until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
Hide Outcome Measure Data
Hide Analysis Population Description
4 subjects were not evaluable for this outcome due to lack of follow-up measurements on ablated lesions
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description:

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Participants Analyzed 21
Measure Type: Count of Participants
Unit of Measure: Participants
7
  33.3%
3.Secondary Outcome
Title Median Overall Survival
Hide Description To estimate overall survival (OS) after locally ablative therapy and erlotinib in EGFR-mutant, NSCLC patients who progressed on prior EGFR-TKI therapy measured as length of time from start of treatment until date of death from any cause
Time Frame up to 5 years after end of treatment
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Single Arm Study
Hide Arm/Group Description:

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Participants Analyzed 25
Median (95% Confidence Interval)
Unit of Measure: Months
29
(21.7 to 36.3)
4.Secondary Outcome
Title Toxicity Rate From Stereotactic Radiosurgery (SRS)
Hide Description Toxicity of SRS will be measured by NCI CTCAE version 4 following completion of SRS, but prior to erlotinib re-initiation. The NCI Common Terminology Criteria for Adverse Events is a descriptive terminology which can be utilized for Adverse Event (AE) reporting. A grading (severity) scale is provided for each AE term. Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental Activities of Daily Living (ADL). Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL. Grade 4 Life-threatening consequences; urgent intervention indicated. Grade 5 Death related to AE.
Time Frame From initiation to the end of SRS, up to 15 days
Hide Outcome Measure Data
Hide Analysis Population Description
Toxicities occurring in at least two participants from SRS are reported below
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description:

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Participants Analyzed 25
Measure Type: Count of Participants
Unit of Measure: Participants
Fatigue Grade 1
4
  16.0%
Grade 2
0
   0.0%
None
21
  84.0%
Pain Grade 1
2
   8.0%
Grade 2
1
   4.0%
None
22
  88.0%
Anorexia Grade 1
2
   8.0%
Grade 2
0
   0.0%
None
23
  92.0%
5.Secondary Outcome
Title Toxicity Rate Attributed to Erlotinib
Hide Description Toxicity of erlotinib will be graded using the NCI Common Terminology Criteria for Adverse Events (NCI CTCAE version 4) which is a descriptive terminology which can be utilized for Adverse Event (AE) reporting. A grading (severity) scale is provided for each AE term. Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental Activities of Daily Living (ADL). Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL. Grade 4 Life-threatening consequences; urgent intervention indicated. Grade 5 Death related to AE.
Time Frame from end of SRS to end of erlotinib treatment (median duration of 5.7 months)
Hide Outcome Measure Data
Hide Analysis Population Description
Toxicities grade 3 or higher and attributed to erlotinib re-treatment, or toxicities occurring in at least two participants are reported below
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description:

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

Overall Number of Participants Analyzed 25
Measure Type: Count of Participants
Unit of Measure: Participants
Acneiform rash Grade 1
5
  20.0%
Grade 2
2
   8.0%
Grade 3
2
   8.0%
None
16
  64.0%
Diarrhea Grade 1
2
   8.0%
Grade 2
1
   4.0%
Grade 3
0
   0.0%
None
22
  88.0%
Fatigue Grade 1
2
   8.0%
Grade 2
1
   4.0%
Grade 3
0
   0.0%
None
22
  88.0%
aspartate aminotransferase (AST) increased Grade 1
2
   8.0%
Grade 2
0
   0.0%
Grade 3
0
   0.0%
None
23
  92.0%
Nausea Grade 1
2
   8.0%
Grade 2
0
   0.0%
Grade 3
0
   0.0%
None
23
  92.0%
Paronychia Grade 1
2
   8.0%
Grade 2
0
   0.0%
Grade 3
0
   0.0%
None
23
  92.0%
Weight loss Grade 1
2
   8.0%
Grade 2
0
   0.0%
Grade 3
0
   0.0%
None
23
  92.0%
Time Frame From start of treatment to date of death up to 60 months
Adverse Event Reporting Description [Not Specified]
 
Arm/Group Title Stereotactic Radiosurgery Followed by Erlotinib
Hide Arm/Group Description

