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A Randomized Phase II Study of Radiation Therapy, Pemetrexed and Carboplatin With or Without Cetuximab in Stage III Non-Small Cell Lung Cancer


Phase 2
18 Years
N/A
Not Enrolling
Both
Lung Cancer

Thank you

Trial Information

A Randomized Phase II Study of Radiation Therapy, Pemetrexed and Carboplatin With or Without Cetuximab in Stage III Non-Small Cell Lung Cancer


OBJECTIVES:

Primary

- Determine the overall survival of patients with unresectable stage III non-small cell
lung cancer treated with pemetrexed disodium, carboplatin, and thoracic radiotherapy
with or without cetuximab.

Secondary

- Determine the failure-free survival and response rates in patients treated with these
regimens.

- Correlate epidermal growth factor receptor, erbB2, and K-ras mutations with survival
and tumor response in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study.

- Chemoradiotherapy (courses 1-4): Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive pemetrexed disodium IV over 10 minutes followed by
carboplatin IV over 30 minutes on days 1, 22, 43, and 64. Patients also undergo
thoracic radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40,
and 43-47.

- Arm II: Patients receive pemetrexed disodium, carboplatin, and thoracic
radiotherapy as in arm I. Patients also receive cetuximab IV over 2 hours on day 1
and then IV over 1 hour on days 8, 15, 22, 29, 36, and 43.

- Consolidation chemotherapy (courses 5-8): Beginning 3-5 weeks after completion of
chemoradiotherapy, all patients receive consolidation chemotherapy comprising
pemetrexed disodium alone IV over 10 minutes on day 1. Treatment repeats every 21 days
for 4 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 3 years.

PROJECTED ACCRUAL: A total of 100 patients (50 per treatment arm) will be accrued for this
study within 10-13 months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed non-small cell lung cancer (NSCLC),
including any of the following subtypes:

- Squamous cell carcinoma

- Adenocarcinoma (including bronchoalveolar cell carcinoma)

- Large cell anaplastic carcinoma (including giant cell and clear cell carcinoma)

- Stage IIIA OR selected stage IIIB disease*

- Any T, N2-3, M0 disease

- T3, N1-3, M0 disease allowed provided disease is unresectable

- T4, any N, M0 disease allowed provided T4 status cannot be determined due to
malignant effusion

- No T3, N0, M0 disease NOTE: *If the largest mediastinal lymph node is < 2 cm in
diameter by CT scan, a biopsy confirmation of mediastinal nodal involvement is
required

- Unresectable disease

- Contralateral mediastinal disease (N3) allowed provided all gross disease can be
encompassed within the radiation field in accordance with the homogeneity criteria

- Measurable disease, defined as ≥ 1 one-dimensional measurable lesion ≥ 20 mm by
conventional techniques OR ≥ 10 mm by spiral CT scan

- The following are not considered measurable disease:

- Bone lesions

- Leptomeningeal disease

- Ascites

- Pleural or pericardial effusion

- Abdominal masses not confirmed and followed by imaging techniques

- Cystic lesions

- Tumor lesions in a previously irradiated area

- No exudative, bloody, or cytologically positive malignant effusion

- Transudate, cytologically negative, non-bloody pleural effusion allowed provided
the tumor can be encompassed within a reasonable field of radiotherapy

- Pleural effusion detectable by chest CT scan but not by chest x-ray that is too
small to tap

- New pleural effusion appearing after thoracotomy or other invasive thoracic
procedure allowed

- No atelectasis of the entire lung

- No direct invasion of the vertebral body

- No scalene, supraclavicular, or contralateral hilar node involvement

- No distant metastases (M1) by fludeoxyglucose F18 positron emission tomography

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-1

Life expectancy

- Not specified

Hematopoietic

- Granulocyte count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

Hepatic

- Bilirubin < 1.5 times upper limit of normal (ULN)

- AST and ALT < 3 times ULN

- Alkaline phosphatase < 3 times ULN

Renal

- Creatinine clearance ≥ 45 mL/min

Cardiovascular

- No symptomatic congestive heart failure

- No unstable angina pectoris

- No cardiac arrhythmia

Other

- Not pregnant or nursing

- Weight loss ≤ 10% within the past 3 months

- No other active* malignancy except nonmelanoma skin cancer

- No ongoing or active infection

- No other uncontrolled illness

- No history of hypersensitivity to carboplatin, pemetrexed disodium, or a monoclonal
antibody NOTE: *Malignancy is not considered active if the patient has completed
treatment and has < 30% risk of relapse

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No concurrent filgrastim (G-CSF), pegfilgrastim, or sargramostim (GM-CSF) during
thoracic radiotherapy or as prophylaxis for myelosuppression

Chemotherapy

- No prior chemotherapy for NSCLC

- No other concurrent chemotherapy

Endocrine therapy

- No concurrent hormonal therapy except megestrol for appetite stimulation or
dexamethasone to prevent rash from pemetrexed disodium

Radiotherapy

- No prior radiotherapy to the chest

- No concurrent palliative radiotherapy

- No concurrent intensity modulated radiotherapy

Surgery

- See Disease Characteristics

- At least 2 weeks since prior formal exploratory thoracotomy

Other

- No prior therapy that directly targets the epidermal growth factor receptor pathway

- No concurrent combination antiretroviral therapy for HIV-positive patients

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

18 Month Survival

Outcome Description:

Percentage of participants who were alive at 18 months. The 18 month survival, with 95% CI, was estimated using the Kaplan-Meier method.

