Cilengitide and Cetuximab in Combination With Platinum-based Chemotherapy as First-line Treatment for Subjects With Advanced Non Small Cell Lung Cancer (NSCLC) (CERTO)

Inclusion criteria:

1. Written informed consent obtained before undergoing any study-related activities.
2. Male or female, at least 18 years of age.
3. Histologically confirmed NSCLC, stage IIIb with documented malignant pleural effusion or stage IV (according to staging system 6th edition).
4. EGFR expression ≥ 200 on tumor tissue determined by local testing using the kit and testing procedures described in the study MOP.
5. Archived tumor material sample for central histology and further biomarker research including mutational analysis of genes such as EGFR, k-ras, b-raf (material details described in the study MOP).
6. At least 1 radiographically documented measurable lesion in a previously non-irradiated area according to evaluation criteria in solid tumors (RECIST), i.e. this lesion must be adequately measurable in at least 1 dimension (longest diameter [LD] to be recorded) as ≥2 cm by conventional techniques or ≥1 cm by spiral CT scan.
7. Eastern Cooperative Oncology Group (ECOG)-performance status 0-1.
8. Leukocyte count ≥ 3.0 x 10(9)/L.
9. Absolute neutrophil count (ANC) ≥1.5 x 10(9)/L.
10. Platelets ≥100 x 10(9)/L.
11. Hemoglobin ≥9 g/dL (without transfusions).
12. Bilirubin ≤1.5 x upper limit of normality (ULN).
13. AST ≤5 x ULN and ALT ≤5 x ULN.
14. Serum creatinine ≤1.25 x ULN and/or creatinine clearance ≥60 mL/min.
15. Prothrombin time (PT), international normalized ratio (INR) within normal limits and partial thromboplastin time (PTT) below upper limit of normal.
16. Sodium and potassium within normal limits or ≤10% above or below (supplementation permitted).
17. Effective contraception for both male and female subjects (if the risk of conception exists).

1. If female, she must:

• be neither pregnant nor breast-feeding, nor attempting to conceive and
• use a highly effective method of contraception for at least 7 days before entry into the trial, throughout the entire duration of the trial and for 6 months following completion of the last dose of trial medication. A highly effective method of contraception is defined as those which result in a low failure rate (i.e. less than1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, IUDs (hormonal or copper-based), sexual abstinence or vasectomized partner, or
• be post-menopausal or surgically sterilized 2. If male, he must be willing to use contraception to avoid pregnancies for at least 7 days before entry into the trial, throughout the entire duration of the trial and for 6 months following the last dose of trial medication. Two negative semen analyses post-vasectomy have to be available in order to be considered infertile.

Exclusion criteria:

1. Prior treatment with an antibody or molecule targeting EGFR- and/or vascular endothelial growth factor receptor (VEGFR)-related signaling pathways.
2. Previous chemotherapy for NSCLC including prior adjuvant therapy.
3. History of or current brain metastasis and/or leptomeningeal disease (known or suspected).
4. Radiotherapy (except localized radiotherapy for pain relief), major surgery or any intake of investigational drug in the 30 days before the start of study treatment entry.
5. Concurrent chronic immunosuppressive or hormone anti-cancer therapy (physiologic hormone replacement or corticosteroid treatment for COPD is allowed).
6. Clinically relevant coronary artery disease (New York Heart Association [NYHA] functional angina classification III/IV), congestive heart failure (NYHA III/IV), clinically relevant cardiomyopathy, history of myocardial infarction in the last 12 months, or high risk of uncontrolled arrhythmia.
7. History of coagulation disorder associated with bleeding, recurrent or recent thrombotic events or history of hemoptysis related to bronchopulmonary cancer. Hemoptysis is defined as coughing more than a teaspoon of red blood per day.
8. Recent peptic ulcer disease (endoscopically proven gastric, duodenal or esophageal ulcer) within 6 months of study treatment start.

9. Presence of any contra-indication to treatment with cilengitide, cetuximab, cisplatin and vinorelbine or gemcitabine including:

   • Known hypersensitivity to cilengitide, cetuximab, cisplatin, vinorelbine, or gemcitabine or to any of the excipients of these drugs.
   • Superior vena cava syndrome contra-indicating hydration.
   • Symptomatic peripheral neuropathy NCI-CTCAE Grade ≥2 and/or ototoxicity NCI CTC AE Grade ≥2, except if due to trauma or mechanical impairment due to tumor mass.
   • Phenytoin (introduced to prevent the anticonvulsant effect of certain anticancer drugs) (contra-indication for cisplatin).
   • Yellow Fever Vaccine, Live Attenuated Vaccines (contra-indications for cisplatin).
10. Pregnancy or lactation period.
11. Concurrent treatment with a non-permitted drug (see Section 6.8).
12. Treatment with any other investigational product within the past 30 days.
13. Previous malignancy other than NSCLC in the last 5 years except for basal cell cancer of the skin or pre-invasive cancer of the cervix.
14. Medical or psychological conditions that would not permit the subject to complete the study or sign informed consent.
15. Signs and symptoms suggestive of transmissible spongiform encephalopathy, or family members who suffer(ed) from such.
16. Patients with hepatitis, massive liver metastases (> 75 %), current alcoholism or liver cirrhosis (because of vinorelbine and gemcitabine).
17. Patients who have been therapeutically anticoagulated
18. Legal incapacity or limited legal capacity.
19. Significant disease (e.g. interstitial lung disease) which, in the investigator's opinion, would exclude the subject from the study.