Stereotactic Radiosurgery or Other Local Ablation Followed by Erlotinib

Stereotactic Radiosurgery: 21 Gy daily for 5 days

Erlotinib: 150mg once daily

All-Cause Mortality
Stereotactic Radiosurgery Followed by Erlotinib
Affected / at Risk (%)
Total   16/25 (64.00%)    
Hide Serious Adverse Events
Stereotactic Radiosurgery Followed by Erlotinib
Affected / at Risk (%) # Events
Total   1/25 (4.00%)    
Injury, poisoning and procedural complications   
Fracture * 1  1/25 (4.00%)  2
Fall * 1  1/25 (4.00%)  1
1
Term from vocabulary, CTCAE (4.0)
*
Indicates events were collected by non-systematic assessment
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
Stereotactic Radiosurgery Followed by Erlotinib
Affected / at Risk (%) # Events
Total   24/25 (96.00%)    
Ear and labyrinth disorders   
Ear pain * 1  1/25 (4.00%) 
Eye disorders   
Blurred vision * 1  2/25 (8.00%) 
Conjunctivitis * 1  1/25 (4.00%) 
Dry eye * 1  1/25 (4.00%) 
Flashing lights * 1  1/25 (4.00%) 
Watering eyes * 1  2/25 (8.00%) 
Gastrointestinal disorders   
Abdominal pain * 1  2/25 (8.00%) 
Diarrhea * 1  3/25 (12.00%) 
Dyspepsia * 1  3/25 (12.00%) 
Dysphagia * 1  1/25 (4.00%) 
Gastroesophageal reflux disease * 1  1/25 (4.00%) 
Nausea * 1  3/25 (12.00%) 
Oral hemorrhage * 1  1/25 (4.00%) 
Vomiting * 1  1/25 (4.00%) 
General disorders   
Edema face * 1  1/25 (4.00%) 
Edema limbs * 1  2/25 (8.00%) 
Fatigue * 1  8/25 (32.00%) 
Flu like symptoms * 1  1/25 (4.00%) 
Infusion site extravasation * 1  1/25 (4.00%) 
Non-cardiac chest pain * 1  3/25 (12.00%) 
Pain * 1  3/25 (12.00%) 
Infections and infestations   
Papulopustular rash * 1  1/25 (4.00%) 
Paronychia * 1  2/25 (8.00%) 
Skin infection * 1  1/25 (4.00%) 
Upper respiratory infection * 1  1/25 (4.00%) 
Urinary tract infection * 1  1/25 (4.00%) 
Injury, poisoning and procedural complications   
Bruising * 1  1/25 (4.00%) 
Investigations   
Alkaline phosphatase increased * 1  1/25 (4.00%) 
Aspartate aminotransferase increased * 1  3/25 (12.00%) 
Blood bilirubin increased * 1  1/25 (4.00%) 
Lymphocyte count decreased * 1  7/25 (28.00%) 
Neutrophil count decreased * 1  1/25 (4.00%) 
Platelet count decreased * 1  1/25 (4.00%) 
Weight loss * 1  2/25 (8.00%) 
White blood cell decreased * 1  1/25 (4.00%) 
Metabolism and nutrition disorders   
Anorexia * 1  4/25 (16.00%) 
Hyperglycemia * 1  4/25 (16.00%) 
Hyperkalemia * 1  1/25 (4.00%) 
Hypernatremia * 1  1/25 (4.00%) 
Musculoskeletal and connective tissue disorders   
Arthralgia * 1  2/25 (8.00%) 
Back pain * 1  5/25 (20.00%) 
Bone pain * 1  1/25 (4.00%) 
Myalgia * 1  2/25 (8.00%) 
Neck pain * 1  1/25 (4.00%) 
Pain in extremity * 1  3/25 (12.00%) 
Nervous system disorders   
Dysgeusia * 1  1/25 (4.00%) 
Headache * 1  3/25 (12.00%) 
Lethargy * 1  1/25 (4.00%) 
Psychiatric disorders   
Depression * 1  1/25 (4.00%) 
Insomnia * 1  1/25 (4.00%) 
Renal and urinary disorders   
Urinary tract pain * 1  2/25 (8.00%) 
Urinary urgency * 1  1/25 (4.00%) 
Respiratory, thoracic and mediastinal disorders   
Cough * 1  6/25 (24.00%) 
Epistaxis * 1  1/25 (4.00%) 
Pneumonitis * 1  1/25 (4.00%) 
Sore throat * 1  1/25 (4.00%) 
Wheezing * 1  2/25 (8.00%) 
Skin and subcutaneous tissue disorders   
Dry skin * 1  4/25 (16.00%) 
Nail loss * 1  1/25 (4.00%) 
Nail ridging * 1  1/25 (4.00%) 
Pruritus * 1  2/25 (8.00%) 
Rash acneiform * 1  5/25 (20.00%) 
Rash maculo-papular * 1  4/25 (16.00%) 
Skin and subcutaneous tissue disorders - Other, specify * 1  2/25 (8.00%) 
Skin hyperpigmentation * 1  1/25 (4.00%) 
Vascular disorders   
Hot flashes * 1  1/25 (4.00%) 
1
Term from vocabulary, CTCAE (4.0)
*
Indicates events were collected by non-systematic assessment
The study closed early due to poor accrual (enrolling only 25 of 40 expected participants) and the development of second line therapy with osimertinib.
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Robin V. Johnson
Organization: UNC Lineberger Comprehensive Cancer Center
Phone: 919-966-1125
EMail: Robin_V_Johnson@med.unc.edu
Layout table for additonal information
Responsible Party: UNC Lineberger Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT01573702    
Other Study ID Numbers: LCCC 1123
First Submitted: April 5, 2012
First Posted: April 9, 2012
Results First Submitted: September 16, 2020
Results First Posted: January 12, 2021
Last Update Posted: January 12, 2021