Outcome Time Frame:

18 months (from randomization)

Safety Issue:

No

Principal Investigator

Ramaswamy Govindan, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Washington University Siteman Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000434616

NCT ID:

NCT00117962

Start Date:

September 2005

Completion Date:

September 2012

Related Keywords:

  • Lung Cancer
  • stage IIIA non-small cell lung cancer
  • stage IIIB non-small cell lung cancer
  • squamous cell lung cancer
  • large cell lung cancer
  • adenocarcinoma of the lung
  • bronchoalveolar cell lung cancer
  • Carcinoma, Non-Small-Cell Lung
  • Lung Neoplasms

Name

Location

University of Chicago Cancer Research Center Chicago, Illinois  60637
Duke Comprehensive Cancer Center Durham, North Carolina  27710
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill Chapel Hill, North Carolina  27599-7570
Veterans Affairs Medical Center - Syracuse Syracuse, New York  13210
St. Joseph's Hospital and Medical Center Paterson, New Jersey  07503
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
Louis A. Weiss Memorial Hospital Chicago, Illinois  60640
Fletcher Allen Health Care - University Health Center Campus Burlington, Vermont  05401
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Mount Sinai Medical Center New York, New York  10029
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Rhode Island Hospital Comprehensive Cancer Center Providence, Rhode Island  02903
CCOP - Hematology-Oncology Associates of Central New York East Syracuse, New York  13057
Sibley Memorial Hospital Washington, District of Columbia  20016
Hematology Oncology Associates of the Quad Cities Bettendorf, Iowa  52722
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
UNMC Eppley Cancer Center at the University of Nebraska Medical Center Omaha, Nebraska  68198-7680
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, Georgia  31403-3089
CCOP - Nevada Cancer Research Foundation Las Vegas, Nevada  89109-2306
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Virginia Commonwealth University Massey Cancer Center Richmond, Virginia  23298-0037
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
University Medical Center of Southern Nevada Las Vegas, Nevada  89102
Eden Medical Center Castro Valley, California  94546
Saint Rose Hospital Hayward, California  94545
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Valley Care Medical Center Pleasanton, California  94588
Fort Wayne Medical Oncology and Hematology Fort Wayne, Indiana  46815
St. Luke's Hospital Cedar Rapids, Iowa  52402
Mercy Regional Cancer Center at Mercy Medical Center Cedar Rapids, Iowa  52403
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health Center Grand Island, Nebraska  68803
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Charles R. Wood Cancer Center at Glens Falls Hospital Glens Falls, New York  12801
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center Kingsport, Tennessee  37662
Mountainview Medical Berlin, Vermont  05602
Danville Regional Medical Center Danville, Virginia  24541
Highland General Hospital Oakland, California  94602
Saint Luke's Hospital Chesterfield, Missouri  63017
Missouri Cancer Associates Columbia, Missouri  65201
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Union Hospital Cancer Program at Union Hospital Elkton MD, Maryland  21921
Arch Medical Services, Incorporated at Center for Cancer Care and Research Saint Louis, Missouri  63141
Cancer Care Associates - Mercy Campus Oklahoma City, Oklahoma  73120
Southwest Virginia Regional Cancer Center at Wellmonth Health Norton, Virginia  24273
FirstHealth Moore Regional Community Hospital Comprehensive Cancer Center Pinehurst, North Carolina  28374
Elliot Regional Cancer Center at Elliot Hospital Manchester, New Hampshire  03103
Pardee Memorial Hospital Hendersonville, North Carolina  28791
Kinston Medical Specialists Kinston, North Carolina  28501
Miriam Hospital Providence, Rhode Island  02906
McLeod Regional Medical Center Florence, South Carolina  29501
La Grange Memorial Hospital La Grange, Illinois  60525
Lakes Region General Hospital Laconia, New Hampshire  03246
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Iowa Blood and Cancer Care Cedar Rapids, Iowa  52402
New Hampshire Oncology - Hematology, PA - Hooksett Hooksett, New Hampshire  03106
Arroyo Grande Community Hospital Arroyo Grande, California  93420
St. Anthony's Cancer Center St. Louis, Missouri  63128
St. Mary's Regional Cancer Center at St. Mary's Medical Center Huntington, West Virginia  25702
Siteman Cancer Center at Barnes-Jewish St. Peters Hospital - Saint Louis St Louis, Missouri  63110
Callahan Cancer Center at Great Plains Regional Medical Center North Platte, Nebraska  69103
Hudner Oncology Center at Saint Anne's Hospital - Fall River Fall River, Massachusetts  02721
Ravenel Oncology Center at Memorial Hospital of Martinsville and Henry County Martinsville, Virginia  24115
Bendheim Cancer Center at Greenwich Hospital Greenwich, Connecticut  06830
Upper Chesapeake Medical Center Bel Air, Maryland  21014